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Impact of cancer screening on the insurance industry Dr Maritha van der Walt CMO Discovery Life Cancer screening • • • • Early detection early treatment Better outcome Lower Mortality Better experience for the insurance industry or not? Cancer screening TITLE SECOND A RY TITLE Incidence as % of all cancers Lifetime Probability Prostate 33% Breast 31% Colon and rectum 10-11% • Prostate 1 in 6 • Breast 1 in 8 • Colon and rectum 1 in 19 PSA screening • • • • • • Very controversial No influence on mortality? Specificity low Unnecessary biopsies Unnecessary treatment Unnecessary complications – Erectile dysfunction – Bladder control TITLE SECOND A RY TITLE ‘it is blatantly inaccurate to report that the European Randomised Study of Screening for Prostate Cancer (ERSPC) showed ‘little or no effect on mortality from the disease over a prolonged follow-up period’. At a median follow-up of 9 years there was a 20% relative reduction in rate of death from prostate cancer among men between the ages of 55 and 69 years.’ ‘screening of very large numbers of subjects was required to demonstrate any statistical mortality benefit, with substantial overtreatment and a very small proportion of men ultimately benefiting from such interventions. Based on these studies, it indeed seems appropriate to question whether this margin of clinical benefit is worth the financial and morbidity costs of populationbased screening. In fact, recently the US Preventive Services Task Force is reported to have posted a preliminary draft recommendation against PSA-based screening for prostatic cancer in all age groups, based on the publication of the above two trials.’ ‘both physicians and their patients should be informed of the benefits and risks of screening or not screening. Other clinical factors, such as age, comorbidities, 10-year life expectancy and patient preferences, should also be taken into account. By being fully informed, patients and physicians are better armed to combat prostate cancer," says Erik P. Castle, M.D., a urologic surgeon at Mayo Clinic in Arizona Impact on claims TITLE SECOND A RY TITLE • Australian study – Males 20-65 years 22% of claims were for prostate cancer – 15% in general Australian population – 2001-2005 18% increase in prostate cancer claims Access to screening or need for stricter underwriting? Management TITLE SECOND A RY TITLE • Treatment – surgery radiation hormonal • Active surveillance • Watchful waiting http://cisnet.cancer.gov/prostate/comparative. html Overdiagnosis of cancer Overdiagnosis • Overdiagnosis versus false positive • Prostate cancer • Breast cancer – Ductal carcinoma in situ Summary • Screening – Not just bringing the claim forward – Many additional cancers identified – Many of the early cancers would have been non progressing, clinically insignificant cancers – Increasing medical, psychological and insurance cost – Emotional pressure to cover earlier cancers on serious illness products Questions and discussion TITLE SECOND A RY TITLE