A tumour is a swelling or new growth, the cells of which multiply in an uncontrolled number. Tumours...
A tumour is a swelling or new growth, the cells of which multiply in an uncontrolled number. Tumours can be divided into benign (innocent) or malignant (cancerous). Benign tumours are normally slow growing and are usually not fatal but may cause problems by virtue of their site, for example benign brain tumours can cause pressure on the brain, possibly resulting in numbness, paralysis, stroke and blindness.
Malignant tumours are far more aggressive and can invade tissues surrounding them which they then destroy. The cancerous cells can gain access to the circulation and spread to remote sites in the body, a process known as metastases. In the presence of metastases, cure cannot be achieved solely by surgical removal of the initial tumour. If untreated, the cells continue to grow and eventually will prove fatal.
.
Causes of cancer.
Although recently there have been dramatic improvements in the research into the causes leading to cancer, the exact cause remains unclear in most cases.
There are several factors that appear to have a strong link to cancer. One of the most commonly discussed factors is exposure to ultraviolet (UV) radiation from the sun and this is now considered to be a main cause of skin cancer malignant melanoma. It is also believed that artificial sources of UV radiation, such as sunbeds, can cause skin cancer. Radiation is also a cause of cancer, such as that released during the Chernobyl nuclear accident. Exposure to radiation can damage the cells of the body and it is normally these changes to the cells that may aid in the development of cancer.
People who work with certain chemicals and substances may be at increased risk of developing cancer. For example, exposure to asbestos dust in the production of asbestos textiles is a common link to certain cancers and the incidence of cancer of the lung is much higher in persons exposed to asbestos dust.
Cigarettes are a well-known link to lung cancer. However, there is an opinion that the health risks associated with smoking may not only be limited to smokers themselves. Exposure of non-smokers to cigarette smoke passive smoking can increase their risk of developing lung cancer.
Studies within families indicate that there may be an inherited factor as some families have a stronger tendency to develop cancer than others. In particular, there are families with a strong history of breast and colo-rectal cancer. The Society of Actuaries Medical Impairment Study (1962-1977) also indicated that where an applicant had two or more first degree relatives with cancer prior to the age of 60, the risk of the applicant contracting cancer was almost double that of the general population for a female and one and a half times greater for a male.
.
Types of treatment.
Benign tumours may be removed surgically if the site allows this procedure. Malignant tumours are treated by surgery, if accessible, chemotherapy or radiotherapy. However, for a number of malignant tumours, a combination of these methods is frequently used.
Unfortunately, some cancerous tumours may be untreatable and the patient will receive only palliative treatment where medication only gives temporary relief from the symptoms but does not actually cure the disease. Where tumours are inoperable, treatment may be effected by radiotherapy or chemotherapy. Radiotherapy is the treatment of disease with penetrating radiation such as X-rays, beta rays or gamma rays. Beams of radiation may be directed at diseased parts from a distance, or radioactive material in the form of needles, wires or pellets may be implanted in the body.
Unfortunately, this treatment can cause the growth of secondary tumours. Chemotherapy aims to prevent or treat disease by the use of chemical substances. Chemotherapy and/or radiotherapy may be used alone or in addition to surgery. Unfortunately, both can produce side effects such as nausea, vomiting, hair loss and weight loss.
.
Better prognosis.
Prognosis is the assessment of the future course and outcome of a patient's disease and depends upon the responsiveness of the tumour to the various forms of treatment. Over the years the prognosis of cancers has improved dramatically with the improvement in diagnostic techniques and the treatment given.
When determining the prognosis, one of the most important pieces of information we can use is staging of the tumour. Staging is a mechanism for categorising the growth and spread of tumours. This can be determined by comprehensive evaluation which may include surgical exploration, computerised tomography (CT scan), magnetic resonance imaging (MRI) and ultrasound scanning.
The staging of malignant tumours falls into four categories.
l The tumour is invasive, but is confined to its tissue or organ of origin only. Surgical treatment is possible.
l The tumour is similar in nature to the first stage but it has also spread to the regional lymph nodes lymph nodes are a group of swellings found throughout the body that occur in the groin and armpit, behind the ear and in many other areas of the body. Surgery is also possible to remove the tumour but there may also be a need for chemo/radiotherapy.
l There has usually been a spread of the disease to the surrounding organs. Surgery may not be able to remove the tumour and additional treatment by radiotherapy may follow.
l Distant metastases have occurred. Treatment may only be palliative. This means that the prognosis for a patient diagnosed with a Stage 1 tumour, would normally be better than that of a patient diagnosed with a Stage 3 tumour. Certain tumours have their own specific staging systems. The most common of these are the Clark and Breslow system for classifying malignant melanomas, Duke's classification of colonic/rectal cancer and the Marshall classification for urinary/bladder cancers.
.
Insurance implications.
There are far too many types of cancer to discuss in this article. However, two of the more common cancers that underwriters see are breast cancer and colo-rectal cancer. Breast cancer is the most common malignant tumour in women in the West. However, males may also be affected but with a reduced frequency than women. Contributory factors appear to be close family history, late first pregnancy and a history of benign breast disease.
Screening programmes using mammography have increased the detection of breast cancer with a reduction in mortality within specific age groups. With physical examination and mammography used together, this can detect a high percentage of breast cancer lesions. However, definite diagnosis is normally confirmed by biopsy removal of a small piece of tissue from the breast for microscopic examination. Treatment can either be by mastectomy surgical removal of the breast or, in certain cases, only the lump itself might have to be removed.
As there is a relatively high relapse rate, it is unlikely that terms would be offered in the first four years from the date of removal or from when treatment ceases.
Colo-rectal cancer is another of the most common types of cancer in the West. Unfortunately, the incidence has not changed over the years, but it is considered that incidence is lower where the intake of dietary fibre is higher. As many as 25% of sufferers with colo-rectal cancer have a family history of the disease, suggesting a genetic factor to the condition. Diagnosis is made with use of internal investigations with cameras such as a sigmoidoscope or colonoscope.
Treatment would normally consist of removal (resection) of the affected part of the colon or rectum with possible chemotherapy and/or radiotherapy. Following surgery, it is unlikely that terms would be available until two years have elapsed. The two-year delay period can be lengthened to five years, depending upon the staging of the tumour. In recent years, the industry, through analysis of its cancer mortality results, has realised that the assessment of tumour risk is not as black and white as once thought. Detailed evidence, especially histology reports, are now requested in addition to a tumour questionnaire. Some life offices also request a private medical attendant's report and occasionally a medical examination.
When considering life cover for most malignant tumours, there is normally a delay period in the early years after diagnosis and treatment. This is because the extra mortality is too speculative for terms to be considered. This period can range from one year up to five years. This is then followed by a period of reducing extra mortality where terms may be considered with an extra premium. This premium normally consists of a temporary extra premium that may be applied to a policy for a number of years. This type of loading will normally revert to standard rates after the rated period. However, some tumours carry a life-long extra mortality and may incur an extra premium throughout the term of the contract.
A history of cancer often results in critical illness and total and permanent disability contracts being declined. However, a few offices will consider cover with a 'cancer' exclusion. A typical case study would be that of a male diagnosed with a malignant melanoma (skin cancer) on his back. The melanoma was excised in June 1996. On the histology report it was confirmed that the tumour thickness was 1.75mrn and the Clark level was III.
Follow-ups since confirmed that there was no further occurrence of the tumour. On considering the underwriting the normal delay period would be two years. We are now in the fourth year and are able to consider terms but with a temporary extra. A typical extra would be £10 per mil per annum for five years, thereafter standard rates.
Where an adviser has a potential application with a known history of cancer, it is recommended that they take advantage of any of the underwriting helplines made available by life offices. These lines are staffed by experienced underwriters who will be able to give an indication of whether terms are available and possibly indicate a level of loading. Underwriters can only give an indication of the likely terms based on the evidence presented and will only be able to confirm terms once an application and medical evidence have been received and assessed.
Martin Williams is an underwriter at Guardian Financial Services.
