Global Cancer Trends – A Fast-changing Risk Landscape

The last five years have seen some incredible advances relating to cancer, primarily in the fields of cancer diagnostics (e.g. liquid biopsy), cancer treatment (e.g. immunotherapy) and cancer classification (e.g. via genomics), as well as in preventative measures.

In this, the first of a 4-part series of insurance-focused articles on cancer, Dr. Achim Regenauer, Chief Medical Officer, focuses on how these advances translate into high-level trends, and why they are so important to Life & Health insurance – all in a concise bulleted format, so there’s no need to wade through complex medical descriptions or interpret sensationalized headlines.

Alongside Dr. Regenauer’s observations, Bryce Shepherd, Head of Capabilities Development, Life & Health APAC, adds valuable market insights and solutions relating to how the industry can adapt to stay relevant, valued and sustainable over the next decade.

Parts 2, 3 and 4 of this article series will respectively address the main advances in cancer diagnostics, treatment and classification – each with corresponding market insights from PartnerRe’s Life & Health experts.

Key factors driving cancer trends

Risk factors: Differences in cancer incidence, mortality and morbidity rates are mainly linked to differences in lifestyle, environmental, social and economic risk factors. Hence there is no one overall trend in cancer and “all-sites” cancer incidence rates (cancers are often defined by their primary location or “site”, e.g. lung cancer) mask the substantial diversity of cancer profiles by country.
Preventative measures: A large proportion of cancers can and are being prevented by e.g. tobacco control, vaccination and the promotion of healthier lifestyles. As research refines our understanding of the risk factors, these measures will expand, further improving incidence rates.
Medical measures: Medical advances in early detection and appropriate timely treatment with more effective, innovative cancer drugs have decreased cancer mortality over the last decade, but often increased the morbidity.

Ever-changing cancer trends mean an ever-changing cancer risk landscape. To stay relevant to consumers, sustainable and valued over time, Life & Health products need to change too.

Business solution: Product risk mitigants

With early detection and new treatments becoming prime influencers of cancer trends, we can intelligently design products with the future in mind by using product risk mitigants. Examples of these are waiting periods or moratoriums, tiered benefits (both static i.e. from outset, and dynamic i.e. changing over the policy lifetime) and severity/impact-based cover wordings.

A practical example is PartnerRe’s innovative treatment-based Critical Illness product– this product mitigates trend risk by reimbursing severe conditions up to a specified cap (e.g. cancer treatment including targeted therapy and even hospice care) and paying daily fixed benefits for minor conditions.

Such approaches realign the benefits to the new financial and emotional impact of a cancer diagnosis and ensure that the product is affordable to a wider market.

A reinsurer – providing expertise in products, pricing and specialised underwriting – can be a key partner for this.

Business solution: Proposition enhancement

Alongside product risk mitigants, proposition enhancements can be used to control rising and/or uncertain trends. We recommend focusing on partnerships to provide preventative, screening and pre-diagnosis services. Firstly, these helpful services can provide a ‘value feedback loop’ with customers and rectify the perception that insurers are only there for claims. Secondly, they can control long-term costs by catching illness early and enabling early intervention, helping to turnaround severity trends.

Business solution: Positive lifestyle incentives

Another promising focal area, still relatively in its infancy, is the inclusion of incentive mechanisms to encourage positive lifestyle behaviours, e.g. to stop smoking, vaccination awareness and the promotion of healthy lifestyles. It is perhaps provocative to say ‘infancy’, as these mechanisms are included in many propositions, but whether their impact is material and consistent remains uncertain. It is not contentious, however, to say that digital health incentives provide an enormous (and expanding, as research uncovers more cancer risk factors) potential, should the mechanism produce the desired effect.

As a supporting and partnership-driven reinsurer, PartnerRe is here to work with, understand, quantify and make changes within the pricing and underwriting context to reward these endeavours. We note the expanding repertoire of correlated lifestyle risk factors and are ready to discuss bringing these into the risk assessment and pricing of cancer products.

Trends in incidence, mortality & morbidity

There is limited published data on recent cancer incidence and mortality trends worldwide.
The global age-standardized incidence rate and age-standardized mortality rate for males is about 1.5 times that of females.
People aged over 50 years are still at higher risk of developing cancer; globally, the number of cancer patients and deaths in this age group accounts for more than 80% of patients and deaths in all age groups¹.
Asia has the heaviest cancer morbidity burden worldwide, due to its high population density.
The rates of many cancers are being brought under control in high-income countries, in line with improving risk factors, early detection and advanced treatments.
In contrast, rates for common cancers, such as lung, breast, and colorectal, are now rising in many low- and middle-income countries due to increases in cancer risk factors typical of high-income countries, such as smoking, excess body weight, physical inactivity and changing reproductive patterns.
In addition, low- and middle-income countries continue to bear a disproportionate burden of infection-related cancers, including stomach, liver and cervix.
Due to more comprehensive cancer screening, the widening of cancer definitions and the more frequent use of advanced imaging technologies with more incidental detections, an increasing, age-standardized incidence rate has been observed for many cancer sites, which often translates into a disproportionate increase of cancer-in-situ².

Business solution: Health management frameworks

Although cancer trends are increasing in some countries and socio-demographics, patient/policyholder expectations of life expectancy have dramatically improved due to advanced medical treatments and health management through positive lifestyle, diet and stress management measures.

Insurers can add value by complementing Life & Health products with health management frameworks that improve access to these positive developments, helping to counteract creeping adverse trends.

Policyholders/patients are then accompanied and taken care of by their insurer, magnifying the value of the relationship. At the same time, if structured correctly for sustainability, such frameworks can reduce overall costs for the insurer by shifting late stage, large lump sum payments to earlier, smaller claims.

Why do these trends matter to Life & Health insurers?

Cancer is the second leading cause of death (after cardiovascular diseases). Globally, every sixth death is due to cancer.
Incidence is highest for insured ages. Globally, the majority of cancers occur in those aged 50 and over; almost 50% of known cancer cases occur in the 50-69 year age group, i.e. the principal age group of most Life insurance portfolios.
Mortality shift. The distribution of cancer deaths across the age spectrum has changed notably since 1990; the share of deaths for over 70’s has increased by 8%, whilst the share of deaths for ages 50-69 and 15-49 has fallen.
Oncology is now the pacemaker of medical advances with liquid biopsy, targeted treatment, personalized medicine and genome sequencing – substantial change is afoot, so it is key for Life & Health insurers to closely monitor the trends in incidence and mortality. In the mid-term future, expect a much higher degree of progress variability reflecting the different medical advances for many cancers.

Business solution: Effective risk management

Asia’s middle-class is growing fast³; indeed, close to 90% of the next billion entrants to the middle class are expected to be from Asia⁴, and by 2030, two thirds of the world’s middle-class households are expected to be living in Asia⁵. There are clear market forces driving up demand in Asia for insurance against the second main cause of death, cancer. Insurers will correspondingly need to manage their increasing exposures to cancer risk (incidence and trend).

This growing demand for cancer insurance products necessitates a deeper understanding and monitoring of the trends: specifically of the evolving exposure due to medical advances, regional epidemiological trends, healthcare infrastructure, screening programs and lifestyle factors.

A reinsurance partner that can provide not just capacity for long-term cancer risk, but also insights into the effective management of this risk, will enable growth and add stability. PartnerRe can provide both to insurers in Asia.

Impact of Covid-19

Deferred and delayed cancer treatments due to lockdown and reduced access to hospitals has an expected minimum additional mortality increase of ≥ 6% for a 4-week delay⁶.
Furthermore, substantial increases in the number of avoidable cancer deaths can be expected as a result of diagnostic delays due to the postponement of routine, non-urgent diagnostic work and suspended cancer screening services.

Business solution: Accessible screening & testing

It’s concerning that a delay of only four weeks can increase mortality by over 6%. Under current pandemic conditions, the market could look to complement base protection products with add-ons and/or services to make cancer screening and testing more accessible. Service examples include tele-consultation or video consultation services, self-testing kits and image-based AI to predict skin cancer.

If a pandemic were to happen again, or customers behaviours change irreversibly to prefer digitally accessible services, such as those offered via mobile phones, then building a proposition that attaches services bringing diagnostic testing and medical services to the policyholder, will be highly valuable. There is an opportunity for the insurance industry to step up and provide the financial structure or partnerships to allow these services to be offered, under the premise that cancer screening and testing today can reduce later stage large lump sums.

Making screening & testing more accessible is therefore good for now and good for the future.

We hope you found this overview helpful. Don’t miss the next article in this series, “Part 2: Cancer Diagnostics – Earlier Detection & Impact on Incidence & Mortality” – includes insights such as the imminent screening for cancer via a simple blood test.

Contributors

Achim Regenauer, Chief Medical Officer, Europe and Asia Pacific
Bryce Shepherd, Head of Capabilities Development, Life & Health, APAC

Contact PartnerRe

Our approach is one of partnership, shared expertise and the creation of success for our clients.

We look forward to discussing these trends and concepts with you, and to turning them into concrete solutions for your business.

This article is for general information, education and discussion purposes only and does not constitute legal or professional advice.

References

¹ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6740016/pdf/13045_2019_Article_783.pdf
² https://www.nature.com/articles/s41598-018-32844-x
³ https://reports.weforum.org/outlook-14/top-ten-trends-category-page/8-the-expanding-middle-class-in-asia/
⁴ https://www.brookings.edu/wp-content/uploads/2017/02/global_20170228_global-middle-class.pdf
⁵ https://www.statista.com/chart/8402/asian-middle-class-on-the-rise/
⁶ https://www.bmj.com/content/371/bmj.m4087

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