So much (more) to consider with cancer
A week doesn't go by without reading about someone famous who has been diagnosed with, or has died from cancer. At the end of last year I was struck by the death of Marie Fredriksson, lead singer of the Swedish pop group Roxette, who produced several of my favourite hits in the 80s and 90s. She died from a brain tumour at the age of 61.
What lies behind these headlines – and often not shared or fully appreciated – is the arduous journey of suffering, coping, anguish or relief in various combinations, often repeated in cycles over long periods for patients and their families. In the case of Marie, her battle was a grueling 17 years.
We all know of parents, siblings, or wider family members who have had or died from cancer, and as we get older, the frequency of this steadily increases. It's not surprising, as cancer is a major cause of mortality. The World Health Organisation (WHO) notes that globally cancer is the 2nd leading cause of death : 1 in 6 deaths globally are due to cancer.
Swiss Re's vision is that "We make the world more resilient". Cancer is a huge opportunity to do just that. As our head of our Life and Health business, Paul Murray, promised last year, this is a priority topic for us, and we will continue to deliver on our promises. It is fast moving and complex, creating new and significant risks for insurers, while creating many ways for us to make the lives of cancer survivors, and the families left behind, better. Below are some of the main areas we are focusing on to help insurers, insureds and society as a whole.
Progress with some risk factors, but much more to go
Many cancers are avoidable (up to 4 out of 10), and smoking is the most significant avoidable risk factor.
Globally, in developed regions like Europe we have done well to significantly reduce smoking prevalence. The popularity of smoking continues to fall, and part of that could also be due to newer alternative smoking and vaping products, for which we do not have long-term harm and carcinogenic data. We continue to follow these trends and the research, and will keep a very close eye on this important new risk, both from a societal and insurance point of view. In developing countries, we have not been as successful, and we all need to push for regulations that reduce advertising, youth access to tobacco products, second-hand smoke and other risk reduction strategies.
Prevention and treatment of cancer-related infections like viral hepatitis (liver cancer) and HPV (cervical cancer) will also reduce these leading preventable cancer risk factors. Obesity and nutrition are two other key risk factors been sluggish to combat thus far. Swiss Re, through its collaboration with the British Medical Journal on nutritional research, will continue to find answers on how to address nutritional uncertainty related to cancer. We plan a publication on this in 2020 following a gathering of experts, and will continue dialogue on this topic.
Screening for cancer "can" be a mixed bag
For all its benefits, there are also harms lurking among various forms of screening. As cancer progresses, and invades more locally and eventually spreads to lymph nodes and other organs, treatment is less successful. The "common sense" approach might then be to screen as many individuals as frequently as possible. However, what is often not appreciated, is that a screening test is not diagnostic nor accurate, and any "positive" test needs further investigations, often invasive, with harmful side effects and psychological impacts.
These harms that impact all those with false positive screening tests, must be weighed against the actual survival benefits of diagnosing the smaller subset of true cancers earlier. For some cancers, this screening benefit is clear, but for many it is not. Driving compliance of beneficial screening programs helps individuals and improves longevity, while educating the public on screening that is perhaps less beneficial, or at least laying out the pros and cons of such screening, allows informed individuals choice. The risk of overdiagnosis is not just a concern to insurers (increased incidence), but can be very harmful to the individual.
Liquid biopsy is a hot topic in terms of screening, but some screening techniques already include technology like liquid biopsy for colon cancer. We share more on the pros and cons of screening in this more indepth L&H Trend Spotlight. We'll continue to conduct further in-depth reviews on screening of key cancers, and an updated report on liquid biopsy will be published later in the year.
New science-fiction-like treatments also bring new hope
Newer treatments that use molecular biology to block certain cancer pathways, or even modify the DNA of a patient's white blood cells, to better detect and kill cancer cells like CAR-T therapies have had great success. Each breakthrough creates more hope we can beat more of this dreadful disease.
Recently released research on T cells that have a receptor for MR1 which seems to be abnormal only on cancer cells, has created optimism of a pan-cancer treatment strategy. Here's a great, simple summary of how it works. These treatments are often very "personalised" and typically prohibitively expensive for the individual, but also for national health systems and even health insurers. Creating protection products that can help cover these costs is a challenge and an opportunity for our industry, and key focus of Swiss Re L&H.