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Tips, trends, and best practices shared by our team of life insurance underwriters and technologists

Identifying and Life Underwriting Colon Cancer

life underwriting colon cancer

In this article, Senior Underwriter, Karen McLeod, provides a detailed overview of the importance of colon cancer for life underwriters. As the second leading cause of death from cancer in men and third leading cause in women, it is imperative that life underwriters learn how to recognize and insure this disease.

Why is Colon Cancer Important to Life Underwriters?

Understanding colon cancer and its associated symptoms and risks is crucial for life underwriters. As one of the top four causes of death by cancer, it is essential for life underwriters to understand the signs, symptoms, and mortality risks for individuals who are or may become affected by colon cancer. In particular, identifying these signs, symptoms, and closely reviewing the colonoscopy results is crucial, especially for applicants over the age of 50. 

What is Colon Cancer?

Colon cancer, also known as colorectal cancer (CRC), is malignant cell growth that occurs in the colon or rectum which forms part of the digestive system.

The colon is an important organ in the body. It is 2.5 inches in diameter and 5 feet in length and serves two main functions: it absorbs water and electrolytes and controls the elimination of digestive waste material. The colon also hosts bacteria required to produce Vitamin K, an essential nutrient for recovering from injury and regulating blood clotting.

This disease can impact men and women of all backgrounds and is most often discovered through a colonoscopy.

10 Key Colon Cancer Statistics

These statistics offer a high-level understanding of the qualities and pervasiveness of this disease.

  • Colorectal cancer (CRC) is the 3rd most commonly diagnosed cancer in Canada (excluding non-melanoma skin cancers)
  • An average of 423 Canadians are diagnosed with Colorectal Cancer every week
  • 175 Canadians die of this disease in an average week. That means, on average, 25 Canadians will die of colorectal cancer every day
  • One in 14 men is expected to develop CRC during his lifetime, and one in 29 will die of it
  • One in 16 women is expected to develop CRC during her lifetime, and one in 32 will die of it
  • Anyone age 50 and up should be screened, regardless of family history
  • Colon cancer is the 2nd leading cause of death from cancer in men
  • It is the 3rd leading cause of death from cancer in women
  • Almost half of all colorectal cancers are found in the sigmoid colon
  • 95% of colon cancers are adenocarcinomas. Other types include carcinoid tumors and gastrointestinal stromal tumors (GISTs)

9 Common Signs and Symptoms of Colorectal Cancer

Colorectal cancer can be difficult to detect. Underwriters should be aware of the following signs:

  • Benign polyps. This is the most common initial presentation that leads to colon cancer. When an underwriter sees this, an Attending Physician Statement (APS) should be ordered to ensure pathology is benign
  • Rectal bleeding
  • Unexplained weight loss. This is especially important to watch for in older people
  • Unexplained anemia
  • Constant tiredness
  • Blood in or on the stool
  • Frequent or constant cramps that persist for more than a few days
  • General stomach discomfort, including bloating, fullness, cramps, and/or frequent gas pains
  • Feeling or sensation that the bowel does not empty completely

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Key Risk Factors for Life Underwriting

Some risk factors may indicate that a person is at a higher risk for being diagnosed with colon cancer. A family history of colon cancer may be one such risk indicator. An individual may be considered particularly high risk if they have a family member who was diagnosed prior to age 45.

Lynch syndrome 2 is also a strong indicator of risk, as it predisposes individuals to multiple types of cancers, including breast, colon, and pancreatic cancers. Age is also closely connected to diagnosis, and risk increases after age 50, at which point regular screening should be undertaken.

A personal history of colon cancer and/or IBD (Inflammatory Bowel Disease) should also be monitored closely. Other hereditary diseases, such as family adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC), should also be considered red flags and be watched closely for complications.

2 Tests for Diagnosing Colon Cancer

There are several ways to discover the presence of colon cancer. A fecal occult blood test (FOBT) can be completed. This test is used to detect invisible blood in stool.

The gold standard for diagnosing polyps and colon cancer remains the colonoscopy. People over the age of 50 should have regularly scheduled checkups with their doctor.

It is important to note that if there is a family history of colon cancer, individuals should be tested 10 years prior to the age their family member was diagnosed. For example, if a parent was diagnosed at 45, then the offspring should be tested at 35.

The diagnosis for colon cancer can be made via a biopsy or polypectomy that can be used to detect the presence of cancerous cells.

3 Main Treatments for Colon Cancer

Several options exist for treatment and will be specifically designed to meet patient needs for the particular case while taking into account any additional health considerations.

The surgical removal of a tumor or tumors is usually completed. Chemotherapy to destroy cancerous cells is also often prescribed to patients diagnosed with colon cancer. Radiation may be used and is typically administered when the tumor has attached to an internal organ or cancer has spread to the bones. Radiation may also be used to kill any cancer cells that may have been left behind.

Determining the Severity of the Cancer

Staging is completed to determine the amount of penetration of the cancer. Duke’s staging system is widely used for colorectal cancers. It is named after Doctor Cuthbert Dukes and includes different stages of progression. A modified version of Duke’s staging system is frequently used.

The American Joint Committee on Cancer or “AJCC” staging system, known as the AJCC-TNM staging system is commonly used. TNM is used to measure the following: T for size and spread, N for lymph node involvement, and M for spread to distant organs. The pathology report includes type, grade, and stage.

The APS should also include all surgical and pathology reports and the follow up oncology reports for a full picture of severity and the prognosis.

6 Red Flags for Colon Cancer Patients

When results come back with poorly differentiated or undifferentiated tumors, this can be a flag. Tumor perforation of the bowel wall, venous invasion, or direct invasion of adjacent organs can also make treatment and recovery more difficult.

Watch out for the following signs, discoveries, or changes in health:

  • History of colonic polyp
  • Pending or recent colonoscopy
  • Uninvestigated or unexplained signs and symptoms
  • Individuals who are over the age of 50
  • Unexplained weight loss or anemia
  • Family history of colon cancer, Familial Adenomatous Polyposis (FAP), or Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

Signs of a Favorable Prognosis

Early detection of low grade tumors is strongly associated with better recovery results and more treatment options.

Individuals under the age of 50 without any family or personal history of colon cancer are at a lower risk. Those without IBD, FAP, or HNPCC and who are not showing signs of weight loss or anemia, are also more likely to respond well to treatment.

Being armed with the necessary knowledge and understanding of colon cancer - diagnosis and treatment - will help you to accurately identify and assess the mortality risk of these applicants. 

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Written by: Karen McLeod

Karen McLeod is the Director of Underwriting Services at RGAX. She is responsible for managing a team of life underwriters and providing superior service to current and prospective clients. In addition to fifteen years’ experience in the insurance industry, she has extensive experience in life, critical illness, and disability insurance and in structured settlements, life valuations, and providing invaluable coaching to underwriters of all levels. Karen holds FALU and FLMI designations and is currently the Assistant Director for the CIU’s program committee.