State does poorly in cancer report
By Robbie Dingeman
Advertiser Health Writer
A national study has given Hawai'i a failing grade on a colon cancer report card because health insurance companies are not required by state law to cover screenings for the disease.
The American Gastroenterological Association and the Entertainment Industry Foundation's National Colorectal Cancer Research Alliance produced the report card last week. The advocates said that only 18 states have legislation that requires preventive screening be covered to help encourage early detection.
Each year, about 60,000 Americans die of colorectal cancer and the association said at least half of those could be saved by earlier detection. According to the Hawai'i Tumor Registry, an average of 653 people are diagnosed each year and about 175 people will die from the disease. That's based on an average of statistics from 1995 to 2000, making it the second most common cancer in women in Hawai'i, after breast cancer.
Dr. James Kakuda, who leads the colorectal screening program at Kapi'olani Medic-al Center for Women and Children, said he sees a general reluctance to discussing the disease as the biggest hurdle to early detection.
"I think there is a strong cultural taboo to speak about colon cancer and the colon and rectum in general," he said. He said doctors also tend to think of the screening less often than they do mammograms and Pap smears.
Kakuda specializes in early diagnosis, prevention and treatment of colorectal cancer. He said a lack of health insurance coverage may discourage some patients but said all carriers will cover some form of screening.
Cliff Cisco is senior vice president for Hawaii Medical Service Association, the state's largest health insurer. He said there is no general coverage for colorectal screenings, although some HMSA plans offer some tests for members over age 50.
Cisco said HMSA resists state mandates because such requirement drive up costs for them and for consumers.
He said HMSA may move toward covering the tests for older members as Medicare has done. "Over age 65, it's certainly more appropriate than the twenty-somethings."
Kakuda said medical insurance covers screenings under certain conditions, that include a strong family history of cancer or associated cancers. "They should ask their doctor about screening because no one test is perfect for everybody," he said.
Kakuda said the four types of screening are: a fecal occult blood test that checks for blood in the stool; a sigmoidoscopy that examines the rectum and lower colon with a scope; a colonoscopy which examines the rectum and entire colon with a scope; and a double contrast barium enema that involves a series of X-rays of the colon and rectum.
Dr. Ginny Pressler is a breast surgeon now working as a vice president for Kapi'olani. She said she scheduled a colonoscopy after she turned 50 four years ago because she knew it was a generally good idea.
Without any history of cancer in her family, she saw the test as routine prevention. So she was "totally shocked" to find that she had a polyp, or growth, in her colon that required surgery.
"More than likely this would have become a cancer," Pressler said. She said people steer clear of most questions about colorectal cancer because of embarrassment.
She believes they also worry about the discomfort of having a scope peering into their colon. She said the test occurs after a patient is sedated and is actually less embarrassing than a Pap smear in some ways. "You're on your side, covered with a sheet with a doctor looking through a TV screen."
Pressler said she's eager to talk about her own success story with early detection because she knows how important it is to schedule screenings that can save lives.
"We can prevent it by catching polyps and removing them," Pressler said. "They can do something about this."
Kakuda said Hawai'i residents seem to have a higher rate of cancer with 60 cases per 100,000 population while the national average is 45 cases per 100,000.
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
