Further Testing Was Not Urged --White House

Times Medical Writer

First Lady Nancy Reagan and White House officials said Wednesday that the President's doctors did not advise him to undergo further examination when a benign polyp was found in his large intestine 14 months ago.

The statement by Mrs. Reagan filled in one piece of information in the continuing medical debate over whether the doctors failed to follow standard procedures by not ordering a full examination of the colon at that time to see whether additional polyps--or cancer--was present.

Some cancer experts contend that the discovery of even the benign polyp in May, 1984, should have been followed immediately by the colonoscopy, particularly because questions had arisen over whether tests indicated that the President had blood in his stool--a warning sign of cancer. But some cancer specialists have defended the way that the President's doctors have handled the case.

Reagan Rejection Possible

Some observers have speculated, meanwhile, that perhaps the doctors had recommended the exam last year but that Reagan himself had decided against it, possibly because he was running for reelection at the time.

In an interview aboard the aircraft carrier America off the Delaware coast, Mrs. Reagan expressed dismay over the second-guessing that has occurred over why Reagan was not given a complete exam 14 months ago. But she said that she too had not urged her husband to undergo a colonoscopy after the discovery of the first polyp.

"I just go along with what the doctors say," she said. And, as for the second-guessers, Mrs. Reagan said: "You have to understand I'm a doctor's daughter. My father (the late Dr. Loyal Davis, a surgeon) never believed a doctor should talk about another doctor's case."

Doctors who have not been in attendance with Reagan have speculated that an earlier discovery and removal of the tumor could have prevented it from becoming cancerous--or at least could have kept the cancer cells from entering the colon's muscle wall, a critical factor in possible spread of the disease. The large tumor was not found until last Friday, when a smaller, benign polyp was removed from the President's colon.

But White House spokesman Larry Speakes said Wednesday that Reagan was not unhappy with either the diagnosis he has been given or the care he has received.

Confidentiality Cited

In addition, Speakes announced that the Reagans do not want the President's doctors to speak further with reporters because "they feel very strongly about the confidentiality of the doctor-patient relationship."

Dr. Steven Rosenberg, the cancer specialist handling the case, had said earlier that Reagan has only a better than 50% chance to survive for five years, although other doctors have argued that a more optimistic prognosis would be reasonable under the circumstances. When asked why, Speakes replied: "They have not seen this description of it. They do not know how far it invaded the wall."

National studies that tracked the survival rates of large numbers of patients after colon cancer surgery show that those with cancers in the same stage of development as Reagan's--a so-called Duke's class B-1--and who undergo the same operation have an 80% to 90% five-year survival rate, said Dr. Glenn Steele, a surgery professor at Harvard University Medical School.

Decision Defended

Steele, the chairman of the National Colorectal Organ Site Program, a federally funded project aimed at improving the early detection of colon and rectal cancer, defended the stand taken by Reagan's physicians.

If he had a "very busy" patient such as Reagan who had just had a benign polyp removed, "I would say that (a colonoscopy) is not indicated," Steele said in a telephone interview from his office in Boston. He said he based his remark on the assumption that White House claims that the President had negative tests for blood in stool samples are accurate.

According to the White House, one such test--known as a hemoccult test--was positive, but doctors said later that the result was a "false positive" and blamed it on the President's diet, which had not been restricted.

Expensive Procedure

The issue over colonoscopies has raised the question of whether doctors sometimes may be reluctant to order the procedure, which is expensive and uncomfortable for the patient, if the indications that it should be used are not clear.

"VIPs don't always get the best treatment. The doctors go out of their way to accommodate them. You don't treat them like ordinary people off the street," said a doctor at Walter Reed Army Medical Center, speaking on the condition that he not be named.

The doctor, not involved in the President's care, suggested that the nuisance of the colonoscopy may have been a factor in not administering it in 1984.

"They didn't want to give the guy a colonoscopy," he said. "It's a bother (for the patient).

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