Hi everyone, I have Kate Baldry joining me today to share her insights into early onset colo-rectal cancer, a diagnosis that is happening more and more. As a Research and Development Underwriter at Hannover Re, Kate has incredible access and insight to claims and health data. Kate has been spending time analysing the increasing rate of bowel cancer diagnoses and any trends that could be causing this.

It was particularly interesting for me as Kate shares that some of the patterns that they have seen are due to people being tall, healthy BMI and having their gallbladder removed – I hit all three of these! The main takeaway that I have from our chat is that whilst these factors might contribute to bowel cancer diagnosis, at the moment it is still very much an unknown. There are a lot of theories but no definitive reason as to why bowel cancer diagnoses are increasing.

The key takeaways:

• Early onset bowel cancer is when there is a diagnosis before the age of 50
• Deep dives into claims have shown that many claimants had no family history of bowel cancer or other disclosures related to digestive health 
• The TNM score of the bowel cancer diagnosis is essential in determining what the options for protection insurance will be

Next time I will be joined by Phil Jeynes, who will be sharing with us his story of a bowel cancer diagnosis and what life has been like for him since.  

Remember, if you are listening to this as part of your work, you can claim a CPD certificate on our website, thanks to our sponsors NextGen Planners.

Kathryn Knowles  00:10

Hi everybody. We are on season 10, Episode 12, and today I have Kate Baldry with me. She is a research and development underwriter at Hannover. E Hi Kate.

 

Kate Baldry  00:20

Hello Kathryn.

 

Kathryn Knowles  00:22

Kate is joining me to discuss the research she’s been doing, getting some insights about early onset colorectal cancer. This is the practical protection podcast you

 

Kathryn Knowles  00:43

So Kate, how are you doing? I know you’ve just been to lucid. I was really, really annoyed I couldn’t make it this year. But how was it? Did you have fun?

 

Kate Baldry  00:52

I did have fun once I had my talk over, once I’d been up on stage and I came I came off stage again, I felt a little bit calmer, it has to be said, but it was an excellent event. It’s very well organized. There are some brilliant talks, and it’s always nice to catch up with people. But I think you had a pretty good reason for not being there this year.

 

Kathryn Knowles  01:11

I did. I did. It was my 40th so it was that kind of thing of, I love underwriting, but do I love it enough to spend my fourth year there conference? And I it was, it was a debate, I have to say, because I really, really do enjoy it, and the fact it’s only once every two years, but, but now I’m glad that it all went well and and I’m sure there was incredible amounts of insights there. I think it was quite an AI focused one this time. So again, it would have been I did my session last time with Lisa, who talks about AI and how a bit, I’m a bit of a reluctant AI person, but I’m sure she’ll be proud of me. I’ve now got one of the smart rings, and I’m monitoring anything and everything that it can possibly monitor. So So yeah, I’m getting there with the AI side of things. But anyway, I’m digressing us as always. So early on set colorectal cancer, I think a really, really good point, because we’re going to have a complete mix of listeners here. We’re listeners here. We are going to have underwriters, actuaries, people in insurance, advisors, people who are in protection space, from an advisor point of view, people who are working in pensions and investments, and don’t usually actually talk about health conditions at all. We’ll have charities, consumers, and I think probably we all kind of, I think, would hear colorectal cancer and think, oh, yeah, it’s that. But I think it’d be really good if we can just have quite a good summary about what is colorectal cancer, kind of, what parts of the body is it affecting, and what would it mean that it’s early onset? If that’s okay.

 

Kate Baldry  02:40

Well, thankfully, this is hopefully one of the most straightforward answers that we will go through today. So early onset simply means that it has been diagnosed under the age of 50. So this could be used for a number of other cancers as well, because sadly, we are seeing an increasing number of solid tumor cancer diagnosis that’s opposed to, as you know, a blood cancer, where it may be circulating in the cells. So we are seeing more solid tumor diagnosis in the under 50s, hence the early onset. And then the colorectal part. You may well have heard it be more commonly referred to as bowel cancer, yeah, and it basically means bowel cancer is the large bowel. Is cancer affecting the colon and the rectum. Brilliant.

 

Kathryn Knowles  03:30

That is absolutely lovely and succinct, and it’s exactly kind of like what you would expect as well. So I’m glad it wasn’t any more complicated than that. So thank you for for just clarifying that, but so I know we’ve spoken a little bit between us, but what is the research showing at the moment, I know you’ve just said there about how we’re seeing more and more people under the age of 50, but I’m sure that there is so so much more that’s the data showing.

 

Kate Baldry  03:56

Yeah, so I may well take a bit of time going on about this, but we have been doing quite a significant amount of research into this, and it’s actually formed the talk that we gave at Lucid a few weeks ago. So a couple of years ago, in lockdown, five years ago, some of the claims team were saying to me, we’re seeing more bowel cancer in younger people. Okay, we thought this what? What could be going on? And then we’ve started to see more articles coming through commenting on this. And then I’m sure you probably remember Deborah, James Bell babe, who was in the press, talking very openly, very bravely about her diagnosis, and obviously savvy. She passed away at the age of 38 and she’s not the only person who who’s been in the public eye with this diagnosis. Either there’s, there’s a Radio One, DJ Adele Roberts, there’s, I think, a guy who used to be on Dawson’s Creek. There was also someone in Is it black panther? I think an American film. I’m absolutely. Terrible with films, but all of these people when they in their 30s and 40s, and obviously there’s been a couple of people in our industry as well who’ve bravely shared their stories. So it was beginning to develop a bit of a picture of we are seeing more of these claims. And when you look at the incidents, you can see that since the 1990s the incidence has been going up steadily, almost sort of doubling every year. But please do remember the the numbers were reasonably small to begin with, so we felt it was worth doing a deep dive into this and trying to really understand what was going on. So what, from an underwriting perspective, I think what we want to understand was, are we getting this right at the underwriting stage? Is there anything that we’re possibly missing, or were there any new things coming through from claims that we weren’t expecting to see? So as I say, we looked into over 100 claims. So this was a mix of life claims, well, death claims, obviously terminal illness claims and critical illness claims in people under the age of 50. And first of all, we were kind of considering, from an underwriting perspective, is there anything going on there that we might have missed? So with underwriting, obviously we have the usual factors that we look at. So, sex, age, smoker, alcohol, BMI, family history, so we mark down all of those. And then at underwriting stage, there would be other things that we might look at in terms of red flags for possible cancer diagnosis. We may be looking at, have they got any unexplained anaemia or blood loss? Do they have any unexpected weight loss or abdominal pain, anything going on in the digestive area that’s maybe unexplained? So we captured all this information, and we did an end to end look at this. And 66% of the claimants were men and the remainder were women. This is a disease that affects men slightly more than women, and the average age was round about in the 40s. But the youngest claimant we saw was only only 27 years old. Yeah. So really, really, quite young. And what we were seeing is that these tumors were actually coming in, generally, stage three or four or sort of, you know, with a higher TNM. And TNM, I’m sure, is something that some of you may have heard of, and some you may not have heard of, but it’s, it’s a grade used to mark tumors used by oncologists. So the T would be like, the size of the tumor, n would be, whether there’s any lymph nodes spread, and M would be, has there been any distant metastases to other parts of the body. What we were seeing is like, I say, higher grade stage tumors, so they weren’t really coming in at a stage one or stage two. It was generally stage three or stage four. So obviously that makes it harder to treat, and often means it’s more extensive surgery, recovery, and obviously a follow up recovery, and, you know, getting better on the path of wellness there. So, yeah, there was quite a lot of information there to be going with. So have you got any questions on that so far?

 

Kathryn Knowles  08:31

Yeah, I suppose this, sorry, something that was just popping into my mind there, as I know you’re saying, it’s typically coming in as grade three, grade four. Is that quite common, because I think, like generally to say, when I’ve supported clients who’ve had bowel cancer, it has typically been grade three, grade four. I don’t think I’ve come across people where it was one of the earlier gradings. And I just is that, in a sense, I’m thinking, Is that common? Is that because, in some ways, maybe the symptoms that you would experience in the early gradings can be quite almost just sort of like, a bit like just your body’s just having, like, a little bit of a slightly different thing going on with it, you know, I’m just sort of wondering why, you know, it’s it gets to, obviously, if it was Something like breast cancer, you would obviously, hopefully notice something quite early on, because you would feel it, ideally, you would feel it quite early on, ish, as quickly as possible, but not always. But I suppose with the bowel cancer, it’s, it’s not going to be, it’s so inside, it’s so internal, that it’s, it’s, must be so hard to catch it early on.

 

Kate Baldry  09:41

Yeah, absolutely. That was a question that we had as well. We thought, why is it that they are coming in at this later stage, and it was very often that they had lymph node involvement and widespread metastases as well? And you might, you might think, well, you’re looking at you. Looking at death claims, you know, they are obviously going to be, you know, you know, quite, quite seriously unwell. It’s going to have quite extensive disease. But this was also critical illness as well. So it was quite a mix. So it was quite unusual to see so many later stage diagnosis and one of the questions that we were asking ourselves was, yeah, why is this so? In the claimant’s own words, the type of symptoms they were most commonly having was blood in their stool, change in bowel habit, abdominal pain and cramping, rectal bleeding, maybe some sickness and nausea, weight loss, and then some other sort of quite non specific symptoms, like you say, We questioned whether, you know, whether is it? Was it just a lack of awareness? You know that people were maybe hesitant to go and see a doctor because they weren’t sure that their symptoms really matter that much. You know, anyone in anyone suffering from a bit of fatigue and bloating maybe could very well shrug that off and ignore it. But I have to say, for the vast majority of claimants, they sought help really quickly from their GP, there was seemed to be a good awareness that, for example, blood in their stool was something that they knew, that they shouldn’t ignore. And I think, to be fair, there have been some fantastic campaigns over the last couple of years by the NHS. And if you the next time you go into a supermarket, have a look at the backs of the toilet rolls. There’s a campaign called on a roll, hashtag on a roll and on the back of them, there’s symptoms about early onset cancer that on the back of all these toilet rolls. Now, obviously, balba has done an incredible amount of fundraising and reset and research. I think there was a storyline in a major soap opera a couple of years ago as well, about a vet who had a stage three and early onset colorectal cancer diagnosis. So there is a lot more awareness in the public eye now. And so strangely, it didn’t seem to be a lack of awareness from people hesitating on, you know, seeing a doctor because of the symptoms. And then we thought, Well, is it lockdown? Maybe, you know, are people, were people being delayed with that? Was it even the GP? Maybe saying, oh, you know, it’s probably nothing to worry about. However, that all seemed fairly appropriate as well. They didn’t seem to be major delays with lockdown. And GPS were generally very, very good at recommending the correct course of action and and getting onto a diagnosis very quickly. So, yeah, it’s very strange that they’re coming in so late, and it really is. It’s baffling. A lot of the oncologists and researchers as well. Some of them are saying, like, we’re seeing young people in their you know, their late 20s, early 30s, who are, anecdotally, quite healthy. You know, they they’re active, they’re sporty. They don’t really, don’t really drink much, so, you know, they eat fairly well, but they’re coming in with this really widespread tumor that looks like something we would see in maybe a 70 or 80 year old. And it, it’s really, it’s really baffling a lot of researchers as well. And And thankfully, there is, there is some major research being conducted into this. There’s two significant studies, global studies. These are and one of them is called prospect, and this is being run out of the UK. And it’s actually Professor Tim Spector is involved in it, and he is obviously involved with Zoe, yeah. So this is looking into early onset colorectal cancer. So this is a global study that’s funded by companies like Cancer Research UK and NCIS in America. And this is really delving into what could possibly be happening. And so we’re not going to see the results of that for probably quite some time, unfortunately, but it’s great to know that it has been taken seriously. There’s also, there’s another study called optimistic, and this is comprehensively mapping the colorectal cancer microbiome. You will hear a lot about microbiome. Yeah, if you haven’t had a podcast on the microbiome, you should probably, you should probably

 

Kathryn Knowles  14:29

help us. Absolutely, I’ve certainly heard of it, and I feel like I’ve been given a little bit of an insight in it, but I’m going to write down microbiome that is definitely a, definitely one to do one on, yeah.

 

Kate Baldry  14:40

Yeah. So if you’re talking about the bowel, you kind of have to talk about the microbiome, the gut microbiome, as well as there’s so much overlapping research into the two of them, yeah, very interesting.

 

Kathryn Knowles  14:54

Are there any patterns at all that people are seeing? Because obviously, you know, it kind of feels like. About if this is happening more and more to younger people, you kind of like, well, there must be something, it must be, I don’t know, some kind of food or chemical in a food, or it must be exposure to something, or maybe genetically, there’s, you know, things are happening, and there’s some kind of link somewhere, you know, it kind of feels like the needs, there should be an explanation, and then everybody’s just on the cusp of figuring out, oh, that’s it. Kind of thing. Is there anything that’s standing out at the moment that’s showing this as a reason for all this happening?

 

Kate Baldry  15:32

There’s loads of theories, but there’s, there’s no kind of silver bullet at the moment. So when we’re looking at underwriting like, I say there are certain things that we capture, but there are also certain things that we do not capture, which are arguably very, very important and that that that’s another podcast,

 

Kathryn Knowles  15:55

absolutely, oh no. We don’t want to add even more to the questions. That’s not

 

Kate Baldry  16:02

so we don’t capture things like diet, exercise, sleep and really quite important things like that in underwriting, as I say, that’s like a whole other podcast and discussion to be had and but it’s not captured in GP records either. Yeah, so and it is something that can change over someone’s life, or even, you know, every couple of months, you know, in terms of maybe what people might be eating, or what, what, what kind of attitude to exercise they might have. So there is a bit of a gap there in terms of underwriting and claims, like capturing this sort of really quite important information, and it has certainly been shown to have a link. So actually, looking at the BMI and the height and weight of many of the claimants, there was a slight trend, actually, towards people generally being more towards a normal rate. So only 1/3 of, only 1/3 of applicants were overweight or obese. Yeah, maybe expecting more people to be overweight or obese. I was

 

Kathryn Knowles  17:14

going to say, I think because as well, because we’ve done, I’ve did a podcast. I was done, if it was a year or two ago now, but it was about, like, long term IP claims. And it was saying about how much higher BMI is really are connected to a lot of long term IP claims as well. So I think a lot of us, in terms of, like, a lot of the medical information and health that you’re given, you’re always told, eat, healthy, exercise. So I think your instinct is to say, well, actually, oh, I’d have expected people with a higher BMI to have been more of the claim set, rather than it being people, you kind of it’s that thing, isn’t it? You kind of think, right, what can I do to stave off cancer, diabetes, heart attack and everything? I’ll eat healthy, I’ll exercise. But then this sort of like trend is now sort of extreme to say, well actually, you know, you might have a normal BMI, but it’s not really helping at this for this specific scenario.

 

Kate Baldry  18:07

Yeah. So my co presenter, Dr, Matt Proctor, he actually went into this in some further detail. So you may have a BMI that’s normal, within normal range. You may have a BMI of, let’s say 25 for example. But if you don’t exercise, that can still be a problem. So exercise is a great protective factor against lots of different kinds of illnesses, but it certainly seems to have a link with colorectal cancer. So just simply by exercise. Everyone says exercise is good, and we just take that as given, and we know it’s good for our physical health and mental health, but we don’t always specifically know why it’s so good for our physical health. But with colorectal cancer, it increases your gut transit. It improves, like your metabolic health, so it can help to sort of control your glucose and your insulin resistance, it can help to, like, reduce cell inflammation, and it also kind of helps with your gut microbiome and your immune system. So there’s loads of really good reasons as to why physical activity is is really important as a as something that you should be doing, and coming back to height and weight, something that we did notice, which was really, really interesting and unexpected, actually, was that our group of claimants were taller than average. So my first claimant was six foot five, right? So had he not been, I might not have even thought, oh, you know, I might not even looked into but six foot five, I thought, oh, that, you know, that’s tall. I mean, anyone’s talked to me because I’m five foot two. But I was like, okay, that’s, that’s unusual, you know, to start with the first person doing that tool. So I’m going to where I can and. To capture people’s heights and see if there’s anything in this. So once I finished collating all the information, my tallest, my tallest claimant was six foot eight. And I even had, I think, was two, two women who were six, six foot tall. So quite, you know, quite the average height. Yeah,

 

Kathryn Knowles  20:18

I’m getting quite paranoid here. I have to say, you know, I am because of the fact of, I’m six foot, and I have a really good BMI. I think my beer has BMI is on 22 but I know, from what you sort of, I think from hinting with different things, but I also know, because I had a medical earlier this year, that my body fat actually makes me obese. So I know Yes. So I’m like, so basically, because the person, when they were testing me, they were looking at me, and they’re like, this is saying that you’re obese, and I’m just stood there, so, like, as a size 12, really slim, sort of, like person, but obviously, and that’s certain, okay, but I think, as with a lot of people, it’s been so hard to prioritize exercise that I’m just at the point now, because, I mean, I’ve got three kids, and my youngest two both have autism, so there’s been quite a lot of intensity in terms of, sort of, like being able to do things and being active, having to be on hands, and I’m completely now, just now, being able to prioritize my exercise, which I imagine is probably the same for quite a lot of people. So as he’s saying, you know, it might be that somebody would maybe look at me and think, Oh, well, fit and she looks quite fit and healthy. Probably wouldn’t think, you know, that she would be prime candidate for something like this. But actually, I’ve got the height, I’ve got the probably the, obviously, the excess body fat that I am working off, I’m getting there with it, but it’s quite scary actually, to to, sort of like when you see that information as well, to sort of I think, Oh God, right, that’s, that’s not the greatest situation for me to be in. I eat really, really healthy. Have to say, though, I think my microbiome would be super, super healthy. So I’m that’s okay. I just got big genetically. I’ve genetically got the hips and the thighs to say that I need to carry all the children for, like, I don’t know, a three hour Trek or something through the wilderness.

 

Kate Baldry  22:11

I’m just laughing thinking about, like, when we both meet face to face, you’re so small, and I’ll be like, Oh,

 

Kathryn Knowles  22:21

hello. That actually happened to me the last lucid to say I met someone, and I just, I was like, hi, and they were like, Oh, dear, what? I know I’m tall, it’s okay.

 

Kate Baldry  22:32

Yeah, there were a few, a few tall people at Lucid, as you may know, there’s a few tall people in the underwriting and claims arena, and I did feel, feel slightly bad delivering, delivering this message, but it was shown in the claims data that, yeah, the the men were on average, well, men and women were on average 3% taller, which doesn’t sound like a lot, but there was something there. And in fact, we did, we did dive into the research, and it did show that for melanoma, colorectal cancer, lung cancer and prostate cancer, height was was a risk factor

 

Kathryn Knowles  23:09

and fascinating. It is

 

Kate Baldry  23:12

fascinating. And I’m sure there’s far more intelligent people than me that could explain why. But I think simplistically, it’s literally that you have more body, you have more cells, therefore more things to possibly go wrong with those cells, absolutely. However, if you’re short, you’re more likely to get cardiovascular disease. So,

 

Kathryn Knowles  23:32

so we’ve all got, like, pros and cons, yeah, pros

 

Kate Baldry  23:37

and cons. But knowledge is power, isn’t it? Right? Absolutely,

 

Kathryn Knowles  23:40

absolutely. I mean, was there any kind of, like specific things? Because I know when we’re doing applications for insurance, you know, they do ask about family history of about cancer and other cancers and things like that, and and I know sometimes there’s this mention of Lynch syndrome as well. I think sometimes in the background, not like specifically on the application, but when you speak you’re speaking to an underwriter, might go, Well, have they had any tests? You know, kind of thing is in, like, when you’re doing your pre sales and stuff like that. So has there been any kind of, is there anything linking to the family history side of things?

 

Kate Baldry  24:15

This was an incredibly interesting finding, actually. So we did, of course, look at family history, as you’ve rightly said, and the family history which we we saw showed that actually zero, there was zero family history of colorectal cancer at outset. So none of the applicants, none of the claimants, had told us about a family history of colorectal cancer. And when we looked into this further, some of the claimants had maybe a post application diagnosis, but it was normally in a relative sort of over age 60 or 65 where we had information where the oncologist may have captured maybe there was occasionally some second degree family history. So in. Would be aunts, uncles, cousins. But again, the numbers were quite small. So that was really quite surprising, because we know that family history is a risk factor, and as you’ve rightly said, due to these genetic type syndromes. However, we do seem to be seeing more colorectal cancer diagnosis that are just sporadic, as you would call it. They just are random, which makes underwriting very, very difficult. Coming back to family history, we we saw a normal amount of other types of family history, but in the course of the research, I did notice that there was a link between a family history of diabetes and males under 60 developing colorectal cancer. Now, whether it’s that’s like an environmental type factor or a genetic type factor, we don’t know, yeah, but that was certainly an interesting finding. And coming back to talking about disclosures as well, the vast majority of applicants had a clean application form, or, like a really kind of normal, expected amount of the things that we see all the time, you know, depression, anxiety, asthma, or other kind of minor one off disclosures. We did see a couple of applicants who had ulcerative colitis. Now, ulcerative colitis is a known risk factor with developing colorectal cancer. We also saw a couple of people who had gallbladder removal, and again, during the course of research,

 

Kathryn Knowles  26:34

yeah, yeah, I have my gallbladder removed. Yes, I’m gonna, I’m gonna put it out there. And the reason is, I had, and nobody ever Well, I said, Nobody believes it. They didn’t believe at the time, I had 357 gallstones. Oh, my goodness, I was in a lot of pain, yeah, yeah. And there weren’t all big ones. Obviously, they were just tiny ones, little, tiny ones. But yes, I’ve definitely had my right. Okay, that’s it. I’m just going to be, I’m going to be so paranoid, aren’t I, about whatever’s happening with any stomach changes or bowel changes now going forward, well,

 

Kate Baldry  27:11

I think knowledge is power, so that the research wasn’t conclusive on the gallbladder removal, but there was something there. And I think the point is we we screen so we screen people, obviously, for bowel cancer, but it’s over, only over the age of 50. And actually, possibly, upon listening to the start of this podcast, people might be thinking, Oh, well, you know, maybe, maybe bowel cancer rates are going up because of screening. It’s not just because of screening. It is going up. Screening obviously helps, but we don’t screen people under 50. So I think the age was 55 in England, it’s coming down to age 50. And I say England because nhs uk, each kind of country will do something different, yeah, but I think the aim is for, you know, Wales, Scotland, Northern Ireland, all to come down to age 50. This doesn’t help the under 50s, the early onset colorectal cancer, age so I think if you have something like the knowledge that you are, you know, you are taller and you’ve had a cholecystectomy, yeah, you have that knowledge, and you can maybe speak to your GP and request a FIT test. I’m really making your day here as well.

 

Kathryn Knowles  28:32

Imagine going to my GP and just saying to them, right? I’ve spoken to Kate Baldry, I’ve got normal BMI, I found my gallbladder out and I’m tall. Check my bowels.

 

Kate Baldry  28:42

Kate baudry black mark in the NHS. But I think it, I think the point is that that you know these things, and then if you observe any changes in yourself, it could be much, much quicker to, you know, to deal with them. And I certainly don’t want to come on here and, you know, try to scare monger or worry people either, because while I say the rates are going up, yes, they are going up in the under 50s. And it isn’t just colorectal cancer, as you well know, the numbers are still small. 90% of cancer diagnosis are still in the over 50s, but 10% are in the under 50s, and they have been rising. So this isn’t to come on and scare everybody under 50, not at all, but to say that, yes, you know it does happen. And gosh, no, we don’t have any kind of, any kind of silver bullet that says this is exactly what it is. We know that there’s a link with with diet. We know that obviously Ultra processed foods another big buzzword that we have to talk about when we’re talking about the bowel. But Ultra processed foods, they’re not a new thing. Actually, I know they sound like a new thing, but, but they’ve really been around since the 1950s Is so post war Britain, we came back with some good things from from other countries, like sugary breakfast cereals and cans of fizzy drinks and convenient sliced white loaf. And we also have things like, you know, increased use of plastic. So we talk a lot about micro plastics as well. There’s another podcast for you. We talk about microplastics and the links with that. But they’ve they’ve also been around since the 1950s Yeah, but if you think about maybe people who were born in the 1950s they hit the 1990s when they were around about 40, and they were being diagnosed with bowel cancer, and that’s when they started to go up. Is there anything in this? Is there anything in these kinds of foods that have been around for a long time? In the 1970s we’ve started to see an awful lot of food additives coming in. You know, preservatives, colorings, texturizers, emulsifiers, things like that. So food is is certainly a known risk factor. I think the WHO guidance is to certain limit your red meat and your processed meats in the 1960s Another risk factor that we have heard about is and it does cause disruption to the gut microbiome, is antibiotic use. So, I mean, gosh, everyone will have antibiotics, I’m sure, in the course of their life. And I think underwriters would have an absolute headache if we were to bring in antibiotic use on the application form. Antibiotic use is great, you know, to treat acute diseases, but there has been a link with overuse of antibiotics causing issues with the gut microbiome and disrupting all the all the goodness inside that. So that’s possibly a bit of a problem as well. And like, I say microplastics, I touched on that briefly, but I think there’s a buzz phrase going around at the moment saying that we ingest about a week’s worth of plastic, a credit card size of plastic a week. Yeah, I know. And you just think, you know, not a scientist, but that doesn’t sound great, like it’s going to be doing anybody any good. So there are, you know, there’s, there’s a, there’s a number of kind of series as to what might be happening there. And I think, coming back to exercise, I think also we talked about exactly why it is that exercise is good. But I think if you’re if you’ve got a sedentary lifestyle and you’re not getting outside, then you’re more at risk of vitamin D deficiency, which lot of people in the UK have vitamin D deficiency because of our our lovely weather, if you’re indoors a lot, then you’re not getting that vitamin D and that that does contribute to illnesses, and it is linked also to colorectal cancer, okay, but we can go back even further than that. So there’s some theories out there that oncologist opposing, like I’ve said, they’re seeing these people and going, you’re so young. Why you know? Why are you? Why are you coming in with these, these tumors? And there’s some oncologists kind of posing the theory that you know, does it actually begin in utero? Yeah, and it’s, it’s a great theory. It makes sense if you think about it. But if you’re thinking that, you know, does the you know, the lifestyle of the of the mother and the father, you know, before and at the time of conception? Could that, could that have an impact? You know, what was their smoker status? What was their alcohol status? And going back to the 1970s over 40% of women still smoked when they were pregnant. It was just like so normal. And even, even 25 years ago, in the year 2000

 

Kate Baldry  34:08

which I still refuse to believe was 25

 

Kate Baldry  34:12

years ago. Yeah, so even, even, like, over 20% of women still smoke then in pregnancy and again, alcohol in the sort of the 70s and 80s, you know, sometimes it was even recommended, oh, you’ve got a bit of anemia. Have a point of Guinness. Yeah, my mom, she

 

Kathryn Knowles  34:29

said they were like, they used to try and get to eat liver and Guinness, because, yeah, she was anemic when she was pregnant with my sister. And she was just like, Oh, my word. She goes. It was the most hideous thing ever. I was just like, oh, but no, but not pleasant.

 

Kate Baldry  34:44

Very, very different times. And you know, they probably, you know, wouldn’t have been going to the gym or anything like that, necessarily. And you know, maternal paternal age is getting sort of steadily, a bit older. Um, there’s studies linking um mothers BMI or or weight gain in pregnancy with um, you know, sort of insulin issues with, you know, with young babies and stuff like that. So there’s, yeah, it’s a good theory. It’s an interesting theory, yeah, and I think we’ll probably hear more about it, but like I say that the prospect and the optimistic studies from the cancer Grand Challenges are going to be really, really interesting to kind of see what they come out with. And I don’t think it’s going to be like just one thing, but it certainly feels like it’s leaning heavily towards things like ultra processed foods. And it’s not just colorectal cancer, it is other cancers. So it’s like breast cancer, lung cancer in non smokers and never smokers is going up. It’s other types of solid tumors that are going up. So I was gonna say as well with

 

Kathryn Knowles  35:57

some of the things, these things when I’m also cause my dad has Parkinson’s so I keep thinking of the Parkinson’s thing as well, because I think a lot of people probably think of Parkinson’s as genetic when it’s actually quite rare for it to be genetic, and it’s also with environmental and this is, I think at the moment, there’s actually quite a big study in the Parkinson’s space about food and what you’ve eaten, and could that be linked to Parkinson’s as well. So it’s, it’s clearly, it’s so clear that whatever we’re putting into our bodies is having some kind of a an influence at some point. But I know you were saying about obviously, we’re not scare mongering or anything like that. That’s that’s not what we’re doing. But obviously, as an advisor, the key thing for us, obviously, insurers are trying to encourage people to take out insurances. As an advisor, we’re trying to get people to take out insurances, and especially things like critical illness cover things like that. I think it can be, it can be quite hard, I think, for younger people. And this is the exact thing is we want the younger people, because we are seeing this more and more, but we don’t want to be saying to them, oh, well, I heard someone say that there was someone who was 27 and you’re, you’re really tall, so you really need to, you know, kind of thing to them, you know, really puts you at risk. Actually, we can’t be saying things like that. And I think, no, and I think what, what can be hard is that I think sometimes people can kind of, like, subconsciously block it as well. Like, if you’re asking them, What have you have you considered what might happen if you are diagnosed with this or this? And it’s just that age old thing, isn’t it? When you’re young, you’re just like, well, it’s not going to happen. Well, it’s not going to happen to me. And you just don’t think unless someone close to you has had it. And obviously, for ourselves, at Cura, we tend to speak to the people who’ve actually experienced it. I know it’s what’s so what’s in a sense, what’s brilliant is that if someone has experienced something, they usually see the value of insurance more than anyone else. But the sad thing is, obviously, is that once, especially something like this has happened, it can make, obviously, getting insurance that bit harder to get. So I think, you know, without going into sort of, you know, really having to say to people, you know, this is you need to look at this. I mean, we will be saying to people sometimes, you know, we’re now at a stage where it’s like more than one in two people will have some form of cancer at some point, statistically. But what are the outlooks for people being sort of like once they’ve experienced something, for colorectal cancer, what is that their life going to be looking like? I mean, obviously, I know appreciate they can be completely treated and back to back to their usual day to day, depending upon what things are happening. But I imagine there’s quite a few things, though, where it can be quite a big change to their lifestyle and their ability to work and things.

 

Kate Baldry  38:33

Yeah, absolutely, completely agree with what you said about about the scare mongering. And we certainly don’t want to be doing that. We really want to empower people, and I think this is why I wanted to come on and talk to you. Really, was to get your perspective, but also to share some of this research that we do. I think sometimes people aren’t always aware of what we might do. You know, as a research and development underwriter at a reinsurer, what to do you do? This is real people’s data, and you know, we just felt it was kind of important to share some of the insights with you. Yeah. So of course, once somebody has received this kind of diagnosis, it’s obviously completely life shattering, completely life changing. And we’re very lucky that in our industry that we have such a superb amount of claims assessors, working across insurers and reinsurers. They are very, very knowledgeable, empathetic, and they do their very, very best to to help people in their times of need, as do the excellent value added services that we have, which I’ll touch on a little bit more shortly, in terms of coming in for insurance again, or coming in for insurance from scratch. When you’ve had this kind of diagnosis, as we’ll say, with any kind of cancer, any underwriter will always tell you, we would need to know what the TNM was or. Stage in your grading. The difficulty we’re seeing with some of these younger people is, as I say, they’re coming in with these later onset tumors, and that can mean that they’ve maybe had, you know, lymph node involvement or metastases, which is always going to be very, very difficult to to get cover for. But the good news is that, obviously, you know, treatments always improving and being tailored more individually towards people. People’s awareness is is good, and the NHS are doing really well campaigning to try and ensure that people do kind of come in with those early symptoms. And so, yeah, I would, I would always come back to, you know, what was, what was the TNM, and to see whether any kind of cover would be possible, and how long ago was the treatment? What was the treatment, etc, yeah. And I was

 

Kathryn Knowles  40:53

going to say, I think, because not everybody knows the TNM. So I think you know, if you can, whatever people are able to give you, from an advisor point of view, whatever they can give you the size, you know, they might not know it as tnn, but they just say, well, it was this big, and maybe where it was located potentially, you know. And quite a lot of people, I think, if lymph nodes have been involved, they generally seem to know, like, they’ll they’ll remember the number. They’ll be like, Oh, well, yeah, there’s so many, you know, and things like that, which is, is obviously really useful. And I think from from like, a practical point of view as well, as, you know, if people have had bowel cancer, they might be fitted with a stoma. And that always really comes out in my mind, because obviously people can have stomas, and it can be absolutely phenomenal, you know, it can be absolutely life changing for certain conditions to be able to have that rather than obviously, have a lot of the discomfort and the ill health that has been caused by the condition they’re experiencing. But that can also as well. A stoma can be really tricky. My dad has one because it’d be of a complication in terms of the Parkinson’s, but obviously he has the Parkinson’s aspects of him as well. It’s really hard actually, to manage. So if you for some people, it can be really, really hard, and it can really make quite a difference. It could sound so tough, but just going on a car journey, you know, in a sense, and if that, if that suddenly fills up when you’re in a car journey, it’s not particularly pleasant, you know, you need to go and get that sorted quite quickly. And I know when we’re talking about these insurances, it’s things like, obviously, you’ve got, you know, you’ve got potentially things like private medical insurance, which will absolutely, phenomenally help you in terms of your treatments and things like that. But if you do have stuff like the critical illness cover or even the income protection, it’s, it’s helping you financially to cope with those things as well, and to be able to make those adaptations, like the fact that you might need to buy completely new clothes to accommodate something like that, and if there are accidents, then you might need to replace your clothes regularly, depending upon the situation and what’s happening. So, so there’s so many different things to look at with that. And I think sorry. Towards the end of, oh, sorry, were you going to say something there if I just jumped

 

Kate Baldry  43:07

on No. So I was, I was, well, this was something that we were kind of talking about. And you know, some of the claimants we were saying, you know, they’re so, so young, you know, some of them haven’t, maybe started a family yet, and they maybe wanted to, or they maybe weren’t partnered yet, or they were kind of, they were previously maybe happily dating and getting out and about and stuff. You know, as someone in their early, early 20s or 30s might be doing, they don’t know anybody else who’s been diagnosed with cancer. They don’t know anybody else who’s been diagnosed with bowel cancer, you know, they’re like, I’ve been fitted with a stoma, but I was, you know, a couple of months ago. I was, you know, maybe on dating sites. And now I’m like, I, you know, I just, I’m not confident. I, you know, I don’t know anybody else in this situation. They may, they may have young children. In fact, one of the claimants, she was only 31 and she was diagnosed when she was eight months pregnant. Oh, wow. And I know so she, she had to spend, you know, the first few months after giving birth, recovering from sort of surgery to take the tumor out, and then obviously the chemotherapy to support that. And I know, and it was, honestly, it was, I would, I would say it was a, it was a great catch by the doctor as well, because she she had bleeding hemorrhoids. And quite frankly, you know, in pregnancy, that’s not uncommon, yeah, but it was a great catch by the doctor, but 31 years old and eight months pregnant, and, you know, again, like her, life has been completely tipped upside down. So these younger people are in, you know, in risk of really being quite isolated, because they don’t necessarily know anybody else who’s had this sort of diagnosis. They can feel very, very alone and like, literally, they do not know who to ask these questions. And I know that some, some of the claims assessors in our industry will have, you know, phone calls like, I don’t know where to buy a bra. Like, I’ve had a mastectomy, for example, I don’t like, I don’t know what to do. And this is where the value added services and the charities are just fantastic. So we’re really lucky, obviously, to have all these value added services within the industry, and they can really, really help support people. There is also for younger people, a dedicated charity called Stupid cancer. Okay, so that’s a really helpful resource, and maybe worth kind of partnering up with within our industry. And then there’s Maggie centers, yes, who you may well have heard me talking about, because there was a team of us at Hanover recently who took on a fundraising challenge, as we’ve had, we’ve had a few family and friends ourselves who have been going through cancer, so we wanted to give something back, and we’ve managed to raise 17,000 pounds for Maggie centers by walking from London to Brighton, 100 kilometers. A few toenails were lost. Maggie centers are wonderful. So there’s, I think, 26 of them in the UK, and they are very often attached to kind of the cancer centers in some of the major hospitals. So somebody may go into the hospital and receive a diagnosis, and then they can go into the Maggie center, and they have people there to have speak to them about finances, to maybe give them, you know, sessions of counseling for them and their families. They have group support so they might have specific cancer, you know, breast cancer support groups or prostate cancer support groups, or general kind of ones by age, or that kind of thing. So they’ve got these really excellent kind of facilities that people can use. And so we obviously really want to call people’s awareness to those that there are, if someone was diagnosed, there are, there are facilities available. But yeah, great.

 

Kathryn Knowles  47:22

That sounds absolutely fantastic. So, so one final little query for me. Always the advisor in me, but in terms of things like life kick and IP, what I would probably expect is, obviously, if someone has had bowel cancer that generally it’s it’s not going to be standard premiums that we’ll be looking at for with the insurances. You know, for majority of cases, and I tend to find that, you know, there are occasions where, because obviously, if we see things like breast cancer, depending upon the type of breast cancer, things like that, we can start to see quite favorable underwriting options quite quickly from point of diagnosis. But with bowel cancer, it often is. I’ve generally found that it’s quite, it’s really, sort of like really looked at by the underwriters, and the terms are still affected quite a bit, even up to maybe 10 years post diagnosis. It’s still seen as quite a a key thing, of key risk that they’re looking for, for the insurances. So, so that is, that’s just the case. That’s kind of the landscape with it. But I’m just wondering, if you give us any insight, you know, if it was somebody, let’s say we had people in the same situation. They’d both been grade three, it had both been, I don’t know, five, six years ago, something like that. I’m not gonna ask you to gonna ask you two specifics, just don’t worry. But let’s say, if somebody was over 50, and that was the case, or under 50, are we going to see do we think that the risk factors would be seen as higher for somebody with early onset bowel cancer than, say, somebody who is over the age of 50?

 

Kate Baldry  49:03

Yeah, it’s an interesting question. I think the difficulty that we’re having is that we are often seeing these younger people with the higher grade and higher stage cancer for whatever reason that might be. So we wouldn’t, we wouldn’t tend to, you know, to treat anyone differently based on their age. If someone is 40 or 60, and they come in with a T 2n, zero and zero tumor, then we’re not going to treat that differently. And if it was t2 then it may be something that the terms may be possible in the future. It’s where they tend to be these larger tumors, and then this, like, I say, the lymph node spread, and certainly the metastases, is always going to be really challenging, unfortunately, as you could well understand, yeah,

 

Kathryn Knowles  49:50

yeah, no, that’s really good to know. Because I thought, you know, is it something at this thing, for all of us as advisors, any kind of, like, little snippets we can get, we’re like, actually, do you know what? Like, this person’s had bowel cancer, that they’re 27 if we take that like as an example, and think, right, it’s, you know, I think a lot of the time we can kind of think it’s just not going to be possible in some ways. I mean, obviously it, I say not going to be possible. I mean, sort of like mainstream because, you know, they are so young, and obviously specialist options would be available in most situations. But it’s just good to know that actually, do you know what? This isn’t, this age thing isn’t possibly going to be a barrier. So that’s really, really positive, and hopefully gives more advice. Is that kind of insights? Good? You know what? I should really, really try and, sorry, see if this is going to be available.

 

Kate Baldry  50:39

Yeah. I mean, it’s, it’s the, it’s the same as, I’m sure, you’re, you know, you’re, you’re very, very well used to dealing with these. It’s always the TNM, and it’s always, you know, how long was it, and how long since the last treatment? And those are just really the key kind of factors when we would be kind of looking at this, you know, outset

 

Kathryn Knowles  50:59

completely. And I have to say as well, for for me in my firm, what I would typically do. And not everyone was onto this, but I would typically do is, if somebody had said to me that they are bowel cancer, and I wanted to support them, and they wanted to have some indications, I would say to them, I need this information, or I can’t do the research, because it’s so different. You know, that TNM side of things, you just have one, one, number, slightly difference on them, and the outcome is huge, you know, in terms of what would be potentially available. So there are certain things where I kind of like, put my foot down and go, I really, really need this information. Because if not, I just don’t feel like I’m being responsible in the sense of, I could say, well, it best case scenario. It’s this worst case scenario, if you don’t have the information, the worst case scenario is always going to be decline, you know, because you’re not going to know. Yeah, underwriters

 

Kate Baldry  51:47

are always happy to help with things like that, you know, if you’ve got a copy of a consultant letter, as most people will do, now, that’s, you know, something really useful to be going with, yeah,

 

Kathryn Knowles  51:58

absolutely. Okay, then, so we’re getting towards the end of the podcast. Now, I know one thing that we’d said, Kate is that it’d be really, really useful for anybody who’s listening, if you have any ideas as to how to best kind of get this information out into the public, into the advisor community, to sort of really hit home the way that you know the data is showing the real importance of things like critical illness cover especially then, please do get in touch. Obviously, feel free to contact me. If you know Kate. Please do. Feel free to get in touch with Kate and chat to her directly. But you know, get in touch with me. I can always let Kate know any of these suggestions, just so that we can try and do it in a really sensible way that works for for everybody, because we want to make sure that we’re getting the really, really key information from people like Kate, get that into the advisors, but then also as advisors, not do any kind of like we said, scare mongering at all. So everybody. Thank you so much for listening, Kate. Thank you so much for joining me. It’s been very, very insightful, and I’ve got ideas for future podcasts as well, which is even better.

 

Kate Baldry  53:08

Thank you. It’s a pleasure, and I hope I haven’t scared you too much. No, no,

 

Kathryn Knowles  53:12

it’s fine. I keep I’ve been planning my head though. I’m gonna go out and speak to Alan, who’s in the other room, and go, guess what? Alan, I’m tall, but no, it’s fine, not to worry. I just but next time, I’m going to have Phil James joining me. Very, very appropriate. After the session, Phil was diagnosed with bowel cancer, and he is going to come on and talk about that diagnosis and also what life has been like since that time. So if you’ve listened to this as part of your work, please do visit the website, practical hyphen protection.co.uk. Where you can get a CPD, CPD certificate. Thanks to our sponsors, next gen planners. Thank you so much, Kate, and I’ll speak to you soon.

 

Kate Baldry  53:53

My pleasure. Thanks guys. Thank you. Bye, bye.

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Episodes of the Practical Protection Podcast include a transcript of the episode’s audio. The text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record.

We often discuss health and medical conditions in relation to protection insurance and underwriting, always consult with a healthcare professional if you are concerned about any medical conditions and symptoms we have covered in any episode.