Download Underwriting Colon Cancer

UNDERWRITING COLON
CANCER
EILEEN STEDEM
LIFE UNDERWRITING SPECIALIST
LIFEMARK ACCOUNT
PRUDENTIAL
The Prudential Insurance Company of America, Newark, NJ
NR-12D35701 Ed. 3/12 Exp. 9/6/2013
For the education of producers/brokers. Not for use with the public.
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GENERAL CONCEPTS AND TERMS
• Cancer is a general term used to describe any of the
multiple types of malignant tumors.
• Cancer can affect any organ or tissue in the body.
• Cancer is characterized by inappropriate cell growth.
For the education of producers/brokers. Not for use with the public.
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RELATED GI CONCERNS
• Ulcerative colitis (UC) - recurrent inflammation of the
colorectum
• Crohn’s disease (Regional Enteritis) - chronic
inflammatory process which may be found in any area of
GI tract from lips to anus
• Familial Adenomatous Polyposis (FAP)and
Gardner’s Syndrome - characterized by hundreds to
thousands of polyps in the colon
• Colon Polyp - tumor of the inner lining of the colon.
Adverse underwriting action is usually due to premalignant potential
For the education of producers/brokers. Not for use with the public.
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BENIGN COLON POLYPS
• Hyperplastic and other non-neoplastic polyps (e.g.,
hamartomas, juvenile, inflammatory lymphoid
aggregates) have little to no risk of progression to
cancer.
• Adenomatous polyps (characterized histologically
as tubular, tubulovillous and villous) can progress to
cancer.
 Tubular polyps are likely to be small and benign.
 Villous polyps are more likely to be large and
contain cancer.
• After one polyp is removed, there is an increased risk of
developing another polyp.
For the education of producers/brokers. Not for use with the public.
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BENIGN COLON POLYPS
GUIDELINES
Colon polyp present, under 1 cm in size, well
followed
No rating
Colon polyp present, over 1 cm in size
Decline
Colon polyp removed, benign
with good follow-up
No rating
with unknown follow-up, no villous elements
No rating
with unknown follow-up of dysplastic or villous
polyp
Table B
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COLORECTAL CANCER ITEMS OF INTEREST
• Colorectal cancer is the third most common cancer in
men and women and the second leading cause of
cancer death in the United States.
• Most colorectal cancer arises slowly from an
adenomatous polyp over 7 to 15 years.
• Incidence and mortality rates have been decreasing
due to screening for and subsequent removal of
polyps via colonoscopy.
For the education of producers/brokers. Not for use with the public.
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RISK FACTORS
Risk factors for developing colorectal cancer
include:
• family history of cancer or polyps
• inherited conditions (such as familial
adenomatous polyposis and hereditary
nonpolyposis)
• diet and or age
• inflammatory bowel disease (such as ulcerative
colilitis or Crohn’s disease)
• personal history of colorectal polyps
For the education of producers/brokers. Not for use with the public.
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FACTORS IMPORTANT IN ASSESSING THE RISK FOR
COLON CANCER:
• Type (i.e. adenocarcinoma, mucinous, signet ring cell)
• Grade
• Stage
• Time since treatment has ended
• Any recurrences or relapses
• Surveillance
For the education of producers/brokers. Not for use with the public.
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COLORECTAL CANCER: ANATOMY
The wall of the colon consists of four layers:
• mucosa (adjacent to the lumen)
• Submucosa
• muscularis propria
• subserosa (outermost, farthest from the
lumen)
For the education of producers/brokers. Not for use with the public.
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COLORECTAL CANCER: ANATOMY
The wall of the colon consists of four layers:
• mucosa (adjacent
to the lumen)
• Submucosa
• muscularis propria
• subserosa
(outermost, farthest
from the lumen)
For the education of producers/brokers. Not for use with the public.
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STAGING CANCER
Stage represents the extent of tumor within the
body. A commonly used classification for stage is
the TNM system.
• T indicates local tumor size and its
characteristics
• N indicates the spread of the tumor to the nearby
lymph nodes
• M indicates spread to distant parts of the body
via metastasis
For the education of producers/brokers. Not for use with the public.
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STAGING OF COLORECTAL CANCER
Stage
0
I
TNM
Duke’s
Description
Tis, N0,
In-situ, tumor confined to mucosa
M0
submucosa
TNM
M0is preferred to the older Duke’s system.
T1, N0,are A
Tumor
throughfor
the mucosa
into
Both
provided
below
reference.
I
T2, N0,
M0
A
Tumor through submucosa in muscularis
propria
IIA
T3, N0,
M0
B1
Tumor through muscularis propria and
into subserosa but not into neighboring
tissues
IIB
T4, N0,
M0
B2
Tumor into nearby tissues or organs, but
nodes remain negative
IIIA
T1, N1,
M0
T2, N1,
M0
C1
T1 or T2 plus 1-3 nodes positive
IIIB
T3, N1,
M0
T4, N1,
M0
C2
T3 or T4 plus 1-3 nodes positive
IV
M1
D
Spread to distant sites such as liver,
lung, peritoneum, ovary, etc.
For the education of producers/brokers. Not for use with the public.
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DETERMINING THE RATING
Step 1: Refer to Rx for Success for colorectal cancer rating based
upon staging and age at diagnosis.
Rating
Age < 65 at diagnosis
Rating
Age > 65 at diagnosis
Carcinoma in situ, Tis
No rating
No rating
Stage I and Stage IIA
Tumor table C
Tumor table D
Stage IIB
Tumor table B
Tumor table C
Stage
Stage III - Best case only with
≤2 positive lymph nodes and
normal CEA
Stage III (>2 lymph nodes
positive) and Stage IV
0-5 years
6th year
7th year
8th year
9th year
10th year
thereafter
Decline
Table B + $10x5
Table B + $10x4
Table B + $10x3
Table B + $10x2
Table B + $10x1
Table B
0-2 years
3rd year
4th year
5th year
6th year
7th year
thereafter
Decline
For the education of producers/brokers. Not for use with the public.
Decline
Table B + $10x5
Table B + $10x4
Table B + $10x3
Table B + $10x2
Table B + $10x1
Table B
Decline
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DETERMINING THE RATING
Step 2: Enter the Malignant Tumor Rating Schedule (found on Rx for Success
Colorectal Cancer). Rating schedule applies only to those individuals who have had
cancer which was presumably cured and who are no longer under treatment. Dating
for entry into the tumor schedule starts with the date that treatment was completed,
including any chemotherapy or radiation therapy.
A
B
C
D
Within 1st year
Decline
Decline
Decline
$5x3
2nd year
Decline
Decline
$7.50x5
$5x2
3rd year
Decline
$10x6
$7.50x4
$5x1
4th year
$15x6
$10x5
$7.50x3
0
5th year
$15x5
$10x4
$7.50x2
0
6th year
$15x4
$10x3
$7.50x1
0
7th year
$15x3
$10x2
0
0
8th year
$15x2
$10x1
0
0
9th year
$15x1
0
0
0
For the education of producers/brokers. Not for use with the public.
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DETERMINING THE RATING
Step 3: Confirm:
• appropriate surveillance is being performed
• liver function tests are normal
• CEA is normal and stable
• no recurrence
• no recommended tests pending
For the education of producers/brokers. Not for use with the public.
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CASE CLINIC # 1
• 70 Male
• Smoker
• Diagnosed with adenocarcinoma Stage I age 66
Tentative offer: Standard Smoker
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CASE CLINIC # 2
• 71 Male
• Diagnosed with Stage I adenocarcinoma 10/2007
with treatment ending 2/1/2008.
• Serial CEA readings since diagnosis with most
recent CEA increased from last year’s CEA but still
below CEA at time of diagnosis and within normal
range.
If CEA increase deemed significant, cannot
consider.
For the education of producers/brokers. Not for use with the public.
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CASE CLINIC # 3
• 69 Female
• Non-smoker
• Diagnosed with Stage IIA adenocarcinoma
8/2009 with treatment ending 1/2010
Tentative offer: Standard Non-smoker with
$5 extra for 1 year.
For the education of producers/brokers. Not for use with the public.
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CASE CLINIC # 4
• 60 Female
• Non-Smoker
• Diagnosed with carcinoma in situ with treatment
completed 6 months prior to app
Tentative offer: Non-smoker Plus
For the education of producers/brokers. Not for use with the public.
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RESOURCES
• For Quick Quotes, send an e-mail to
[email protected]
• To reach the RU of the Day, please call
1-888-828-4PRU (1-888-828-4778), prompt 1 and
ask Account Representative for RU of the Day
For the education of producers/brokers.
Not for use with the public.
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IMPORTANT INFORMATION
Insurance issued by the Prudential
Insurance Company of America, Newark,
NJ. Underwriting rules are subject to
change at our discretion.
For the education of producers/brokers. Not for use with the public.
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