Underwriting and the rise of early adult-onset cancer

By Emily Bancroft

Cancer is something that has touched the lives of many people. The World Health Organization states that, “Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, or nearly one in six deaths.”

Although most cancers historically were viewed as a disease hitting people in their later middle and older ages, there has been a developing trend of cancers being diagnosed at earlier adult ages. As Generation X, millennials, and even older members of Generation Z age, more of these early-onset cancers are being identified.

As this subset of the population seeks life insurance, it will be important for the life insurance community to understand the long-term implications of these diagnoses. Let’s explore the most frequently diagnosed early adult-onset cancers and their causes, as well as the psychological impact of an early diagnosis, and what insurance professionals must consider while working on these risks.

Most common early-onset cancers and their definition

The threshold for what is considered early adult-onset cancer would be cancer diagnosed in adults aged 50 and younger. The types of cancers impacting these younger adults varies. As noted in Nature Reviews Clinical Oncology, “Cancer is a multifactorial disease that most commonly affects people older than 50 years of age. However, evidence indicates that the incidence of cancers of various organs (including those of the breast, colorectum, endometrium, esophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid) has been rising in adults younger than 50 years of age in many parts of the world.”

The recommended age for beginning some cancer screenings such as colonoscopies has been lowered from 50 years of age to 45 in an effort to detect cases at an earlier stage. It will be important to remain cognizant of studies being conducted, and reported upon, in the coming years so that life insurers can attune their risk assessments and understandings of these earlier cancer populations.

Causes of early-onset cancer

It’s natural to wonder why we are seeing more cases of early-onset cancer. Cancer occurring after age 50 is usually assumed to be connected to the longitudinal effect of cellular damage that comes from aging, but these younger-onset cancers are likely to have a different culprit. Some cancers are correlated with an infection such as HIV or HPV, exposure to chemicals or hazardous environmental conditions such as burn pits in military combat, or genetic factors. Those cancers can often be traced back to those circumstances.

The current early adult-onset cancer trends are not fully understood yet, but one theory relates to a shift in lifestyle habits since the 1960s. More people are overweight or obese and lead more sedentary lifestyles. Meanwhile, food has become more processed with contaminants and preservatives.

Psychological impact

The beginning of adulthood is a time of constant change. This is a time people expect to be carefree from a health standpoint while they focus on their education, attaining and developing a career, finding a partner, traveling, starting a family, buying a home and all the things that help an individual establish themselves in adult life. Cancer is not something that is often in front of mind at this stage of life.

When an unexpected cancer diagnosis presents itself, the psychological disjunction between what the person thought would be happening in their life and what is actually happening can be overwhelming. It is important to consider this aspect of their cancer history as well.

Underwriting considerations

There are many factors to consider when reviewing these risks. Early-onset cancers tend to be more aggressive, and the treatment itself has undesirable side effects. Basic details needed to assess the risk include:

Age at time of diagnosis.
Type, stage and grade of cancer.
Additional details innate to the type of cancer such as PSA at time of diagnosis, Gleason score, estrogen receptors, etc.
Any genetic testing that has been conducted.
Family history (type and age of diagnosis/death if applies) or any other personal history of cancer.
What treatment was administered and when it ended.
Cancer recurrence and the related details.
Appropriate follow-up screening care.
Any other health history.
What the prospect has done and what they are doing to maintain their health, for example, physical activity, healthful eating, smoking or alcohol cessation.

An additional aspect for consideration is whether there have been any unintended side effects from the cancer treatment itself. Sometimes there are cardiac impacts from chemotherapy and radiation, which can compromise the status and functionality of the heart. Moreover, these treatments can cause a multitude of other challenges like secondary cancers, lymphedema from lymph node removal, osteopenia/osteoporosis from hormonal changes, chronic fatigue and so on.

The mental and psychological aspect of cancer can be challenging and should be evaluated thoroughly if psychological diagnoses are present. This becomes especially important if there are long-term side effects from the cancer treatment as it can further impact mental health.