Improving cancer outcomes: Risks and opportunities for the life insurance sector

By Brad Heltemes

Although cancer remains the leading cause of death among life insurance policyholders worldwide, considerable progress addressing cancer mortality has been made over the past two to three decades. In the U.S. alone, mortality has declined by 1.6% on average annually from 2012 to 2022.

This trend is expected to accelerate over the next 10 years, according to new research and analysis in the Improving Cancer Outcomes chapter of the Munich Re Life Science Report. An explosion of exciting breakthroughs in cancer research will change how cancers are defined, prevented, diagnosed and treated, leading to significant improvements in mortality even beyond those achieved over the past few decades. However, these rapid changes will have profound impacts on the life insurance industry. Agents, advisors and their partner carriers must stay ahead of the curve to manage risks, better inform their policyholders and capitalize on new opportunities.

Continued progress in cancer genetics

We are now witnessing a paradigm shift in how cancer is envisioned, from mostly a tissue-based diagnostic approach to one based on the tumor’s unique genetic signature in conjunction with additional available data. These advances are being driven by cancer genomics in combination with artificial intelligence.

Genetic profiling of tumors is increasingly used for diagnosis and treatment selection, allowing for better prediction of prognosis and treatment response than traditional pathologic diagnosis. As cancers become reclassified based more on their “genetic signature” than their site of origin, it could potentially lead to thousands of unique cancer subtypes.

Enhanced risk prediction

Preventive measures have driven the reduction in cancer mortality. AI-powered risk detection can help further this trend by using AI to integrate and analyze vast amounts of biometric, genetic and imaging data to improve cancer risk prediction. It may even help determine the most effective strategies for reducing these risks.

Earlier detection through improved diagnostics

Furthering the goal of early cancer diagnosis will require continued improvements in diagnostic and screening methods. Most cancers currently lack effective screening approaches, even for high-risk individuals.

An exciting potential breakthrough is liquid biopsy, the analysis of fluids (usually blood) to identify markers that indicate the presence of cancer. While still in its early development phase, liquid biopsy holds immense promise. Researchers are already studying liquid biopsy tests that can screen for multiple cancers in asymptomatic individuals, and a handful of such tests are now on the market.

For cancer diagnosis, although tissue biopsy still remains the gold standard, it is invasive, costly, and may yield incomplete results. Liquid biopsy can be a useful adjuvant or even replacement in some cases, recognizing genetic patterns not evident on biopsy, helping guide treatment, and identifying residual or recurrent disease.

Additionally, AI has already led to refinements in identifying signs of malignancy in imaging studies and in blood, urine and tissue samples. AI-assisted “machine eyes,” capable of recognizing patterns not apparent to human observers, are already helping doctors diagnose breast, lung, prostate and skin cancers with increased precision.

More innovative, personalized cancer treatments

Continued progress in personalized treatments, further enhanced by tumor genetic analysis with targeted drug development, is reshaping cancer treatments. Such therapies have already led to many improved cancer outcomes, offering new hope for cancer patients, and innumerable additional treatments are in development.

A future state could include personalized cancer vaccines, such as mRNA vaccines, which use tumor cells to develop factors that can stimulate a tumor-specific immune response. Such innovations, however, will come at a high financial price, which could significantly impact health insurance costs and limit access in some markets.

Many kinds of cancer are no longer a potential death sentence. Recent studies have demonstrated how several previously terminal cancers can now be managed similarly to other chronic diseases.

Considerations for agents, advisors and insurers

The combined impact of improvements in cancer mortality will be favorable for life insurance businesses but potentially unfavorable for businesses in the health and longevity insurance spaces. Therefore, insurers must stay well-informed. Life insurance agents, advisors and insurers should follow key trends around pricing, underwriting and claims so they can match their clients with the most appropriate products.

From a pricing perspective, emerging, costlier treatments may adversely impact health insurance rates and, therefore, potentially increase the demand for living benefits options among clients. In underwriting, the introduction of direct-to-consumer tests for cancer prediction and diagnosis could present a potential for anti-selection. The shifting of classifications of many cancers and the transition of some terminal cancers to chronic diseases will require the adaptation of insurance product definitions, potentially changing claims triggers, eligibility criteria and payout structures.

Although much progress has been made in reducing cancer mortality rates, plenty of room for improvement remains. Most cancers are still not diagnosed until they are in advanced stages that are less amenable to treatment. And experts agree that more than 40% of cancers could potentially be avoided altogether through preventive measures. With the noted recent advances however, there is much reason for optimism.

Brad Heltemes, MD, is vice president and medical director of research and development at Munich Re Life US and has 25 years of experience in insurance medicine. Contact him at [email protected].