A 40 year old man with a family history (father and grandfather of colon cancer complained of pain and bleeding for more than three years to his internist. A sigmoidoscopy to 40 centimeters was negative. The symptoms continued for almost two years, after which the patient independently went to a gastroenterologist. A colonoscopy was concurrent with malignant neoplasm at 65 centimeters. The patient required a colectomy, with three of 21 positive lymph nodes. A medQuest internist reported there was a negligent failure to perform a baseline colonoscopy every three to five years, with sigmoidoscopies in between. A medQuest oncologist opined that the delay in diagnosis resulted in loss of survival.