Download Breast Cancer Awareness

109/10/2008
Alex Koodrin
National Technical Manager
Breast cancer awareness
October is internationally known as Breast Cancer Awareness Month. The month‟s activities –
culminating in Pink Ribbon Day on Monday, 27 October – are designed to promote awareness
of breast cancer and to help raise funds to support research.
The Facts
Breast cancer is the most invasive cancer among Australian women, such that 1 in 8 women will be
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diagnosed with breast cancer before the age of 85
Breast cancer is also the most common cause of cancer-related death in women in Australia, with a
2
total of 2,641 women dying from breast cancer in 2004
Eighty-eight percent of women diagnosed with breast cancer will be alive 5 years after their
3
diagnosis
Of Australian women who have been diagnosed with breast cancer in the last 23 years, about
4
130,000 are still alive
The incidence of breast cancer is on the increase. The number of new cases of breast cancer per annum among
women rose from 5,318 in 1983 to 12,027 in 2002, and the projected number of new cases is expected to be
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14,818 in 2011. The relatively good news is that the breast cancer mortality rate for Australian women has fallen
markedly since the early 1990s, from 31 deaths per 100,000 females in 1990 to 23.4 deaths per 100,000 females
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in 2004.
Breast cancer imposes a large financial burden on society, being the second „most expensive cancer‟ after non7
melanoma skin cancers, with total expenditure of $241 million in 2000-01 , when $96 million was spent on
population screening mammography, $72 million on hospital admitted patients, $27 million on prescription
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pharmaceuticals and $21 million on out-of-hospital medical costs.
However, most of the financial costs relating to cancer relate to lost productivity, largely borne by individuals and
their families. The hidden costs of cancer faced by many sufferers include extended time off work, whilst enduring
increased expenses, the effect on long-term employment prospects, as well as the possible impact on unpaid work,
such as the ability to care for family members. As we know, the latter largely falls within the female domain. As well
as lost income, cancer-affected households often encounter out-of-pocket expenses relating to transport,
medications, specialist clothing and mobility devices, and childcare and housekeeping costs. It is been estimated
that the lifetime economic cost of breast cancer, per person, in NSW, is $653,600, comprising a financial cost of
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$64,300 and a „burden of disease‟ cost (non-financial cost) of $589,300.
1
Breast Cancer in Australia: An Overview 2006, Australian Institute of Health and Welfare and National Breast
Cancer Centre, 2006, xv
2
Ibid., xvi
3
Cancer survival and prevalence in Australia, Cancers diagnosed from 1982 to 2004, Australian Institute of Health
and Welfare, July 2008, 71
4
Ibid.
5
Breast Cancer in Australia,1
6
Ibid., 20
7
The cancer journey: informing choice, Australian Senate Community Affairs References Committee report on the
inquiry into services and treatment options for persons with cancer; available from
http://www.aph.gov.au/senate/committee/clac_ctte/cancer/report/report.pdf
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Breast Cancer in Australia, 69
9
Cost of Cancer in NSW: A summary of a report by Access Economics Pty Limited for The Cancer Council NSW,
April 2007, available from
http://www.cancercouncil.com.au/html/policyaction/campaigns/downloads/costofcancerNSW_report_summary.pdf
Life insurers provide cover for breast cancer sufferers in many ways. Depending on the severity of the condition, a
client may make a cancer-related claim for income protection, trauma cover, Total and Permanent Disablement
(TPD), and of course life cover with a terminal illness provision. Two of the three „living‟ covers, income protection
and TPD, generally have work-based and/or income-based definitions, involving partial or total disability or
permanent incapacity. A trauma cover claim, on the other hand, is governed by the cancer definitions in the
insurer‟s policy document. In 2007, CommInsure paid a total of $46.4 million in retail trauma claims. Of those
claims, 51% were for cancer, and almost half of those, 21.4%, were for breast cancer. CommInsure paid a total of
$7,833,739 to breast cancer trauma claimants in 2007! The average age of a claimant was 47 years: the youngest
was aged 24 and the oldest was aged 64.
Generally, all insurers pay a full trauma benefit upon diagnosis of invasive breast cancer, i.e. any malignant tumour
characterised by the uncontrolled growth and spread of malignant cells requiring major interventionist treatment. In
addition, many insurers, including CommInsure, pay a full benefit for carcinoma in situ of the breast (where the
tumour has not yet spread to surrounding tissues) which results directly in the removal of the entire breast (with or
without removal of lymph nodes).
There are two types of breast carcinoma in situ: ductal carcinoma in situ (DCIS) and lobular carcinoma in situ
(LCIS). They are also called „pre-invasive‟ breast cancers. DCIS is the most common type of non-invasive breast
cancer, where cancer cells inside the ducts do not spread into the fatty tissue of the breast but stay inside the milk
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ducts. About 1,200 women are diagnosed with DCIS each year in Australia. Previous NSW statistics for
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carcinomas in situ have indicated that about 95% of diagnoses were for DCIS and about 5% were for LCIS.
CommInsure‟s Chief Medical Officer Dr Alan Carless offers the following insights into insurer definitions of breast
cancer and the comparison of the various trauma policies available in the market place:
„The breast is a highly specialised sweat gland prone to carcinoma that is typically hormonally sensitive. All trauma
policies cover invasive breast cancer and all cover total mastectomy for ductal carcinoma in situ (DCIS) that has
spread widely within the duct tubules like carp in a river system. But these cancer cells continue to behave like
carp, not crocodiles. They stay in the ducts. This form of cancer has no proven potential to escape this basement
membrane control. No-one is certain if current treatments are saving any lives. While all companies either sell or
give away modest partial cover for localised DCIS, the value of this to clients is questionable. Compare on the
basis of full benefits, then decide if extra cost options are appropriate given the client‟s risk acceptance profile.
Remember that:
Invasive cancer is disfiguring and traumatic.
Lumpectomy for DCIS is not so disfiguring and the condition is not life threatening.
Lobular carcinoma in situ is “off the radar screen” in trauma cover.‟
„Check for full benefit conditions that are covered in some but not all policies and, since they are all rare traumas
and unlikely claims, try to understand how important they are in the context of the client‟s experience. If friends or
distant relatives have had any such trauma conditions, that doesn‟t affect a client‟s risk but it does affect perception
of risk. This is the recency effect or insensitivity to prior probabilities, a fallacy well understood by gambling
researchers.
„Finally, if there are still several policies that seem equal, look at partial benefits to see if they have much chance of
making an important difference to the client in the future. If the client has particular concerns, options that extend
cover might seem relevant to the client.‟
„Looking at policies this way puts likely partial benefit and unlikely full benefit definitions at the level of consideration
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they deserve, behind the more important definitions, policy features and overall company credibility.‟
10
Ductal carcinoma in situ: Understanding your diagnosis and treatment, National Breast Cancer Centre, 2004, 4;
available at http://www.nbcc.org.au/resources/documents/DCC_understandingdcis.pdf
11
Cancer Information Update Newsletter No. 7, February 1998, The Cancer Council NSW, available at
http://www.cancercouncil.com.au/editorial.asp?pageid=853
12
Medical Definitions, Dr Alan Carless, paper presented to Victorian Adviser Forum 20 May 2008
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Summary
Breast cancer is the biggest cause of cancer-related deaths among Australian women, and imposes a large
financial burden on society.
The incidence of breast cancer is increasing. At the same time the survival rate for breast cancer sufferers has
also increased dramatically since 1990.
CommInsure paid a total of $7,833,739 to breast cancer trauma claimants in 2007!
Advisers and clients should look at the whole range of benefits in trauma policies, not just isolated definitions. It
is important to also look at the way insurers underwrite, manage and pay claims and offer automatic upgrades to
existing policies.
Important information
This information was prepared by The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA) which is a
wholly owned but non-guaranteed subsidiary of Commonwealth Bank of Australia ABN 48 123 123 124, for the use of advisers and staff only
and is not to be issued, reproduced in whole or in part, or made available to members of the public. The taxation information, social security
information and examples are of a general nature only and should not be regarded as specific advice. It is based on the continuation of present
taxation laws (2008-2009 rates), superannuation laws, social security laws, rulings and their interpretation as at the issue date of this article.
Advisers should refer to the relevant life company policy documents for further clarification. CommInsure is a registered business name of
CMLA.
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