HealthWatch: Some Colon Cancer Screenings May Not Find Disease

SAN FRANCISCO (CBS 5) — Colon cancer kills 50,000 Americans a year but is one of the most curable cancers if caught early through preventative screening. However one Bay Area family said their mother’s screening gave her a false sense of security – with deadly results.

“My mom died as a result of them not looking, not screening as they proclaim to do,” said Dawn Hardy. In 2005 her 62-year-old mother, Doris Schoby, went to Richmond Kaiser for a routine cancer screen called a sigmoidoscopy, which uses a flexible tube with a camera to examine the lower 1/3 to 1/2 of the colon.

“And her doctor told her that she was good-to-go for 10 more years,” said Hardy.

But there’s a problem with sigmoidoscopy – it doesn’t reach the upper colon – and that’s where Doris Schoby’s cancer was hiding.

She died three years later.

“And the frustrating part of this is just knowing this was so preventable.”

American Cancer Society – Cancer Detection Guidelines

National Cancer Institute – Colon Cancer Screening

U.S. Preventative Services Task Force

Colon Cancer Foundation

Preventable, because a more complex procedure called colonoscopy examines the entire length of the colon and might have found Schoby’s cancer.

So why does Kaiser use sigmoidoscopy over colonoscopy to screen most of its patients?

“Sigmoidoscopy is faster, it’s cheaper, it uses fewer personnel,” said attorney Kevin Liebeck, who sued Kaiser for the Schoby family. “Kaiser profits by that. Certainly not the patient.”

UCSF professor Dr. Alan Venook said it’s not so simple. Although colonoscopy is considered the ‘gold standard’ procedure, he said, “Colonoscopy vs. sigmoidoscopy for screening is a very controversial topic…because it’s more difficult to do a colonoscopy.”

Dr. Venook said colonoscopy requires a bigger staff, more preparation, and drugs for sedation. The procedure also carries more risk for the patient. What’s more, there aren’t enough resources to screen everybody using colonoscopy.

“Colonoscopy is a good test,” said Dr. Theodore Levin, “but there are lots of other good ways to screen for colorectal cancer.” Dr. Levin heads Kaiser’s colon cancer screening program for Northern California. He said sigmoidoscopy – and an easy-to-use take-home test to check for blood in the stool – is less invasive and enables Kaiser to screen more people, find more cancers, and save more lives.

“The best screening test is the one patients will get done. And there’s not enough evidence to say that one screening test is better than another.”

“The point is that some screening is better than no screening,” said UCSF’s Dr. Venook.

But what about the people those less-invasive tests miss?

After much digging, Doris Schoby’s family discovered that her doctor actually did find a possible pre-cancerous growth in her lower colon, but the lab lost the tissue before it could be analyzed – and Schoby’s doctor let the matter drop without ordering a full colonoscopy.

“He gambled with my mom’s life, and he was wrong,” said Schoby’s daughter Dawn.

Kaiser never admitted any mistakes in the case but in September, 2010, an arbitrator awarded the Schoby family maximum damages of $250,000. The arbitrator ruled that Kaiser’s treatment of Doris Schoby “fell below the standard” of care; and that her cancer “would probably have been cured or at least curbed” with a colonoscopy.

“She would still be alive today,” said her daughter, eyes filling with tears. “With us…Watching her grandchildren grow.”

In a statement to CBS-5, Kaiser said it does not deny treatment based on cost. The health plan’s statement follows:

Kaiser Permanente Response to CBS-5 10/28/10

We want to express our condolences to Mrs. Schoby’s family. As an organization, Kaiser Permanente is committed to providing quality care and we regularly review our processes in order to further improve our services.

We could not disagree more strongly with statements made by the Schoby family’s attorney. We take special issue with the attorney’s broad criticism of Kaiser Permanente screening practices without any factual support for his claims and his assertion of improper financial motivations where none exist.

Kaiser Permanente is recognized as a national leader in colorectal cancer screening. As a result of our aggressive outreach program to screen members in the target age group, our screening rates lead the State and most of the nation (see links below). We follow national guidelines for types and frequency of screening. This year we expect to screen more than 70 percent of our members in the target age group in our fight against colon cancer.

The U.S. Preventive Services Task Force, American Cancer Society, and others advocate screening by any of several techniques, including stool tests (FIT), sigmoidoscopy or colonoscopy. Our goal is to screen the most people possible in the target age group for colon cancer. Not all patients agree to undergo screening, and some may prefer one test over another. Our high screening rates have been achieved by making it as easy as possible for patients to use a screening method that they can accept and tolerate. Kaiser Permanente physicians discuss with their patients the most appropriate screening tool based on the patient’s personal situation and family history.

It is a core principle at Kaiser Permanente that sound medical practices and patient well-being come before financial considerations. We constantly review the most current scientific literature, participate in national conferences and contribute significant research work on colorectal cancer screening and prevention—and as knowledge and technology change, so do our practices.


California Office of the Patient Advocate (OPA)
National Committee on Quality Assurance (NCQA)

Background information on colon cancer screening
Regular screening for most people begins at age 50. For those with a family history of polyps or colon cancer, and for those with irritable bowel syndrome, screening is recommended to begin at age 40, or 10 years earlier than the age of onset of polyps or cancer in the earliest affected family member. Kaiser Permanente has an aggressive outreach program to reach those who should be screened, including office visits, phone, e-mail, and direct mail reminders.

We encourage our members to discuss with their physician the most appropriate screening tool, based on the member’s personal and family history of risk factors for colorectal cancer, the potential risks from screening, and the inconvenience of the various screening tests.

FIT Testing (Fecal Immunochemical Testing) every year: Since 2007, we mail a home fecal test annually to every Northern California Kaiser Permanente member between the ages of 50 and 80. This is a relatively easy, non-invasive test. Using this as an initial step increases the number of people being screened and reserves the more invasive testing for those who are at risk or test positive on the FIT. Patients who test positive on a FIT test are immediately referred for a colonoscopy.

Sigmoidoscopy: Unless otherwise recommended by a patient’s physician, sigmoidoscopy is recommended every five years for members over 50 who do not have any other risk factors. It has a high level of accuracy combined with a very low level of patient inconvenience and risk of complications. When adenomatous polyps are found using a sigmoidoscopy, patients are usually recommended to have a colonoscopy.

Colonoscopy: Colonoscopies are recommended for patients who are at high risk for developing colon cancer (i.e., patients who have symptoms of colorectal cancer, had an abnormal result from another screening procedure or have any other associate high risks). Unless otherwise recommended by a patient’s physician, a colonoscopy is recommended every 10 years. Colonoscopy has a high level of accuracy but also a higher level of patient inconvenience and risk of complications.

(© CBS Broadcasting Inc. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)

  • Linda Abrao

    Thank you for airing my sister’s story. If it at least helps one family not having to watch their love one suffer as she did our family is grateful. Thank you again,

    • Cynthia Reeves

      I’m sorry to hear about your loss and the experience. I’ve been enduring chemotherapy since September 2009. I had the procedure done, as mentioned, that doesn’t require examination of the full colon, nor requires additional staff, for rectal bleeding in Spring of 2008. In Spring of 2009, I experienced stomach symptoms that were labeled by Kaiser as either acid reflux or ulcers. It was worst – I was diagnosed with IV Colon Cancer in June 2009. Being fatigued, experiencing side-effects and still trying to work, my time went beyond the statue of limitations for seeking legal assistance. I would advised anyone who experience symptoms that are not confirmed as cancer/labeled as something else and their current meds don’t fix the problem, demand that Kaiser get a full visual even if that means a CT scan (it took 2 of those to get the real diagnosis during emergency room visits). My Oncologist is VERY cooperative with me.

  • Dawn Hardy

    I appreciate Kaiser’s Dr Levin comments on adequate screening for colon cancer being a sigmoidoscopy combined with home stool card testing. However, Kaiser never once did the stool card testing on my mother. Kaiser proclaims to be nationally recognized as a leader in colorectal cancer screening, however, their actions do not show it. We as consumers in the healthcare industry deserve the gold standard, a colonoscopy, we pay for it. I feel that, unless medically contraindicated, a colonoscopy once every 10 years is more affordable than the fight for life my mother went through. Here, again, Kaiser is justifying using a cheaper, easier procedure that their own physician could not ensure be thoroughly done. Thanks, but no thanks Kaiser. I have already had my first colonoscopy through a provider that is not looking just at a budget. Dawn Hardy RN

    • Shirl

      oYrfgg I’m not easily impressed. . . but that’s impressing me! :)

  • Dalene Van Scyoc

    I fully believe that Kaiser pinches every peeny. I feel that the $250,000 medical malpractice cap needs to be changed. We need to change these laws to make a greater impact. If they are in the wrong they need to feel it in their pocket like we do.

    • Cheyenne

      kOUZq9 Sounds great to me BWTHDIK

  • Wendy Kuh

    I know how difficult the last three years have been for all of you. As you’ve said, if this helps even one person, then, your mother’s death was not in vain. You’ve done a lot of research over the years in preparation for this moment. Even though, it’s bittersweet, I want to congratulate you and Dawn for a job well done. Thank God for the producer/reporter who saw the newsworthiness to write the story, and conduct the interviews! It’s my prayer that this will be the beginning of the healing process for you, and your family over the neglectful, and egregious acts of others and the roles they played in what, ultimately, led to the death of your mother.

  • Marilyn Winn

    I want to thank channel 5 for airing the story of my sister. I hope this makes people aware that Kaiser only cares about cheaper and easier procedures then peoples lives. I miss my sister everyday, thanks to the neglect and poor care that Kaisers gave her.

  • Jeannie Moore

    I;m so sorry you lost your mom. This could have easily been my family. My mother had a sigmoid scope 2 years prior to her stage 3b colon cancer dx. She, too, was told all is good – only hemmoroids, but her cancer was just above the reach of the scope – just above the sigmoid colon. Though it is true that doing the stool test every year and a flexible sig every 5 is one screening tool, whenever there is blood, whenever there are serious symptoms, the only true peace of mind will come from a colonoscopy. You hear many docs say the sig is like doing a mamogram on one breast.

  • William Hardy

    The fact of the matter is that Kaiser failed, not just one person or life, but an entire league of people, a family, and Kaiser still makes their feeble attempts suggesting that they bestow patients (members) with “affordable, high-quality health care services which attempt to improve the health of their members and the communities they serve.” (Kaiser Permanente mission statement, 2010) Hypocrisy is definitely managed here within this mission statement. The lack of ethics, values, and duty involving Kaiser’s medical practices are notably marked and demonstrated in the blatant negligence that my mother-in-law and our family had to endure. Her health, her life, her family was comprehensively changed by the economic savor of this health plan’s bottom line, and as such, they cut corners, set aside concern, disregarded practices that Dr. Levin stated are “other good ways to screen for colorectal cancer” (Levin, 2010), and they abandoned my mother-in-law’s fight for life in what we all desire and pay for—a commitment in quality health care. So, Kaiser, I offer this to your administrators, physicians, nurses, medical staff…Stand up, step back, and look at the one person you call a member, a client, a patient, and realize that when we look for your help, when we ask for your help, when we capture your minds with complicated matters, whether it be medical or not, the obvious choice dictates that you have a commitment to the six values of medical ethics. Use this framework well to guide your practice, decisions, judgments, and focus your human conscious to meet beneficence, most certainly take a moment to reinvent what you have learned in medical school; your mistakes damage a whole community, never just one person.

    William Hardy

  • J. Lee

    My sister also got a clean bill of health after she had sigmoidoscopy from Kaiser a few years ago. But in July 2009, she got a diagnosis of colon cancer stage IV, originated from her upper colon. A year later, she passed away at age 68 in July 2010. My question to Kaiser is this: What is the percentage of people died from such a preventable disease because they only got sigmoidoscopy instead of colonoscopy? In Kaiser, In order to get full colonoscopy, you need to have positive result from fecal test. Is that sometimes too late?

  • David Wolden

    Kaiser’s procedures might be adequate if they are followed, they were not. Kaiser procedures call for a colon cancer test, test was preformed with no result. With no result would you not retest? There was no retest. The arbitrator stated that Kaiser did not meet their own standard of care. Kaiser can state whatever they desire, their actions prove that they did not follow them in this case. Kaiser’s claim that they review the latest procedures is one thing, applying them is another. The most current procedures called for a full colonoscopy .There is another fact that was not in this article, Doris had a higher risk of cancer from previous treatment. That higher risk called for a colonoscopy not a sigmoidoscopy.

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