Things should certainly be looking up in terms of bronchogenic carcinoma (lung cancer). The number one cause of preventable disease and death in the United States, less and less people are smoking than ever before. According to the Center for Disease Control (CDC) 2016 statistics, the percentage of smokers in the period since World War II has dropped from over 43 percent to under 16 percent of U.S. adults. And newer treatments for lung cancer are being broadcast on television advertisements regularly. It should certainly mean improved underwriting with this disease by all standards.
Lung cancer however still carries a dire prognosis. It is the leading cause of death in both men and women, and what had been a predominately male incidence has been shifting rapidly toward a 50-50 proposition. Cigarette smoking still causes between 85-90 percent of lung cancers, and the debility of second hand smoke incidence has been duly recognized. Newer drugs are certainly increasing survival in certain kinds of lung cancers, but often that difference is limited to months and is not universal in its beneficial effects among lung cancer sufferers.
Newer studies are helping to identify which individuals are more prone to lung cancer. Obviously, not everyone who smokes develops the disease, and some types are more virulent than others. Both length of time smoking and amount (number of pack-years) are contributing factors. Newer evidence indicates genetic factors play a role in the development of the disease. Those with exposure to asbestos or certain types of atmospheric pollutants have higher risks of developing cancer. As mentioned, those who don’t smoke but are exposed to high levels of second-hand smoke are also at risk.
Four main types of cancer account for over 90 percent of the subtypes of bronchogenic carcinoma. Squamous cell carcinoma (about 20 percent) arise from the bronchial lining and spread locally at first. They are most often diagnosed with bloody sputum and examination of cytology from bronchial secretions. Adenocarcinoma (up to 40 percent) arises from mucus glands and is most diagnosed as the results of constitutional symptoms and an abnormal chest x-ray. Large cell carcinoma (a particularly aggressive type) and small cell carcinoma (which begins centrally and first causes obstructive symptoms) make up most of the rest. Spread occurs first by local extension into the lung and then into local and distant lymph nodes. Spread via the bloodstream is also common.
Lung cancer is graded by stages—Stage 1 being the earlier stage where the tumor is small and there is no distant invasion. Stage 4 is the most ominous and indicates the presence of distant metastasis. Earlier stages are the most amenable to surgical removal but unfortunately, a minority of affected people have localized enough cancer to where removal of the mass or even of the affected lung itself will prove curative. More often than not systemic disease is present and treatment is initiated with radiotherapy or chemotherapy. Small cell cancer is the most chemo sensitive type and the use of chemotherapy is usually the first treatment in these cases.
Newer and more optimistic findings have occurred with newer therapies designed for first line treatment of patients with locally advanced or metastatic non-small cell lung cancer in those who test positive for the PD-L-1 biomarker and do not have EGFR or ALK genetic tumor aberrations. Known as pembrolizumab (Keytruda) and nivolumab (Opdivo) among others, these medications have been shown to extend survival. This survival is not always prolonged however and can be measured in months rather than years in many individuals.
Underwriting for lung cancer is still quite difficult in terms of insurability. Those with even treated Stage 1 disease have a waiting period of years followed by a significant temporary flat extra premium. Most advanced cases even with positive initial results may have waiting periods of over five years for any type of insurability, again with high added premiums. Those that have gone a significant period without disease recurrence may qualify for standard insurance assuming the smoking or causative agent has not left their lungs damaged in any other way (chronic obstructive pulmonary disease, or COPD, for example). Those who continue smoking after diagnosis are generally declined in any event.
