"Given this early stage of their development, we need to carefully examine their potential, their risks, and the implications for insurers."
- Natalie Kelly, Head of Global Life & Health Underwriting at Swiss Re
Last year, Swiss Re’s ‘Future of Life Expectancy’ Report revealed that life expectancy in many countries has plateaued for the last two decades. However, the reinsurer now believes the next wave of mortality improvements may come from addressing preventative lifestyle factors and introducing better medical interventions for one of the most prolific killers: cancer.
“Innovations in screening, diagnostics, and treatment will likely all contribute to better outcomes for cancer morbidity and mortality in the future.”
Every day, almost 300k people die from cancer around the world. Although screening programmes are recommended, none are globally accepted. In the UK, the government announced the national rollout of targeted lung cancer screenings in June 2023 while prostate cancer remains without a national programme. Similarly, women aged 25-64 are permitted to a pap test for cervical cancer every three to five years, but only those aged 50+ have access to breast cancer screenings.
At present, a tissue biopsy (surgical intervention to remove a piece of the cancerous tissue and test it) is the gold standard pathway for diagnosis once cancer has been detected. This can be invasive, painful, time-intensive, and is typically not feasible for the pancreas, brain, and ovaries. Consequently, associated cancers are often diagnosed at a later stage.
“These [cancers] are usually detected through routine examinations or when patients are symptomatic, resulting in lower treatment efficacy and survival probability.”
Multi-Cancer Early Detection (MCED) tests are a type of liquid biopsy designed to identify the early presence of a wide range of cancers. MCEDs are minimally invasive and relatively risk-free, which is ideal for asymptomatic patients. While the majority of MCEDs are still in development, it’s hoped these tests will be integrated into clinical practice following regulatory approval.
Since MCEDs could improve cancer-related outcomes, there is potential net benefit for insurers and policyholders alike. By identifying cancer at its nascent stages, and with the possibility of earlier treatment, insurers may anticipate a decrease in mortality for various cancer types and potentially mitigate long-term treatment costs. This has led multiple insurers to establish partnerships with MCED companies to provide tests as an added-value service for those with an elevated risk of cancer. Over time, other insurers are expected to implement MCEDs along the entire insurance value chain, if sufficient scientific maturity is reached.
The ability to confirm a MCED cancer signal is critical for promptly triaging patients with cancer versus those with spurious signals. Ergo, the follow-up protocol for individuals with positive MCED results may pose a complex challenge since the test could struggle to identify the cancer site of origin, leading to subsequent procedures such as full-body scans. This comes with the risk of identifying other incidental findings, which may or may not be of clinical significance. Furthermore, there may be no treatment strategies available if positive MCED cancer signals aren’t clinically validated with traditional testing.
“This may pose a challenge for interpretation by insurers, given current guidelines, where neither cancer staging criteria, nor existing Critical Illness (CI) claims definitions, are met.”
Insurers should also consider risks with underwriting & disclosure, overdiagnosis, price assumptions, healthcare costs, and genetic testing regulations.
Natalie Kelly, Head of Global Life & Health Underwriting at Swiss Re, concluded that while MCEDs offer us hope of catching cancers at the earliest stages, boosting survival rates and reducing costs by avoiding complicated late-stage treatments, “we need to carefully examine their potential, their risks, and the implications for insurers.”
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