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UNDERWRITING CORRELATION FOR CANCER CASES

UNDERWRITING CORRELATION FOR CANCER CASES. Are we going to accept a proposed insured with known cancer?. IT DEPENDS. Accurate risk assessment requires. Correlation with Family History Present Occupation Lifestyle : diet, smoker, drinker, hobbies A working knowledge of the anatomy

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UNDERWRITING CORRELATION FOR CANCER CASES

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  1. UNDERWRITING CORRELATION FOR CANCER CASES

  2. Are we going to accept a proposed insured with known cancer?

  3. IT DEPENDS

  4. Accurate risk assessment requires • Correlation with Family History • Present Occupation • Lifestyle : diet, smoker, drinker, hobbies • A working knowledge of the anatomy • An understanding of nomenclature used in pathology reports (staging, size of tumor, lymph nodes, mets) • Attending physician’s statements (since when, Dx, course of CA, treatment, other therapies, present status) • General familiarity with current medical treatment (surgically removed, chemo, radio, ablation, etc.) • Co-morbidities

  5. For underwriting work up, the following requirements are suggested: • Application Form • Financial Adviser’s Report • Full medical examination (FME) • Attending Physician Statements • Histopathology (biopsy) Report • Tumor Markers

  6. Differentiation of the characteristics of tumors

  7. TNM Classification • Tis – pre-invasive carcinoma (CIS – carcinoma in situ) • T0 – no evidence of a primary tumor • T1 – small tumor confined to the organ of origin • T2 – relatively large but restricted to the organ of origin • T3 – some invasion of adjacent tissue • T4 – massive invasion of adjacent tissue &/or organs • TX – unable to assess primary tumor

  8. TNM Classification • N0 – no regional lymph node (LN) involvement • N1 – evidence of involvement of movable regional LN • N2 – evidence of involvement of fixed regional LN • N3 – massive LN involvement • N4 – involvement of juxta-regional LN • N0 – unable to assess reg’l &/or juxta-reg’l LN . M0 - no evidence of distant metastasis . M1 - distant metastasis present . MX - unable to assess distant mets

  9. Staging System* • Stage 0 – Carcinoma in situ: no associated invasive (infiltrating) carcinoma • Stage I - T1-2 N0 M0 • Stage II - T1-2 N1 M0 • Stage III - T1-2 N2-3 M0 T3-4 N0-3 M0 • Stage IV - Any T Any N M1 * differences are found in different organs

  10. Histopathology Report • provides an indication of the type and staging/grading of the tumor • read carefully and correlate with the APS

  11. Grade Refers to the degree of differentiation of malignant tumor : • Grade 1 – Well differentiated, low grade carcinoma • Grade 2 – Moderately undifferentiated, intermediate grade carcinoma • Grade 3-4 – Poorly differentiated ( markedly undiffert’d, anaplastic), high grade carcinoma

  12. Tumor Markers • Are by-products of tumor growth; may be hormones, enzymes, other proteins • Carcinoembryonic antigen (CEA ) for GI tract (colon), pancreas, lung, breast • Human chorionic gonadotropin (HCG) for uterine choriocarcinoma, ovarian/testicular • Alpha-fetoprotein (AFP ) for liver, yolk sac remnants, testes and ovary • Prostate Specific Antigen (PSA) for prostate

  13. Serial measurement of tumor markers will give an indication of the size and activity of the tumor and adequacy of treatment Persistently elevated tumor marker levels mandate medical consultation Persistently elevated levels may indicate that there is residual tumor that was not removed

  14. The general criteria and ratings or the tumor rating guide varies from one company to another’s insurance manual

  15. “ Underwriting is more than a science: it is an art ”

  16. Thank You

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