Courier Times Burlington County Times The Intelligencer Baseball Football Basketball Hockey... Colon checks rising but not enou

It's not just a matter of catching the cancer when it's still small and more easily treated. The disease usually starts with toadstool-like growths called polyps that can take a decade to turn cancerous. Remove them in time, and the cancer never even forms.

The good news: Deaths are declining faster for colorectal cancer than for any other cancer, a 5.7 percent drop between 2003 and 2004 that scientists credit to small upticks in screening.

Where's the improvement? Mostly, it's in increasing colonoscopies, says Michigan's Morris. A study published in December found an almost sevenfold increase in routine colonoscopies once Medicare started covering them in 2001.

Even though for most people the cheaper fecal-blood tests are equally effective, other studies have found problems getting people to repeat them year after year as required, Morris says. "People hate doing" them.

As for the middle ground of a sigmoidoscopy, blacks, women and the elderly are more likely to have cancer in part of the colon that doesn't reach, she adds.

Where does the legislative fight fit in? The cancer society found that colonoscopies and sigmoidoscopies rose faster between 1999 and 2004 in states that mandated coverage of all the options.

Ghose's industry group argues that almost every insurer already covers some colon screening. A 2004 congressional probe, the latest available data, surveyed a few dozen insurers in states without mandates. Just 16 percent of small-employer plans and 31 percent of large-employer plans covered fewer than all four options. Least likely to be covered were colonoscopies and barium enemas.

Morris says the key is ensuring enough choices are available , not just for the insured but the uninsured, too , that people simply pick something. "Once we're used to the notion, it might be easier to talk about the less expensive choices."

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