Impaired Risk Review...
When Is Screening Essential?
Robert Goldstone
February 2015

The proper assessment of current health is essential for underwriters to come to the best (and hopefully most aggressive) decision on policy pricing. This is straightforward when tests and current assessment of well being have been done by an attending physician and favorable results lead to standard and preferred issues. What about screening tests for health that assess risk and allow both the doctor and patient/insured to look for disease that isn’t currently causing symptoms? The United States Preventative Services Task Force has recommendations for screening, but instead of being straightforward, many remain quite controversial.

The Task Force, for example, recommends  mammography every two years for women aged 50-74. Just about everyone, however, knows someone or has a friend or relative in whom breast cancer has been diagnosed well before age 50. Organizations such as the American Cancer Society and the American Congress of Obstetricians and Gynecologists start screening at age 40. Is there a right answer? Most insurers and the majority of women concerned about their health would agree with the earlier age. But is it a bigger risk for all involved not to screen until a later age, if at all?

Most insurers require PSA testing above a certain age, 50 being a common norm. But the U.S. Task Force recommendation was that screening did more potential harm than good unless certain men were deemed to be high risk. Both the American College of Physicians and the American Cancer Society suggest full conversations with men regarding risks and potential benefits before screening is decided upon. There are many documented cases in which insurers were the first to catch a rising PSA, indicative of cancer, but the prostate cancer screening guidelines remain controversial.

Colonoscopy recommendations have been more uniformly agreed upon. Screening at age 50 should begin (at earlier ages if a strong family history exists) and done periodically every 5-10 years depending on findings. Colorectal screening has been found to be an effective preventative measure in removing precancerous polyps as well as looking for occult cancer in an earlier stage when it is not symptomatic. Both the Preventative Task Force and the American Cancer Society agree on these recommendations.

Other screening tests are also recommended. Cervical cancer screening with Pap smear and HPV testing is recommended every five years for women over 30. While CT scanning for lung cancer is not routine, it is recommended yearly beginning at age 55 for those who have a 30 pack/year or more history of smoking, using the low dose CT technology. Screening for abdominal aortic aneurysm is recommended as a one-time test for male smokers and former smokers age 65-75.

One thing that is universally agreed upon is health screening with periodic history, physical and routine lab testing. Insurers would not want to participate in risk taking where there was no evidence of health maintenance and some periodic screening for heart disease, cholesterol, general medical health and wellness. Regular medical checkup and wellness visits are generally looked for in both males and females over the age of 50, with periods in between dependent on age and results of previous testing. Preferred and super-preferred status is certainly benefited by a track record of good health and continued preventative health measures. 

Author's Bio
Robert Goldstone, MD, FACE, FLMI
MD, FACE, FLMI, board certified internist and endocrinologist, was most recently 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 1991. Goldstone does consulting full or part-time as well as on a fill-in basis for companies who need a medical director/physician. He can be reached by ­telephone at 949-943-2310. Emaill:

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