The increase in prostate cancer claims may not be quite as much as insurers fear, writes Dr Chris Hiley
The Prostate Cancer Risk Management Programme is not a national screening programme. The major change in policy that has occurred since the situation was last comprehensively reviewed in 1997, is that men who are interested in having a prostate specific antigen (PSA) test will be able to ask for one from their GP. However, this relies on men knowing about the PSA test in the first place. Few, if any, GPs are intending to operate a call or recall system for regular tests, of which a genuine screening programme would usually consist. There is also a chance that some men may also decline the test once they discover how effective it actually is.
There has certainly been an increase in the numbers of cases of prostate cancer diagnosed as a result of the increasing pattern of ad hoc PSA tests. This increase may continue and become more marked after the Prostate Cancer Risk Management Programme takes effect.
However, the increase will be nothing like that which would occur if there was a genuine screening programme. So the anticipated problem of losses to the industry through increased payouts may not be as large, or as steep, as feared.
Currently, only 10% of prostate cancers are diagnosed in men under 60 years of age. This figure will probably increase, but it is in this age group that aggressive forms of the disease are more likely to appear and where there is sufficient life expectancy for a life threatening situation to develop ' meaning it would be classified as a critical illness.
Currently only about 4% of critical illness policies are held by men over 50. While this may change over time, there does not seem to be sufficient overlap between the two groups at present to prompt the need to make fast decisions. Instead, it is likely there will be an extended period of interesting discussion between the Association of British Insurers and The Prostate Cancer Charity.
It is worth noting, however, that the aggressive nature of a prostate cancer, measured by the Gleason Grade, is a significant predictor of disease progression and could be useful in defining the type of cancer that might be excluded in a new definition.
It could be that the Gleason Grade says more about critical illness than the preferred option of using the TNM staging system currently under consideration, and as used in other countries. TNM staging is broadly a geographical description, saying where the cancer is, whereas the Gleason Grade says more about how fast the cancer is travelling.
