It is natural, therefore, that increased cancer screening programmes and improved cardiac diagnostics – which may serve to increase the total number of identified cases of disease in the population – should put CI providers on their guard.
Changes in population-based screening for breast and bowel cancer, and the availability of prostate cancer testing on request, have increased population cancer incidence rates.
Equally, changes to clinical practice in cardiology now allow doctors to detect tiny amounts of heart damage with great accuracy. This can create a mismatch in opinion between the cardiologist diagnosing a myocardial infarction using current criteria and what an insurer may regard as a valid CI claim.
Both of these changes accelerate diagnosis, thereby improving outcomes for patients. They are also likely to translate into increased numbers of CI claims, which are dependent on both incidence trends of the underlying disease and also developments in screening and diagnostic methods. And it is the latter that is most concerning for the future of CI providers.
Population-based breast cancer screening has been extended to include women under the age of 50 and up to age 70.
In 2011 the Continuous Mortality Investigation published CI insured lives standard table series AC04. These tables are centred in the year 2004 and are based on little data above age 65. Therefore, they do not reflect the increase in breast cancer incidence in the population resulting from the extension of the screening programme.
The same applies for recent changes to the rate of detection of prostate cancer. While the rate of increase appears to have slowed down, prostate cancer rates may still be 10 per cent to 30 per cent higher than the experience that contributed to the AC04 tables.
Despite the UK National Screening Committee ruling out population screening for prostate cancer, detection rates have still increased. This is due to opportunistic screening using prostate-specific antigen testing. However, at any point in time incidence levels represent only a fraction of the likely underlying prevalence of disease in the population.
While the new Association of British Insurers’ definitions introduced a measure of severity in the cancer definition for prostate cancer through the introduction of a Gleason score – which would, in theory, reduce the number of eligible prostate cancer claims – there are a couple of factors working in the opposite direction.