LINCOLN — In the summer of 2002, Margaret Stamp returned home to Sarpy County from college four weeks after her 74-year-old grandmother, Phyllis Behm, had died from a short battle with colorectal cancer. 

Stamp found her dad, Mark Behm, a former northeast Nebraska county attorney and private practice lawyer, wincing in pain on the living room floor. Stamp described him as in shape and thin. She said he looked healthy and didn’t drink or smoke.

But that weekend, Stamp’s father was doubled over, and he told his daughter, “Call your mom.”

“I’d never seen him like that,” Stamp recalled. “Never even remember him getting the flu or sick. Next thing we know, he’s in emergency surgery — it’s stage IV [colorectal] cancer, and there’s nothing they can do.”

Behm grew up in Olde Towne Bellevue and graduated from the University of Nebraska College of Law in 1976. He served as the Cedar County attorney from 1977 through 1993 and had a private practice in Wausa for many years, later a private practice with other attorneys in Randolph. Behm was also a 1980 delegate to the Republican National Convention for Ronald Reagan and was president of Out Front Properties, a local property management company where his daughter is now vice president.

Stamp said her father’s doctors did what they could to prolong his life and make conditions less painful, and he continued practicing law until about a week before he died in April 2004, at the age of 52.

Twenty years later, Stamp and others have successfully pushed for new state laws that expand insurance coverage for colorectal cancer screenings and associated procedures. The latest law took effect this week.

Stamp recalled losing her father as different from cancer deaths she had seen in some movies, where someone closes their eyes and goes to sleep. She said it was awful and that her father said over and over he couldn’t breathe, had muscle spasms and felt his body shutting down.

“To me, anything you can do to stop that is worth every penny,” Stamp said. “It’s worth going in, getting your colonoscopy, even though I know it can be literally a pain in the butt for some people, but you don’t want that message, ‘It’s too late,’ because then there’s nothing to do but plan the funeral.”

‘We can save lives’

Legislative Bill 829 from State Sen. Carol Blood of Bellevue took effect Jan. 1. It requires insurance companies to cover each “integral part” of performing a colorectal cancer screening, including:

• Removing polyps (abnormal cell growths in the underlining of the colon or rectum) found as part of a colonoscopy.
• Any pathology examination of a polyp biopsy.
• Required specialist consultation prior to the screening.
• Bowel preparation medications prescribed for the screening.
• Anesthesia services performed in connection with the preventive colonoscopy.

Its adoption followed passage of LB 92 in 2023, which included a provision from State Sen. Eliot Bostar of Lincoln that required insurance plans to cover screening colonoscopies, as well as an annual stool-based preventative screening test designed for patients with minimal to average risk of colorectal cancer.

Nebraska is ranked in the lower half of states for colorectal cancer screening rates, according to the Nebraska Department of Health and Human Services.

Blood told the Nebraska Examiner she came up with the idea for her LB 829 when she was getting a colonoscopy and was handed a release before her procedure saying most insurance companies wouldn’t cover part of a colonoscopy should they find something, like a polyp, which can grow into cancer over time.

“Why would you want somebody to be put under anesthesia and look for something and just leave it there?” Blood said. “It made no sense whatsoever.”

Blood said her colonoscopy found something that her insurance didn’t cover, which left her on the hook for a procedure that cost $800 to $900.

Congress has closed this “loophole” for people on Medicare and Medicaid as part of the Affordable Care Act, Blood said, while others with private insurance were told they “could just go pound sand.”

“I thought, well, we can save lives with this one tweak,” Blood said of her Nebraska law, which passed 41-5 in the spring.

What is colorectal cancer?

Jungyoon Kim, Ph.D., who does colon cancer screening research at the University of Nebraska Medical Center’s College of Public Health, said colorectal cancer develops in the large intestine areas like the colon or rectum that are part of the digestive system.

Most colorectal cancers start with a polyp, Kim said, most of which are benign. However, some polyps can change into cancer over time, mostly over many years, like 10-15 years.

Symptoms can include blood in the stool or toilet after a bowel movement, constipation over a long period, abdominal pain or cramping, changes in the shape or size of stool and sudden or unexplained weight loss. If observed, Kim said a doctor should be consulted immediately.

One of the most common misconceptions, though, is that people think they must wait to see symptoms before getting screened, Kim said, which gives polyps time to grow. 

“Sometimes, if you see the symptoms and go to the doctor, it might be too late,” Kim said. “That’s why the United States Preventative Services Task Force recommends to get screening when people become 45, even if they do not have any symptoms.”

People with a family history or who have previously had cancer should be screened earlier, Kim said, such as in their 20s or 30s.

Kim said that when a doctor can find and remove polyps, it stops the growth in its tracks and is “like you’re preventing cancer before it even becomes cancer cells.” 

If colorectal cancer is detected early, Kim said, the chance of the cancer being cured is about 92%.

Some cancers can be prevented by regular screening, which includes breast cancer through mammograms at the age of 40 or other screenings for cervical or lung cancer.

Disparities include rural Nebraska

According to the Nebraska Department of Health and Human Services, early-age colorectal cancer diagnoses are on the rise. By 2030, the cancer is predicted to be the leading cause of death in people younger than 50, according to DHHS.

It is already the second-leading cause of cancer deaths in men and women combined.

Kim said disparities exist among racial minorities, people living in rural areas, people who are low-income or people with limited access to insurance or certain doctors, who can’t access screenings.

Blood noted those disparities as a reason for the bill, as every medical procedure comes with a certain amount of risk, but that for some patients, they had to “play Russian roulette with what’s in their body” and decide whether they could pay or come back later, if needed.

“That just seems wrong, especially when you look at how much higher colon cancer rates are in our rural areas,” Blood said.

Kim and Stamp said the new law made sense. Stamp added it will help avoid costlier cancer treatments and help save lives.

Importance of prevention

Stamp said her father had found some blood in his stool about two years prior to discovering he had cancer. His doctor had said it was probably hemorrhoids but gave him an at-home testing kit just in case, as at the time he didn’t have a family history of the disease.

The day after Stamp’s father found out he had cancer, Stamp said her mother found the at-home test in her father’s drawer at home. Stamp noted that around 2000, colon cancer wasn’t talked about as much as it is today. She said some people are still embarrassed to talk about it.

Stamp, a University of Nebraska-Lincoln alum who is now 44 and lives in Omaha with her husband and two teenage daughters, got her first colonoscopy at the age of 24. 

She has had three more colonoscopies since, with a fifth planned in 2026, and encouraged others to get the procedure, which she described as a “walk in the park.” 

“You are taken such good care of, and it is nothing compared to getting cancer and having to have surgery or chemotherapy or one of those colostomy bags,” Stamp said.

Stamp said her father missed her getting married about six months after his death and her two daughters being born, all for not realizing he had cancer.

“It was two quick deaths in the family that got me starting to try to advocate for colon cancer and having colonoscopies,” Stamp said. “… Anything people can do for prevention, it is so worth it, because it’s one of those things you don’t see coming.”