Model created to help life insurers calculate breast cancer survivors' risk of death

March 22, 2018, ECCO-the European CanCer Organisation

As early detection and treatment of breast cancer improves, more and more women are surviving the disease. However, they still face challenges, which include determining the moment when it might be reasonable to state they are "cured" of the disease, and obtaining life insurance.

"In the Netherlands, most applications for are accepted, but not for survivors. A lot of former breast cancer are rejected for life or subjected to higher insurance premiums," said Ms Marissa van Maaren, a researcher at the Netherlands Comprehensive Cancer Organisation (Utrecht, The Netherlands), at the 11th European Breast Cancer Conference today (Thursday). "Others might not even apply for life insurance because they might think they do not have a chance of being accepted. Former cancer patients in other countries may face similar problems.

"At the request of the Dutch Association of Insurers and the Dutch Federation of Cancerpatient Organisations (NFK), we have created a model for predicting the extra risk of death of breast cancer patients and survivors for up to ten years after their diagnosis. Importantly, this model takes into account that survival rates improve as each year passes by. This should provide patients and their clinicians with increased insight into their prognosis, and medical advisors with a more reliable basis on which to make their decisions."

Ms van Maaren and her colleagues matched 23,234 women diagnosed with breast cancer in 2005 and 2006 with the general Dutch . Information on the patients, including age, year of diagnosis and stage of breast cancer, was taken from the Netherlands Cancer Registry. There were 10,101 women diagnosed with stage I cancer, 9,868 with stage II and 3,265 with stage III.

"We were interested in the excess risk of death for , so the risk of death in the patient population minus the risk of death in the general Dutch population. We also wanted to take into account the number of years survived after diagnosis," she explained.

Then she built 30 models, ten for each of the three stages of breast cancer for each year of survival after diagnosis up to ten years. The models were adjusted to take account of important prognostic factors that might influence the risk of death, such as type of breast cancer, whether or not the cancer had spread to lymph nodes, age at diagnosis, type of surgery, and if treatments such as radiotherapy, chemotherapy, hormone therapy and other targeted treatments were used.

"All the separate models were integrated into one model that, for every stage of disease, shows the extra risk of death in the first ten years compared to the general Dutch population, conditional on the number of years survived after diagnosis," she said.

To give an example, the model can show that a particular patient with certain characteristics who applies for life insurance two years after diagnosis might have a 5.8% extra risk of dying within ten years compared to the general Dutch population, but if she applies five years after diagnosis her risk may be reduced to 4.2% and after nine years it may be 0.6%.

"This could result in lower premiums as the years go by, although the exact premium may vary depending on the insurance company," said Ms van Maaren. "It's also important to bear in mind that treatments for breast cancer have improved a lot since 2005 to 2006 when these women were diagnosed."

The researchers tested the accuracy of the 30 underlying models and found that they had a reasonable to good ability to predict the outcome and to discriminate between the risk of dying or staying alive. In addition, validation on an external population showed similar outcomes.

Now, Dutch are testing the newly-developed model, comparing its results with those from old data, and calculating how it might affect whether or not someone is accepted for life insurance and the effect on their premiums. Then it will be discussed with all patient organisations and working groups involved in the project, and when everyone agrees that the model is valid enough to use, it could be implemented.

As the model is based on the Dutch population, other countries would need to validate it against their own populations before it could be used. "However, we do not expect that the extra death rates, in other words the difference between breast cancer survivors and the general population, will be very different," said Ms van Maaren.

"Currently, insurance companies in The Netherlands are using international data to assess ' and survivors' risk of dying, which may not be specifically targeted at the Dutch population. In addition, every insurance company is free to use other information on which to base their decision. We think it is unjustified to reject patients based on data that may not predict the risk for a Dutch breast cancer patient or survivor correctly. At present, the life insurance application process is not transparent and this results in a lot of uncertainty and incomprehension among patients and survivors. We hope insurance companies will use this model and be more transparent with patients regarding the outcome of their life insurance applications."

She said the model could support decisions made by clinicians, insurance companies and patients but would not automate the process. "Clinicians and insurance companies take account of a number of other variables not included in this model, such as the presence of other diseases and conditions. But it could provide clinicians with a basis on which to deem a patient cured of the disease, and insurance companies have a more reliable basis for their life insurance application process that is based on more recent Dutch clinical data," she concluded.

Co-chair of the European Breast Cancer Conference, Professor Isabel Rubio, director of the Breast Surgical Unit at Clinica Universidad de Navarra (Spain), who was not involved with the research, commented: "This is an interesting study; however, it is just based on the Dutch population and would need to be re-worked for populations in other countries. It does appear to be a useful tool that might help former patients lead more normal lives and caregivers could use this information to better inform survivors about their actual prognosis."

Explore further: Risk of a second breast cancer can be better quantified in women carrying a BRCA mutation

Related Stories

Risk of a second breast cancer can be better quantified in women carrying a BRCA mutation

March 21, 2018
The risk of a second breast cancer in patients with high-risk BRCA gene mutations can be more precisely predicted by testing for several other genetic variants, each of which are known to have a small impact on breast cancer ...

Race, insurance status linked to job loss after breast cancer

February 15, 2018
Job loss following early-stage breast cancer diagnosis is associated with race and insurance status, but not with any clinical or treatment-related factors, finds a new study from the Brown School at Washington University ...

Fibrous dysplasia associated with increased breast cancer risk

September 14, 2017
(HealthDay)—Patients with fibrous dysplasia (FD) are at increased risk for breast cancer, according to a study published online Aug. 30 in the Journal of Bone and Mineral Research.

Insurance plays significant role in breast cancer disparities

October 16, 2017
Differences in insurance account for a substantial proportion of the excess risk of death from breast cancer faced by black women, according to a new study. The study, appearing in Journal of Clinical Oncology, concludes ...

Differences in cancer survival by type of insurance

December 4, 2017
(HealthDay)—From 1997 to 2014, improvements in cancer survival were mainly limited to patients with private or Medicare insurance, according to a study published online Nov. 30 in JAMA Oncology.

Study evaluates need for biopsies during follow-up care in women with early breast cancer

January 31, 2018
In an analysis of more than 120,000 women diagnosed with and treated for early-stage breast cancer, researchers from The University of Texas MD Anderson Cancer Center determined the rate of additional breast biopsies needed ...

Recommended for you

First immunotherapy success for triple-negative breast cancer

October 21, 2018
There is new hope for people with an aggressive type of breast cancer, as an immunotherapy trial shows for the first time that lives can be extended in people with triple-negative breast cancer.

Healthy diets linked to better outcomes in colorectal cancer

October 20, 2018
Colorectal cancer patients who followed healthy diets had a lower risk of death from colorectal cancer and all causes, even those who improved their diets after being diagnosed, according to a new American Cancer Society ...

Why some cancers affect only young women

October 19, 2018
Among several forms of pancreatic cancer, one of them specifically affects women, often young. How is this possible, even though the pancreas is an organ with little exposure to sex hormones? This pancreatic cancer, known ...

Scientists to improve cancer treatment effectiveness

October 19, 2018
Together with researchers from the University of Nantes and the University of Reims Champagne-Ardenne in France, experts from the National Research Nuclear University MEPhI have recently developed a quantum dot-based microarray ...

Mutant cells colonize our tissues over our lifetime

October 18, 2018
By the time we reach middle age, more than half of the oesophagus in healthy people has been taken over by cells carrying mutations in cancer genes, scientists have uncovered. By studying normal oesophagus tissue, scientists ...

Study involving hundreds of patient samples may reveal new treatment options of leukemia

October 17, 2018
After more than five years and 672 patient samples, an OHSU research team has published the largest cancer dataset of its kind for a form of leukemia. The study, "Functional Genomic Landscape of Acute Myeloid Leukemia", published ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.