Despite the fact that situations can be markedly similar, there isn’t always one rating applicable when considering a prospective insured who has had cancer—even when the same organ is involved. While two situations can seem almost identical, underlying factors such as individual susceptibility, general health, age at onset, and numerous other factors must be considered by an underwriter.
Obviously the organ involved is a major key. Some cancers are more ominous from the beginning because they lie so close to drainage areas, as well as blood and lymph systems. For instance, cancer of the esophagus and pancreas can be so advanced before discovery that effective treatment is a long shot from the start. Yet prostate cancer is slow growing and can be effectively treated even years after discovery.
Types of cancer can be different within the same organ. For example, some pancreatic cancers can be deadly in six months, while others may take eight to 10 years to manifest lethal consequences.
The size of the tumor in cancer is important. Larger is worse, particularly in endocrine organs such as breasts or ovaries. Histopathology, or appearance, plays a role; it lets us know how invasive a cancer is and how entrenched it is likely to be at diagnosis. The grade tells us how much rogue cancer cells look like original tissue; the more original architecture that is preserved, the better the prognosis. Undifferentiated cells, which don’t look much like the original ones, have the most difficult prognosis.
Extent of involvement of cancer is a key in forecasting its course. Cancers that have spread by either blood or lymph systems means multiple other organs may be involved (metastasis). The more organs involved and the distance of metastases, the poorer the prognosis. This is even true when there is a prolonged remission, because cells can reactivate and cancer can reappear.
Other factors which have little to do with the actual pathology of a cancer can influence underwriting and its course. Age is one of those factors—generally the cure is more difficult when the diagnosis occurs at a younger age. Some cancers behave more aggressively in men than in women, or vice versa. Genetics can also play a role—cancers have more aggressive outcomes when they run in families.
Sometimes the type of treatment will enter into the prognosis for the long term. Massive courses of radiotherapy or chemotherapy for blood-borne cancers or leukemia have malignant effects and can actually increase the risk of a second cancer. Treatment may have to be so radical in order to eradicate a cancer that overall body function and/or organs such as the heart or lungs are harmed. Additionally, receptor status can play a role in cancer assessment; for example, breast cancer may have cells that are more receptive to certain curative treatments, making the outcome better over the long run because they are more amenable to therapy.
Last, remember that overall health also plays a role with cancer prognosis. Those who have other diseases that alter the immune system (diabetes, for example) can also affect how the body will respond to treatment—both in the short and long term.
Each type of cancer is not identical in the same organ, in similar people, or in individual response to therapy. Assessing each of the elements individually helps underwriters know where the better prognoses are and which cases can qualify for more aggressive offers.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.