How to stop a silent killer: colorectal cancer screening. (On First Reading).

Because of the clear health advantages of colorectal cancer screening, a growing number of states have mandated insurance coverage for it. Those include Connecticut, Delaware, Illinois, Indiana, Maryland, Missouri, New Jersey, North Carolina, Oklahoma, Rhode Island, Texas, West Virginia, Wyoming and Virginia. Utah's law encourages insurance coverage.

Medicare and Medicaid recipients are covered for all or part of the cost of the testing.

And while insurance mandates make some policymakers uncomfortable about their role in rising health insurance premiums, Senator Robert C. Carpenter, sponsor of the North Carolina law, says that the legislation "will prevent 1,500 to 2,000 deaths a year from colorectal cancer in the state. It's a slow-moving cancer that can be detected early. The insurance companies supported this bill because they saw it as an investment rather than a cost. Screening tests cost less than treatment."

Maryland is taking a comprehensive approach. Money from the tobacco settlement has been pledged to reduce cancer mortality and disparities among ethnic minorities by developing community-based programs to educate and screen people for various cancers.

"Maryland has the third highest colorectal cancer mortality rate in the nation," says Carlessia A. Hussein, who directs the effort. "Since colorectal cancer can be detected early and mortality reduced, it was chosen by most of the local jurisdictions in Maryland as the first cancer to target." She reports that each jurisdiction has developed outreach activities to encourage people to get screened.

Maryland's public education efforts have reached more than 33,000 people and about 2,600 colorectal cancer screenings have been performed on low-income uninsured people.

Colorectal cancer is the second leading cancer killer in the United States, after lung cancer. And tumors in the colon or rectum are the most common type of cancer in men and women aged SO years and older. The American Cancer Society estimates that 148,300 people in the United States in 2002 will be diagnosed with colorectal cancer, and 56,600 will die from it.

RELATED ARTICLE: WARNING SIGNS OF CANCER

Factors thought to increase the risk for colorectal cancer include family history, a high fat diet, excessive caloric and alcohol intake, obesity, a sedentary life style and smoking. Colorectal cancer usually starts from a polyp in the colon--which is the large intestine or the large bowel--or in the rectum. Symptoms include:

* Blood in or on your stool.

* Frequent unexplained pains, aches or cramps in your stomach.

* A change in bowel habits.

* Unexplained weight loss.

But some people who have polyps or colorectal cancer do not necessarily have symptoms. This is why screening is essential.