New Cancer Diagnostics - A Threat to Critical Illness Cover?
A consensus among medical experts is that histopathology will lose its importance in selecting appropriate cancer treatment, and eventually diagnosis, over the course of the next 15 years. During this time, liquid biopsy techniques targeted at finding circulating tumour cells (CTCs), circulating tumour DNA (ctDNA) or microRNA/exosomes in the blood are expected to develop evidence-based accuracy.
Much depends not only on continued technical progress of the new technology. For it to be integrated into national health systems it will have to demonstrate its cost effectiveness. The aim must be reduced treatment expenses overall compared with current practice, despite the greater number of diagnoses.
The relatively long timeframe is somewhat reassuring for insurers with Critical Illness portfolios. A positive CTC or ctDNA test result alone would not fulfil the current standard cancer definition in many markets.
While these technologies are developed it makes sense to revisit the language used in CI cancer definitions. The urgency is most acute where standardised wordings mean changes can be implemented only after industry-wide consultation. Markets that offer guaranteed premium rates clearly face a different challenge to markets where reviewable premiums are the norm.
The challenge for all insurers is to phrase a cancer definition in a way that ensures a similar level of severity even with the advent of a new technology. Severity prevents CI paying out for only minor rather than life-threatening disease and as a result stops products from becoming unaffordable.
Current pricing uses experience observed from historical diagnostic tools. New technology is likely to lead to cancer being detected more often and at an earlier stage. The rapidly falling cost of DNA sequencing could see individuals undergo such tests in exchange for a potential pay-out of the sum insured under their CI policy or take out a policy after learning their risk or diagnosis.
The new blood tests described have the potential to overhaul the diagnostic process - with yet unknown consequences for the frequency of cancer detection. Insurers must also plan for a future where new tests mean very different supporting evidence for cancer claims than is common today. As cancer is the leading cause of CI claims, how it is diagnosed has a strong impact on insurers’ claims experience.
On a more positive note for both customers and insurers, early cancers will be more amenable to treatment so that eventually the burden of invasive cancers could be reduced. This would actually have a positive effect on incidence rates and improve mortality markedly. Hence, a different level of cancer incidence rates can be expected to emerge in the future, even if the diagnostic approach does not undergo dramatic change immediately.