Addressing the impact of novel cancer diagnostics on Critical Illness insurance

Critical Illness (CI) insurance is a living benefits protection product which provides indemnity cover if one of a range of major medical disorders such as cancer occurs. Where possible each disease is defined according to existing clinical diagnosis criteria for the specific disorder but definitions can become outdated. This has the potential to happen following the introduction of liquid biopsy for cancer.

Liquid biopsy is increasingly being used in clinical practice and has the potential to alter the diagnostic cascade, which could directly impact CI cancer incidence although the magnitude of this remains uncertain. The aim of the Expert Forum on Cancer Diagnostics was to gather insights from experts to increase our understanding of the potential impact advances in cancer diagnostics, such as liquid biopsy, may have on Swiss Re's CI book of business.

The event was split into two parts; the first part focussed on cancer biomarker technologies and the second part on advances in imaging techniques and the regulatory environment for cancer diagnostics. 

Kenneth Bloom, from Human Longevity Inc, kicked off the day with an overview of early molecular cancer diagnostics and targeted therapy in cancer care. He highlighted the role of molecular diagnostics in personalized medicine, disease monitoring and surveillance as well as the limitations of liquid biopsy for the early detection of cancer. Nicola Aceto, from the University of Basel, gave a snapshot on liquid biopsy, highlighting success stories and the need for further clinical validation of liquid biopsies before they can be used for the detection of early stage cancers. Vincent Mooser, from the University Hospital in Lausanne, discussed the use of germline genomics as a cancer risk indicator. Damian Page, from Roche, discussed the current limitations of cancer diagnostics in personalized treatment from a pharmaceutical perspective.

The take home message from the morning session was that the use of liquid biopsy for early detection of cancer is still in its infancy and more clinical validation is needed before it can be routinely used in cancer diagnosis and screening. Current applications of liquid biopsy in clinical practice include monitoring of minimal residual disease, disease prognosis, drug response and development of treatment resistance, and the identification of genetic determinants for targeted therapy.  But the present gold standard for diagnosing cancer remains traditional tissue biopsy.

Luigi Catanzariti, was the first speaker in the afternoon session. He discussed the use of companion diagnostics and the future of preventive immunotherapy for early stage cancers. He emphasized the fact that diagnostic partnering is now an integral part of pharma strategy but regulators treat drugs for targeted therapy and companion diagnostics as two quite different categories. Pierre Hutter, from Sophia Genetics, emphasised the importance of genomic data collection and how the data can be used to learn and improve predictive and treatment algorithms. Hans Hofstraat, from Philips, discussed the role of imaging technologies in detecting, staging, monitoring and follow up of cancer patients.  He emphasized its application in the development of personalised therapies and its value in staging cancer precisely. Thomas Hany, from a private radiology practice, closed the afternoon session by giving an overview of the use of imaging technologies in clinical practice, sharing insights of their limitations.

The take home message from the afternoon session was that imaging technologies play a vital role in locating and staging cancer.  This is needed for deciding best treatment options and for monitoring recurrences. The speakers highlighted the fact that imaging techniques play an important role in the early detection for many cancers, mainly breast and lung cancer.  However, on their own, they have limited ability to be used in early cancer diagnosis.  Even state of the art imaging techniques have limited ability to be used alone for early cancer diagnosis, but when combined with other diagnostic tools, such as liquid biopsy, diagnostic sensitivity and specificity is greatly increased.

To conclude, new cancer biomarkers and imaging technologies are extremely useful in the treatment, prognosis and surveillance of cancer. However, no tumor marker or imaging technology identified to date is sufficiently sensitive or specific to be used on its own for early detection of cancer. Tissue biopsy is and remains the gold standard for diagnosing cancer in the foreseeable future.

This article is based on the "Expert Forum on Cancer Diagnostics" which took place on 7 November 2016 at the Swiss Re Centre for Global Dialogue. Summary by Giselle Abangma, Health Research Analyst, Swiss Re.