A Creative Plan for Fighting Cancer -- And Slashing Medical Costs

About 400 physicians are gathered today in Lansing, Mich., to hear an unlikely message: A major health insurance company wants them to test symptom-free patients to determine whether they have or may get cancer. And it will pay the doctors to do it.

The plan, conceived by one of the state's top cancer doctors and to be carried out by Blue Cross-Blue Shield, will save lives and money. It also serves as a powerful demonstration that the best solutions need not come from the ongoing health-care reform melee in Washington.

"It's so simple," said Dr. Michael Harbut, a leading cancer specialist who conceived the idea. "Our program will stop cancer before it starts and find it before it kills." Indeed, to listen to him describe the program is to wonder why such a system hasn't been in place for decades.

Its push for early screenings is expected to increase cancer survival rates as more cases are caught early enough to institute effective treatment. The program will also find people exposed to cancer-causing agents -- but who don't have the disease -- and show them how to protect themselves, according to an outline for the plan that Sphere obtained.

"As cliché as it might sound, this is a situation where everyone wins," said Harbut, who is co-director of the National Center for Vermiculite and Asbestos-Related Cancers at Michigan's Karmanos Cancer Institute.

The surprisingly simple program is based on a few key premises:

• Thirty percent to 80 percent of all cancers are caused by exposure to chemical agents in the environment or the workplace.

• Simple, low-cost tests can permit physicians to determine whether their patients are at risk.

• Eliminating cancer or treating it early can save lives and millions of dollars in medical costs.

As many as 3,000 primary-care physicians, pulmonologists, internal medicine specialists, oncologists and family doctors are expected to volunteer to participate in the program over the next 18 months. Blue Cross-Blue Shield will pay $500 to each physician who takes training in all aspects of the program. It will also pay them for each patient they survey, test or examine.

"This evidence-based approach will help doctors prevent and detect cancers and other serious illness contracted as a result of exposure to these dangerous substances," said Ann Schwartz, Karmanos' president and CEO.

The program will target three leading cancer causers: arsenic, asbestos and radon.

Naturally occurring arsenic is found in drinking water throughout the nation, but the contamination can also come from fertilizers, animal feeding operations, metal smelting, mining and coal-burning. Regardless of the source, arsenic is a significant hazard in Michigan, studies show.

Many municipal water systems and almost all private wells lack the capability to remove the cancer-causing agent from water used for cooking, bathing and drinking.

Researchers have repeatedly shown that arsenic exposures, even at levels deemed acceptable by the Environmental Protection Agency, are associated with lung, skin and bladder cancer, diabetes, cardiovascular disease and a number of other adverse health conditions.

Under the Karmanos program, all physicians have to do when they see patients is take a 24-hour urine sample and have it tested for arsenic.

"It's painless, simple and costs patients nothing," Harbut said. "Physicians are even paid to administer the test and evaluate the results."

In addition to picking up that cost, the insurers will also pay for special arsenic-blocking water filters for patients -- or even bottled water -- if the tests come back positive.

The program's second target, asbestos, has caused tens of thousands of deaths in Michigan and hundreds of thousands more throughout the country. Workplaces in the state -- the auto assembly lines and taconite mines -- were heavily contaminated with the substance. Its iron mines still are.

And "it's not just the workers," Harbut said. "We've got about 300,000 homes here that are insulated with asbestos-contaminated Zonolite vermiculite from Libby, Mont."

EPA tests have shown that the most gentle disruption of such insulation -- getting down the Christmas decorations for example -- can fill an attic with invisible asbestos fibers.

The Karmanos program will use a simple measure of pulmonary function or lung capacity to determine whether patients are at risk and in need for further testing. Those who are will be referred to two environmental and occupational medicine centers in the state.

Radon is the last of the deadly trio that the Blues and the Karmanos Cancer Institute are going after.

The colorless, odorless and tasteless gas is found in basements throughout the country. It invades indoor air primarily from soil under homes, granite foundations and other sources. EPA says that radon is the largest source of radiation exposure for the general public and that even very small exposures to radon can cause lung cancer.

There is no clinical test to identify exposure to radon. So physicians in the Michigan program will recommend that patients check for the presence of the gas in their homes by obtaining free radon kits from their local health department.

The state's labor unions are applauding the program.

"Many have been exposed to toxins whose serious health consequences will not appear until 15 to 40 years after exposure. This new program goes a long way in advocating for and protecting the health and well-being of our residents," said Michigan AFL-CIO President Mark Gaffney, a member of Blue Cross-Blue Shield's board of directors.

And at least one other insurance company is exploring taking the innovative plan nationwide, said the team from Karmanos.

"Where politics has failed to protect the health of families," Harbut said, "science, medicine and -- uniquely -- an insurance company are acting to do so."

He added: "This could be great for medicine and patients."