7th June 2023

ABI Cancer Changes

CIExpert has been receiving numerous questions regarding the ABI minimum standard wording for cancer which was tweaked within the September 2022 publication.  One change relates to the exclusion of thyroid cancer unless it has reached T2N0M0 and the other is the alteration to the early-stage prostate cancer exclusion.

One of the aims of the triennial publication is to future-proof the condition wording reflecting the latest changes to both diagnostic techniques and treatment to protect insurers from increased claims in respect of future applications.

Back in 2018 the minimum standard cancer wording was altered to enable insurers to exclude thyroid cancers having progressed to at least TNM classification T2N0M0.  Back then all the insurers opted to retain their current wording, not wanting to be the first to make the change.

In March this year L&G bit the bullet becoming the first adviser-supporting insurer to include these changes and in due course others are sure to follow.

The thyroid cancer change is the most important one and was kick-started by the South Korean experience where improved diagnostic testing has resulted in overdiagnosis highlighting lesions that would not be clinically significant.  Companies are offering free diagnostic checks in return for a share of the critical illness payout – a no win no fee arrangement.  The fear is that the UK will suffer a similar overdiagnosis which has resulted in South Korean incidence being over 400% higher than in the UK.

There are over 4,000 thyroid cancer diagnoses in the UK each year and the impact on future claims relates to the percentage of these that meet the new T2N0M0 claims barrier.  What does T2N0M0 actually mean?  T relates to the size of the tumour, with T2 meaning that the tumour is still wholly within the thyroid and is between 2cm and 4cm across.  N describes whether the tumour has spread to the lymph nodes with T0 meaning it hasn’t.  Finally, the M confirms whether it has metastasised (spread  to other parts of the body) M0 means it hasn’t.

Thyroid staging is different to other parts of the body inasmuch as T2N0M0 indicates a diagnosis of stage 1 cancer for those under age 55 whereas for thew over 55s it can also encompass stage 2.

Two aspects rear their heads when it comes to assessing the outcome within a critical illness plan.  What percentage of the diagnosed population is affected and at what ages.

Our research indicates that around 75% of diagnoses are Stage 1 with close to 15% at stage 2 with the main ages of diagnosis showing as 30 to 65.

The other important change to the cancer definition relates to early-stage prostate cancer.  Until now early stage prostate cancers - categorised as a Gleason score below 7 - have been excluded.  The revised minimum wording now allows tumours classified as below Gleason 7 to be included as long as they have undergone treatment by prostatectomy.

This might seem a momentous change but in truth it only has a small impact.  There around 51,000 diagnoses of prostate cancer each year and of these close to 20% are below Gleason 7.  Additionally, only 5% of sufferers are treated, due to the potential side-effects, and of these prostatectomy is carried out in 11% of cases.

Accordingly, prostatectomy is no longer within the less advanced cancer of the prostate definition and scores for this particular definition will be lower.

The outcome, when comparing current plans against more recent versions, is to show the older plans as having a slightly better cancer definition.  Many advisers have been put off by this but it has to be viewed in the context of other changes.  CIC plans have been through similar changes before when early-stage prostate was excluded from the cancer definition and when coronary angioplasty was removed as a 100% paying condition before returning as an additional payment condition.

It is in the nature of the plan that changes in incidence and in diagnostic techniques will continue and plans have to adapt to remain affordable.  Advisers need to understand the changes and their effect on the scoring within the CIExpert system so that they can adequately  explain the differences to their clients.

Alan Lakey, CI Expert

Protection