An Early Diagnosis of Challenges Ahead for Critical Illness Insurers
Initiatives to sequence 100,000 individual genomes in the UK and to develop a DNA study of one million Americans will create a vast genetic dataset. There is pressure to return incidental, but relevant, findings to participants. Despite this aim being complicated by the sheer volume of information and uncertainties over its true meaning, people wish to know their results.
Gen Re surveyed attitudes to genetic testing, obtaining anonymous responses from 134 insurance employees and their personal contacts in the UK and Ireland. Around 45% of responses were from people working outside the life insurance industry or not having medical training. A little over 85% said they would be prepared to undergo testing (a small subset with a medical background revealed greater reluctance).
Half of those saying they would have the test felt it would provide them a better understanding of any health risks they might face, mostly to allow early medical intervention if required. In the under age 35 group, 15% want to understand risks they might pass along to their children. One in four people age 35 and over would have a test if there were a “good reason”, such as family history or existing illness, while few under-35s qualified their answers in this way.
Not quite half (44%) indicated they would pay for a test, most of whom thought that 50-250 GBP represented a fair price. In the overall group, 37% would be interested only if testing was free of charge, while a further 6% would be tested only if they were offered some form of incentive.
Those who didn’t want to be tested were reluctant about being burdened with knowledge about diseases about which they believe they could do nothing; they felt a test was unlikely to be useful in the absence of a clinical problem or history of genetic conditions in their relatives. Just one person cited data privacy concerns.
We extrapolate from our sample that most people are open to being tested for genetic conditions, believing that it will help them manage their health better.
The conclusion is supported by the results of a sizeable new study by the Wellcome Trust Sanger Institute. It polled the views of almost 7,000 people in 75 countries, two-thirds of whom have no medical background, and 98% of whom said they would want to be told about indicators of a serious preventable or treatable disease found using their genomic data.
Some caution is required, however. Finding indicators for disease in genetic code doesn’t guarantee disease will develop. As today’s genetic markers don’t identify highly penetrable disorders with 100% sensitivity, they are no more helpful than standard clinical approaches.
Scientists have made great progress in developing techniques that provide early detection of cancer. Indeed, we all take it for granted that finding cancer early is beneficial. But it’s not that simple. Some of the cancers that may be detected are slow growing and unlikely to cause health problems in a person’s lifetime.
Finding early stage cancer can render a person “over-diagnosed” and treatment for such indolent conditions can significantly affect a person’s quality of life. As a result, health policymakers are reluctant to recommend screening in the absence of evidence that suggests that the benefits of early detection outweigh the harms and costs of simply detecting cancers unnecessarily.
There are indications that screening activity could increase in future as a result of new cost-effective and non-invasive screening tests and genomic research that will help identify indolent cancers without risk of harmful over-treatment.
It’s important for insurers to monitor these developments because experience so far with screening - for prostate and thyroid cancers, for example - shows that increased activity can increase the cost of CI cancer claims significantly.
In a recent article, I set out the results of various autopsy studies which showed that far more people die with cancer than is ever diagnosed. This is cause for concern in terms of the cost of providing critical illness cover if very sensitive screening tests are developed and become widely used.
CI insurers need to consider possible responses like the use of exclusions or new severity measures. Alternatively, there might be scope for product differentiation by actually extending cover with smaller payments for these additional findings.
But everyone has to accept that increased health screening poses a real challenge to CI insurers seeking to provide guaranteed terms in a highly uncertain future.