Kathryn (00:06):

Hi everyone. We are on season eight, episode five and today I have Matt ran back with me. Hi Matt.

Matt (00:12):

Good morning Kathryn. How’s life treating you?

Kathryn (00:14):

I am very well thank you. Except I kind of look like I’ve been in a bare knuckle fight. I have to say my hand is very, very sore and I cut my hand in three places the other day and I sent Alan a picture. He was like, what have you done? I was like, I don’t know. I would move the washing from the washing machine to the tumble dryer and I somehow cut my hand in three places and I’ve just said to him, I was like, this is clearly a sign. I shouldn’t do the laundry. I shouldn’t be involved.

Matt (00:44):

Self-harm to get out of the laundry. Kathryn’s a little bit over the top. Let’s

Kathryn (00:47):

Do I know, I know. It is. It just genuinely have no idea how this happened at all. But how are you Matt?

Matt (00:52):

It’s not too bad recovering from a cold, but it’s that kind of time of year really and I think the looking after our wonderful little grandson and on basis that he goes to nursery three days a week, I think we’re suffering grandparent bugs. Let me put it Absolutely. Rather than when all this used to start when people were for the parents, at least when the child was five, we went to school,

Kathryn (01:24):

Everything and anything don’t you?

Matt (01:26):

He’s been going to nurses. He’s about 10 months old, I think so, yes, yes. We’re full of bugs of all types of sorts, but it’s worth having to see him, let me put it that way. The odd bug and the odd sniffle is well worth it. Small price to pay.

Kathryn (01:41):

Yes, absolutely. I was going to say when they are that list, so you just bring home everything. One of my colleagues the other day, she picks up her child from nursery and I have to say I felt really bad about this, but I thought it’s one of those learning lessons I would say as a parent and she was just like, oh, my little one, he made some bread at nursery. I had some, it was the nicest bread possible and all this stuff and I just went, I was like, I’m sorry. I was like, but you’ve made a really rookie mistake here. And she was like, what? I was like, you don’t know that that was his exact one that he made. I was like, that could be any child’s bread. You don’t dunno what germs you’ve just got now. And she was just like Online? No, and I was just like, yeah. I was like never eat anything that comes home from school. Leave it for the kids.

Matt (02:25):

Oh dear, dear, dear. I’m going to say on that, but no, we’ve not eaten anything yet, so thank you for that.

Kathryn (02:32):

It’s absolutely learning lessons. Well, okay everybody, today we are talking about insurance options for people that have had or currently have prostate cancer. This is the Practical Protection Podcast. So Matt, always good to start off with, can you please explain to us all what prostate cancer is?

Matt (02:57):

Yeah, absolutely. I thought it would be just taking a step back as I usually do just to explain a little bit more about the prostate itself because I think when we look at prostate cancer we can look at some of the signs and symptoms of prostate issues. It’s just good to step back just for a few minutes and look at really what the prostate is and what it does because what it does and where it is actually will give everybody a clue on some of the signs and symptoms to look out for. So I may just do that very quickly. The prostate itself is typically known as a glam and excuse me, my nose is going already. Right, okay. And it’s found just below the bladder and in front of the rectum. It’s about the size of a walnut, although I have described it or scenic described as a size of a chestnut or a pinging pong ball.

Kathryn (03:55):

I’ve heard it as size of a satsuma

Matt (03:57):

Satsuma, goodness gracious. Well, it was making my eyes water to think well pinging pong ball and I thought, next article I read this is going to be the size of a bloom football that

Kathryn (04:09):

You ever know. Well, I said that’d be a concern, wouldn’t it? That would be underwriting wise we would want to know about that.

Matt (04:14):

Well absolutely, so as I say, just below the bladder in front of the rectum size of a walnut and importantly here, just in some of the signs and symptoms that men find themselves suffering from, it actually surrounds the urethra and for those who are not necessarily completely up to speed with terminology, that’s the tube that empties the urine from the bladder, you can immediately think that if on basis that’s where the prostate is located, it surrounds the urethra, then any enlargement in that prostate is likely to cause urinary symptoms, which we can go onto a little bit later on.

(04:56):

Again, as men age, the prostate tends to increase in size and again, everybody will, I’m sure most anyway will know that some urinary system, sorry symptoms are pretty common in older men and that’s actually quite natural because as I say, the prostate does tend to increase in size and therefore it starts to squeeze the urethra of that tube. Its function is pretty important, particularly in reproduction, keeping mankind and womankind going and it produces its main functions, produce the fluid that makes it part of the semen, otherwise linked to seminal fluid and also plays an important role in hormone production linked to test testone and also it helps regulate urine flow. So going back to this urine issue again, just for those like a little bit of detail, and I promise I won’t go into too much here. The prostate can be divided into three different areas, the inside of the prostate and it does actually, the prostate actually does have two lobes.

(06:12):

It’s called transition zone and this is right in the center but also surrounds the upper part of the urethra. So that year in June, and this is the area of the prostate that tends to undergo benign. So in other words, non-cancerous growth in old age, something called or technically called benign prostatic hypertrophy or BPH. So hypertrophy is enlargement, but benign is an important word to be used there and if it presses against the bladder and the urethra, it can lead to differences in urinating. Then there’s a central zone, but also, and finally there’s the peripheral zone, which is at the back of the prostate near the rectum. Hence why doctors will often use the DRE or digital rectal examination, which is effectively a gloved finger inserts up into the rectum to feel the shape of the prostate. And a lot of men, if they suffer for any issues, particularly trying to go to the toilet, have a wee, then doctors will often do that test and they will feel the shape of the prostate, see if it’s smooth, fill it, whether it’s enlarged and they all act accordingly.

(07:42):

It has to be said here that the importance of the DRE, it’s because malignant tumors mostly develop in that outside part of the prostate, so that examination, that’s really why that examination is done. I’ve seen many, many reports, thankfully mostly positive, where the prostate is described as smooth. If it’s got bumps and lumps on it, then the individual will be referred for further tests. In terms of the testing themselves, the most commonly known test, to be honest with you is the PSA test, prosthetic prosthetic pneumonia, prostate specific antigen test. It can provide early notice of prostate cancer but also can provide false positives. This

Kathryn (08:37):

Is a really interesting one. I do prostate cancer training in part of my training course when I don’t think you can understate just how wrong the PSA can be. I think it’s when I was doing it and it was on the NHS site that it said three quarters of people will be told they have prostate cancer when they don’t and that 15% of people will be told that they don’t have it when they do, and I mean that’s just phenomenally inaccurate and it is so bizarre that that’s still used or it still seems to be the best way of checking it at the moment.

Matt (09:14):

Yeah, I would agree with what you say there. I’ve got pretty slightly different numbers, but nevertheless they are not good enough by any stretch of the imagination. Yes, PSA certainly the most well-known test and I’ve had PSA tests myself by the way, I would add because for self-awareness rather than any symptom which it can produce false positives. You’re absolutely right. And maybe just to go into, explain that a little bit more that raised PSA can be due to recent sexual activity. We talked about the prostate and its production or its involvements in seminal fluid and PSA is actually found in some seminal fluid. Okay. Right. So due to recent sexual activity, a urinary tract infection or an enlarged prostate, the benign prosthetic, I can’t say it this morning, but

Kathryn (10:14):

You’ve got a thing about prosthetics at the moment, haven’t you? Prosthetics?

Matt (10:17):

Yeah,

Kathryn (10:17):

I know. I’m not even sure how that’s going to fit in with this whole area that we’re talking about, but

Matt (10:22):

No, well, you never know do you in the future?

Kathryn (10:24):

Well, you never know. Yeah,

Matt (10:25):

Laboratory,

Kathryn (10:26):

There’s always advancements and different things.

Matt (10:28):

Indeed. Well, yeah, anyway, not prosthetic at all, but the benign prosthetic hypertrophy or even because of extensive exercise running marathons or some really, really hard Iron man type of event. Oh,

Kathryn (10:46):

Interesting.

Matt (10:47):

So I’ve got to a figure here that it’s only got a 90% accuracy rate and as you quite rightly said, and even more importantly, that some people can have a normal PSA, but despite having prostate cancer, so now the wises and wherefores, again, I think we could go on to this, but I mean Kathryn, I’m sure you were around, I know you were a very young lady in the nicest possible way I might have, thank you. But the government back in the early two thousands in the naughties, is that to the pronunciation?

Kathryn (11:23):

I have no idea. Just go off with Yeah, probably the naughties. Yeah, go.

Matt (11:27):

2002, 2003, the government decided that they were going to introduce PSA testing for everybody over the age of 50 and that in fact caused quite a seismic change in the critical illness industry whereby wordings were changed for prostate cancer that insurers would only pay out on gleasons seven or more. Talking about gleasons a little later on. Yes. However, because of exactly the issues that we just mentioned, it was abandoned. So really in the last 20 odd years, they haven’t really come up with anything better, although that is changing. I read quite a few articles about how better tests are coming on board, but they’re not widely spread yet. Okay, so is there anything else particularly, I mean there are better tests around and really those are things like MRI scans and other scanning techniques. They are put by far better ways of finding with biopsies and stuff as well, wasn’t it?

(12:45):

Yeah, the thing with biopsies is that they tend to, many people actually get infections for the prostate from a biopsy, so it’s not the test of choice, lemme put it that way for skin, I might add, but you’re absolutely right. Biopsy can help, but if you think of a biopsy and it’s a biopsy is the same with any organ. Now the prostate now, whether it’s the size of a walnut, a ping pong ball or a football, no, let’s forget football just for a second because it’s rather big. It’s quite a small organ gland. Sorry. If you think of somebody doing a liver biopsy, it’s huge liver comparison now biopsy, you are going to take a fine needle aspiration, you’re going to take a few cells from one part, one tiny part of an so it could miss it couldn’t say it could miss it completely. Yeah, yeah, absolutely. So you’ll probably find at the end of the day, it’s a mixture. The best course of action that is around at the moment is a mixture of all these things, A PSA, the rectal examination, MRI scan and maybe a biopsy, but noticing the downside of those. Yeah.

(14:02):

Is that okay in terms of the prostate? Yeah, what it is, yes, definitely. It’s in terms of what is prostate cancer, which I think was your initial query then it’s an interesting one, let’s be honest about it. Prostate cancer, that wonderful term cancer, again, it can not exactly be bought into question, but is this type of cancer serious or not? And the answer to that is yes, it can be, but they’re often very low scoring types of prostate cancer where certainly what we call stage, I know these stagings can be quite confusing. I’ll try and shed some light on that a bit later, but stage one prostate cancer has a hundred percent survival rate over five years. That’s good. So you can see that the very early stages of this cancer in terms of mortality, it doesn’t really come into play in terms of a killer, let me put it that way now in terms I’ll stick to what’s relevant really to insurance and what we will all know and see particularly from critical illness covers is the Gleason score.

(15:37):

Now interestingly, the Gleason scores tend in more modern times seem to be going out of fashion, if I can call it that. Oh, interesting. It’s interesting for critical illness definitions, but something much more simple than a Gleason score just by sheer grading, it’s the grade group of one to five, one being the least concerning, five being the worst, but either which way I’m going to stick to gleason’s because that’s the one that we all probably are aware of the most and how a gleason’s score is arrived at. As an interesting one for a start, it’s a score or a rating that comes from a laboratory technician, albeit a very, very skillful one, looking at the prostate gland obviously or post ectomy and dividing it up and looking at the cells that are within that organ, that gland. And what they effectively do is take two readings if you want. They’ll take the most common cell pattern and add it to the second most common cell pattern.

(17:04):

Cell patterns are an indicator of how those cells have mutated or not in terms of forming cancer, what is commonly known as cancer. And then each is given a score of one to five and then the scores are added together and you arrive at the Gleason score. So it’s an overall picture of the way that the prostate has been impacted by the changing in cells. And we all know a lot of listeners will know that a score of seven or over on the GSS is considered as cancer. A score of six or lower is considered much lower risk. The current plans that are out in the market, the critical illness plans that are out in the market that can still result in a claim but for a less advanced cancer. And that’s a relatively recent developments is my understanding. Kathryn?

Kathryn (18:05):

Yeah, I would think so.

Matt (18:06):

In terms of cover for less advanced cancers, I think after 2002 three all cancers under the Gleason score of seven were excluded, but now more recent terms, I think the A BI is recent definition change, well recent inverted definition changes now allowed for claims for less advanced cancer as well.

Kathryn (18:26):

Well, yeah, we’ve definitely got claims for less advanced cancer. It’s interesting what you’re saying there about the numbers because we don’t tend to get details of those numbers in a sense, so we wouldn’t know. Usually it’s a bit like with heart attacks when insurers got, it’s a bit of a side type. We’re looking at troponin levels, we don’t know in a sense there’s advisors policy holders, so like, oh well that insure if future PON level hits this number, that means they do pay out, but this one you have to hit a number. I dunno so many higher for them to pay out. So we don’t have that. It’s just really interesting to hear that on that one. And I think in terms of the Gleason score, what’s really useful as well is to say to advisors especially is that number seven can be a little bit of a pain in some ways.

(19:09):

And so you’ve got 6, 7, 8, 9, 10 in a sense when it comes to greason score. So six, the good thing about six and eight is that that the majority of cells in the minority of cells have been in the same kind of level, so six would be classed as three plus three, so the majority of cells are three and the minority of cells are still three. I know this product may doesn’t make sense, but just bear with me until I get to seven. So with seven, what’s really important to know as an advisor, someone might say to you the Gleason score was seven, but it’s really important to know if it was seven, which is three plus four or seven, which is four plus three because the first number that leads it is where the majority of cells are and where the majority are behaving. So a three plus four means that most cells are still within this three number, but some have gone to level four and with when it’s four plus three, forgive me for all the numbers, it means that the majority of cells have been in the four stage and only a minority is still at that three level and that can really change the indications that you get in terms of the offer because one of them is saying that the cat answer has obviously advanced more than the other I’ve started.

(20:17):

Bring that one in there.

Matt (20:19):

No, I think you’re absolutely right. I mean it is an interesting point that you raised there and I’m an underwriter by trade and I understand exactly what you’re saying by the way. Yeah, absolutely true. It is interesting. Just sniffing back to that grade group, I wasn’t actually going to mention the grade group, but I’m glad did because you’ve just highlighted something there in that grade group one, sorry if I’ve just said this, but is a Gleason score of six or less. Okay, Gleason pattern three or less plus three to raise your point A Gleason seven three plus four is a grade two, A Gleason’s seven or plus three is a grade three. So your new grades rather than having two sevens, three plus four and four plus three are now two and three. They are very separate. That’s

Kathryn (21:16):

Going to make it so much easier.

Matt (21:17):

Yeah, so I’m glad I mentioned grades.

Kathryn (21:21):

Yeah, no, definitely. Well, it’s one of the key things I’d go through. I always say on my training, I’m just like, right, there’s certain things that I won’t do research for unless I know and it’s like I’ll say the PSA reading, we know it’s absolutely horrendous actually in terms of accuracy, but we have to have it.

Matt (21:37):

Well, it’s very, it’s useful. Sorry. It is useful, but yes, I know what you mean.

Kathryn (21:41):

Yeah, in terms of accuracy, that’s the thing. I know that it’s the underwriters, you do need it, but I always say I need the prostate reading and I need the Gleason score because it’s that thing again of you don’t know and you can fall on those times where people can say, oh, it’s all fine now, but maybe the thing is you need to know what it is now, but you need to ideally know what it was originally as well because oh yes, very much so. You guys are going to want to see the undergrad are going to see how they’ve responded to treatments, what treatments happened and things like that. And without that information in terms of doing your research, you can do your research but all you’re going to be able to come away with and all the underwriters are going to be able to come away with if you don’t have those PSA in Greece and readings is they’re just going to say to you, well, it’s either anywhere from a small premium increase to a decline, so the only answer you’re going to get.

(22:33):

So it is so important to have these specific details and people can get them quite easily if they just ring with their GP or see the letters that they’ve been sent. But it’s also important as well as that to be very clear that with some people, especially with cancer, they can compartmentalize the fact that they’ve had cancer and so they might literally have put it in a little box in their head and thrown it away in a sense, and they might not be able or in the position mentally to be able to ring up the GP or to talk about these kinds of figures. They really do need it to be something that they need to keep a very clear barrier between themselves and those figures and stuff. If you are in that case, then you can potentially still advise somebody but you just again have to be so clear to them and say, that’s absolutely fine. We can go ahead, but I cannot give you an accurate indication. I just don’t, we won’t know until they’ve seen that medical report.

Matt (23:30):

Yeah, absolutely fair. Yeah, as you know, I’ve had stage three colon cancer, so I can sympathize with how people react to it. There’s no two ways about it.

Kathryn (23:43):

Absolutely.

Matt (23:44):

Okay, well thank you. Thank you for that.

Kathryn (23:47):

I’ve got a question, Matt.

Matt (23:48):

Yeah, I was going to say, do you want me to continue or fire?

Kathryn (23:50):

Yeah, I’ve got a question. So in terms of underwriting, so really standard, I thought people are starting to see the theme here when we talk about underwriting risk, so it’s like when we diagnosed ideally the month in the year, what treatments or medications have you had? What investigations? Obviously with prostate cancer it’s really important with this one because with the majority of cancers excluding blood cancers, we do do staging and grading with prostate cancer. Obviously we are getting more of that grading side of things that you say, but we do have the Gleason score on the PSA, which is why it’s so important to know as well. But I have to say in terms of underwriting outcomes, it’s very different with prostate cancer versus some other cancers because I mean obviously there’s a complete range of different outcomes, different treatments, and they will determine as to the options for somebody, but people can at times get life insurance when they actively have prostate cancer and I know that there’ll be medical reasoning behind this, so I’m just going to really quiz you on it if that’s okay.

(24:55):

And I’m going with this probably already, but so prostate cancer, well controlled, well managed, we can potentially get life insurance for people, but for women or female cancers such as breast cancers and things like that, I’m assuming that they’re not having, they’re not a cancer that can be just maintained and treated in a sense. It’s just really strange sometimes when you look at it and you think, well, hang on a minute, all obviously the majority of cancers would be a no if you actively have it for life insurance or any of the other insurances and for a lot of obviously the women’s cancers to the breast cancer, ovarian cancer room cancer, anything like that would be a no if you actively had it, but prostate cancer is a maybe, so why is prostate cancer different? Please?

Matt (25:50):

Yeah, okay. I think I’ll come back to you with two points. One is the term cancer. Okay, the term cancer is used, although everybody thinks, and I can understand it, they say cancer, oh my goodness, this is going to be a death sentence or it’s going to be, I suppose the term is they immediately think malignant. Okay, now malignancy, there was a huge range within that term malignant and therefore cancer with prostate cancer. Fortunately for those who suffer from it, there is prostate cancer generally, particularly for caught early, the usual caveats with any sort of cancer, the great of growth generally speaking, so the way that those cells differentiate themselves start to grow in a random fashion, the standard kind of definition of cancer is much, much slower than in to use some of the cancers that you’ve just raised, the breast cancer, uterine cancer, ovarian cancer, things like that. Now why that is, I can’t do not know why prostate cancers grow tend to grow, not always, but tend to grow at a much, much slower rate than other types of cancer. Maybe it’s the unique cellular structure of a prostate.

(27:37):

I’m not in a consultancy capacity to give you an absolute answer for that apart from to say that the prostate cancer cells do not, some of them, sorry, I have to caveat everything by some and generally do not replicate in a random way very quickly and as such, this type of cancer is far slower growing than the other types of cancers that you’ve mentioned. You’re absolutely right, and again, it’s one of the reasons why I talked about prostates and went into a little bit about where they are, what they surround, their function and what have you, but if I can just give you an example of this, only it is post covid, I sort a statistic somewhere and we know what’s happened with the NHS and surgery and things like that in the post covid environment, but latest figures show that only 5% of men undergo treatment within a year of being diagnosed with prostate cancer.

(28:55):

That’s quite a statistic with the remainder placed under active surveillance or watch, I’m not sure what this term means watchful way, it’s a wonderful term. It didn’t really fill me with a lot of confidence, but either which way, and yes, I have underwritten in the last 12 months, certainly men who have prostate cancer and who, albeit they have had medical loadings, but pretty small ones to say the least, but it’s all around really. What can I just maybe add here and hooks back into what I was saying about where the prostate is, there is an increasing view that the damage caused by particularly ectomies to a man’s life far outweighs the actual mortality risk of living with that cancer. So I think what I’m finding, what I’m seeing what I’m reeling is that prostatectomies, for instance, are only carried out when it’s absolutely necessary because of the fear of the side effects and there are other types of treatments other than obviously other than just prostatectomies and these are growing. My understanding is that these are becoming much far more sophisticated in having to deal with prostate problems. However, the current medical view is to leave in terms of surgery, radiotherapy, all these other types of treatment that are around their cryotherapy to leave well alone until it’s absolutely necessary, noting these are cancers that are caught early.

Kathryn (30:46):

Yes,

Matt (30:46):

Once they’ve already gone to a gleason’s seven or war, then that’s a different outcome or sorry, a different clinical picture likely to different clinical picture in terms of the treatment. So I think, have I explained it very well there? I think you have or say, so living with prostate cancer is common.

Kathryn (31:19):

Yes, yes. I was going to say that is a really common thing. It was that thing of psych. I just wonder why it’s different.

Matt (31:27):

It’s the cells don’t react to the same way basically. It’s not the duplication replication of those cancer cells just does not seem or isn’t seem it. They don’t multiply and spread at the same rate as many of the other cancers that we see. That’s fundamentally the reason and therefore the outcome from a mortality perspective is far better. I’ll caveat by saying at the early stages, so you’re looking at up to including six, seven, the ballpark changes then

Kathryn (32:11):

And when it comes to prostate cancer, I know we’ve mentioned the PSA, we’ve mentioned Gleason. Is there any other kind of terms that we should be looking for? Any kind of treatments? I know that there’s, I mean there’s a ridiculous amount of treatments when I’m doing the training and I go through them with people and are there any that would make us, I think as with anything, when we hear cancer as an advisor, as an underwriter, if someone’s had chemotherapy, that would usually be an indication that there really has needed to be quite in a sense it’s not the first part, is it really chemotherapy?

Matt (32:47):

It’s pretty much secondary. Yeah,

Kathryn (32:49):

We need to get in there and get this kind of thing. So if you hear chemotherapy, then that would indicate to you that it hasn’t been a mild case unless, and I do say this as well, unless sometimes someone’s been treated privately. There’s quite a few times when I trust people and I do say to them, especially with heart conditions sometimes I tend to find in this, and I don’t want to be stereotypical, but men who own businesses who have got quite high value, they have maybe had something done a little bit of, I can’t think of the name of it, but it’s a bit of an operation to the heart as a preventative rather than a reactive. And then he kind looked at it and you said, why would they have done that? Because you wouldn’t usually get that. I would usually expect you to be quite more ill to be able to get that treatment.

(33:38):

And then you realize actually you find out that they’ve had private medical insurance, so actually it has been done as a preventative rather than necessarily a reactive or there’s been something there very early, so they’ve just gone, oh, let’s just get in and get it quickly kind of thing. And it’s really useful sometimes to ask that I always find of people just to check as well, was this done NHS? Was it private? Because it can really actually change again, the outcomes because I think everybody goes to the default of thinking this was done on the NHS, which somebody would have to be much worse in terms of their diagnosis to get the treatment than they would do if it was private. But yeah. Are there any kind of terms of anything specific that we should be looking at, any kind of complications at all?

Matt (34:20):

Well, I think you’ve quite rightly said that. You said already that the Gleason score or maybe start introducing your grade group as well. I’ve not seen that in a prostate cancer report by the way.

Kathryn (34:38):

No

Matt (34:38):

Group, but if you can get those two important things out in terms of the treatments, you said that you have already got an extensive list, so you’ve got prostatectomy, radiotherapy, brachi therapy, hormone therapy,

Kathryn (34:55):

Cryotherapy. I always warn the fellas before I start talking about cryotherapy your eyes as to what that is. I’m just like, I’m sorry. I was like, just bear with me. I’ll talk about it. Be open and done with soon.

Matt (35:09):

It’s an interesting one, doesn’t it? Because if you look at the critical illness definitions for low grade or early stage, I think it’s the more way of describing it then treatment is always a part of the payout, part of the definition and yet of the ones we’ve just mentioned, I didn’t mention high intensity ultrasounds, but I’ll stop giving treatments after. It’s interesting how some insurers do not take into account some of those treatments in terms of satisfying the treatment part of the definition. So it’s an interesting one. It has to be said.

Kathryn (35:55):

I suppose it’s when I say to people, because when I’m advising people to take out critical illness cover, and obviously I would never ever negate any kind of treatment or anybody’s views or feelings towards doing it, but absolutely, I always say to people along the lines of, if it’s in the broad sense, and forgive me Matt, because I know that this won’t cover all eventualities, but I’ll say to you in a broad sense, if you were going to say have a very, very minor, very, very minor skin cancer and it was going to be whipped off at the GP and you’re out and done and dusted in 20 minutes not being anywhere kind of invasive, very, very, very, very minor, very early court I’ll say to people, that’s not, you’re going to get 300 grand payout for that. It would be unusual if it did in a sense, obviously, obviously skin cancer certainly can pay out, but I’m talking very, very mild here, but I said, when you’re going to get a payout, it’s where you’re going to be uncomfy for a bit and that’s I think probably the closest I can get to without actually being able to say this staging, this grading, because we just don’t have that information as advisors.

(37:02):

But I’ll say to ’em, it’s where it’s not going to be pleasant. Obviously all cancers are unpleasant, but you’re going to feel physically it’s not going to be nice what you’re going to go through. There’s going to need to be some interventions in there and I suppose with some of them, Matt, those interventions you were just mentioning there, I suppose the ultrasound one, I can imagine it’s not invasive and oh

Matt (37:25):

No, by definition

Kathryn (37:26):

And it’s, there’s not really going to be that impact to actually having to have some kind of obviously surgery where you want a general anesthetic where you’re going to have much more of a stronger intervention and recovery period due to, obviously I’m thinking especially if we’re talking ovarian cancers, there’s a significant amount of muscle groups that they’re going to need to go through probably to get there and get it all out or even obviously for the bowel or anything like that. So yeah, I imagine some of those ones where you said they don’t need the definition, it’s probably because it’s something where a product walk out aren’t there the same day I imagine.

Matt (38:06):

I mean I think there are going to be two ways about this. One is seeing that if you go back to the really old days of dread disease for people who were old enough like me, then that’s critical illness was initially called.

Kathryn (38:20):

That’s a chirpy term for it,

Matt (38:21):

Wasn’t it? Oh no, it was wonderful, isn’t it? I wonder which market guru came up with that one Anyway,

Kathryn (38:26):

I’m going to say it was a man

Matt (38:30):

Quite right too. Is a less invasive treatment really dread disease? Is it really critical? But those are subjective arguments to have as you pointed out yourself just a minute ago. But it’s a difficult one to have, I have to say. And also, again, you’ve touched on it, the actual psychological impact of being told you have cancer, even though it’s an one you didn’t in the slightest infer it, but nobody should out there, particularly on the sales side, should underestimate how people react to the term cancer.

Kathryn (39:14):

Well, I was going to say as well, that example that I give, the reason I do it is that, and when I do it say it in the training as well, it’s just along the lines of if somebody hears cancer, they’re not hearing cancer as specified definition, they’re not hearing the insurance term. They’re hearing, oh, my work, I’ve got cancer. And that is all of us have heard ate about the amount of people that die from cancer. Not necessarily. I was going to say there’s a lot of focus on that, not necessarily as much focus, but there is more and more about the amount of people who survive cancer and who live with cancer long-term as well. There’s a significant amount of people in those brackets and I think that’s why it’s so important as an advisor to be very clear from the start, the last thing you want to do is to have that situation where you’ve arranged something for somebody, they are diagnosed with something and then they feel that you’ve actually not been clear with them or that it’s not living up to what you said it would be and they’re going to be paying a good amount of money for these insurances and we want to be clear about that because we live in this day in, day out, all of us, majority of people don’t.

(40:20):

They’re arranging something eight years down the line. They’re told they have cancer, they go back and they look at this document that says it’ll pay out if someone’s diagnosed with cancer. They’re not looking at the little bits of wording, but they might just remember that conversation and hopefully remember it where you’ve said to them, look, hopefully we’ll do it. We’ll go forward with the claims, we’ll support you every single which way. But sometimes the cancers aren’t always eligible for a payout, which I’m sure doesn’t help anybody at all who doesn’t reach that level or just misses that level. And the positive is that if you aren’t eligible for the payout that your cancer hasn’t been too intense and not too intense. That’s not the right wording, but it hasn’t been the seriously nasty types. However, for the person who has cancer, they’re going to feel that their cancer is the seriously nasty type and they are going to feel that it’s intense and it’s important that we just try and really manage that mindset and that’s kind of forward thinking as to what people might be expecting.

Matt (41:29):

Yeah, yeah, that’s very well said. I think, yeah,

Kathryn (41:33):

I’m so worried that some of the wording that I used then wasn’t right when I’m saying not too intense or not one of the super nasty ones, and it’s like I wouldn’t ever want to offend anybody by suggesting that any cancer, but it’s just in terms of these insurances, there are specific cutoffs. I don’t see them, I’m sure, I know that your wife is a claims handler, so she would know these kinds of cutoffs, things like that. I’m sure you’ve spoken to her at times, but I have no idea if a stage two grade B cancer would pay out in full or be a partial payment or not meet some definitions and I dunno if a stage one C would meet different ones, depending upon what they are, they should obviously, at least what we were saying before, those less advanced cancers would hopefully sit within them. But then that again sometimes comes down to the way that the insurers word it because some of them will say less advanced cancers and they’ll name a list of different ones and you might just have to have had one that doesn’t fit in that list. Whereas another one might just say less advanced cancers, but leave it very broad and open, which would actually include that diagnosis. So it’s very complicated as we all know.

Matt (42:40):

Absolutely. I mean I hope that the A BI definitions on kick, and I think this is where it does get complicated, by the way, on critical illness insurance. I know that the guys in the committee, the API and the insurance advice that they get as well as oncologists and goodness know what else, all of the specialists people work very, very hard in trying to make these things as clear as possible, but you’re absolutely right that saying to somebody who’s being diagnosed, they’ve been told that they have cancer and saying, well, it’s not severe enough under this definition. That’s a difficult conversation to have and that’s why to an extent, cancer, remember we’ve talked about this before where I think that claims assessors have such a difficult job and also we should really take their hats off to them. These are the people

Kathryn (43:36):

That I couldn’t cope with it emotionally. I was going to say, I just couldn’t hats off to them.

Matt (43:41):

Yeah, I completely agree. And I mean being, well, I used to do a fair amount of claims myself, but having been married to Teresa, well, how do I put it, living together for best part of 37 years, married for 35, 34, and she’s been a claims associate all her life, take my hat off to a completely on doing that job day in, day out. So it’s a difficult one, but I do know the people behind who come up with these definitions do try and they’re absolute damnedest to make sure these policies are value for many, whatever that means when you have a diagnosis of cancer.

Kathryn (44:23):

Absolutely.

Matt (44:23):

I think just this cancer business, again, it’s this term cancer, I’m not sure maybe whether we’ve got this right. You mentioned a tiny little, sorry, tiny little subjective words. You mentioned somebody going into the GP surgery just to have a skin cancer removed. That’s highly unlikely that in clinical terms that that would really be cancer.

Kathryn (44:56):

They

Matt (44:57):

Probably told that it’s cancer or early cancer or it might turn into cancer and it’s that big C word again. And yeah, I think we’ve probably done that particular conversation to death, but I think you’re absolutely right in suggesting to everybody that when they potentially are having conversations with people and there are other diseases as well, not just BO cancer, that they’re just wary of the death sentence mentality that still exists out there for many people when they hear that termly, well done you for raising it in my opinion. Can I just go back to

Kathryn (45:39):

Raising everything we are getting towards the end. We’ve not got long go on

Matt (45:45):

One thing out. You mentioned terminology and so on and so forth. I think that’s where we got to, and again, I’m going to have to go back to critical illness here, but if you look at the definition, we’ve talked about gleasons, but you’ll also find in the less advanced cancer definitions, you come back to good old clinical TNN classification.

Kathryn (46:06):

Yes.

Matt (46:07):

So you’ve got that one as well on the less advanced cancers. So if you’re looking at for life insurance for instance, it’s worth mentioning to your potential client whether that particular they’ve been given that particular classification as well. Definitely. And TNM very, very quickly, for those who haven’t listened to previous podcasts, T tumor size N is nodes, number of nodes. Impact is in M, it’s metastasized. So in terms of the less advanced cancers for critical illness, the scale given the grading given has to be a minimum of T two A, which means it has to be a certain size. The A means that the tumor is confined to one half or less and half of one of the prostates two lobes. N means remember this is the minimum no nodes impacted and it’s not metastasized. So you get a payout there on relatively early cancer, but TTNM maybe one that your clients have heard of as well as Absolutely.

Kathryn (47:23):

Oh, definitely. It’s always a good thing to have to say. If you ask someone the staging and grading and they haven’t got a clue what you want about, and then you start asking, well do you know the size of it and things like that, sometimes that can help as well. Actually you might say it was two centimeters or something, but then go Right. Do you have a TNM have that arsenal there as well just to do that right. As we’re getting towards the end, Matt, what we do be expecting in terms of life kicking IP for somebody who has prostate cancer and let’s say we’re looking at a very favorable, it’s really well maintained, it’s stable, it’s low PSA low Gleason score, what would you be expecting?

Matt (47:59):

Okay, the manuals are changing. The insurance guidelines do tend to change on this subject and for life insurance, I think I mentioned an example of case I’ve seen relatively recently, very low stage and the case was initially postponed six months from the date of diagnosis, and then there was a loading of 50% to the loading throughout the term of the policy. And if you think about this disease is going into the chronic category as opposed to acute with very high mortality early on, long you survived, then the risk can maybe good answers to normal terms standard rates. Then a lot of these ratings for prostate cancer now are being loaded on the base of a continual medical loading throughout the term of the policy where the more severe cancers still attract loadings on a rating that would attract a certain amount of money per thousand pounds worth of some insured

Kathryn (49:15):

Per rating. Yes,

Matt (49:17):

We’ll see that kind of change in terms of critical illness, a very low stage critical illness, then I am seeing a kind of a move to exclusions.

Kathryn (49:35):

Yeah, I would expect that. Yeah.

Matt (49:36):

Bear in mind you’ve also got got payout for low grade as well in there, not just over gleasons seven or more on gleasons, so you’re going to get the exclusion as opposed to a loading and income protection. I must admit I’ve not done a prostate cancer in its broadest definition of cancer for a very long time, but I’ll be very surprised if the insurers will cover it. Income protection.

Kathryn (50:09):

Yeah, absolutely. That’s what I would be expecting to. And just before I go on to the case study to sort of finish off today, I mean it’s one of those things where I think we’ve been able to do possibly standard terms for life insurance before, but it was where the readings were incredibly favorable and the person was actually quite old. So I think it was just kind of seen as these are really good readings and what we kind of expect the prostate to be doing this at this age in a sense. So it kind of seems a bit like we expect blood pressure to change as we get older. That type two diabetes becomes something again, when people get older, it’s not always a given, but people are more likely to develop it as they get older, as they start to move less. So it’s not seen as big a concern as say somebody who is a lot younger.

(50:55):

But one thing that I’m interested in just very, very quickly is the whole thing about breast cancer exclusions versus prostate cancer exclusions in the family medical history. So we do tend to find that with women who’ve got a family medical history of close family members that will usually be mother or sister. Obviously male relatives can also have breast cancer and at a young-ish age, so probably well under the age of 60, that can lead to a breast cancer exclusion on the person’s critical illness policy due to the family member, and you might even see that some insurers do a cancer exclusion. So you need to really, really watch those definitions as an advisor, make sure you’re getting the best one, but we don’t have the same when it comes to male life policies in the sense of prostate cancer, you don’t get a prostate cancer exclusion if someone, a close male relative also had prostate cancer. What’s the reasoning behind that? Is that too big a question?

Matt (51:58):

No, I don’t believe in two bigger questions to be honest with you. I think you should ask absolutely everything that you want to ask. Let me say this, I am surprised that if a male member of the family that is defined as close in insurance terms, I a father or brother who has had prostate cancer under the age of 60, they’re not rated

Kathryn (52:32):

Yes, but not an exclusion.

Matt (52:37):

I would say, again, this probably comes down to lack of, no, I’m sorry, I’m just trying to think through the way that the actual question you’ve asked me there. So you’re saying an absolute exclusion, but for family history, my view would be for critical illness then and what you’re going to pay out for under critical illness. In other words, the fact you’ve now got less advanced cancers being paid out on, then there should be an exclusion there. That’s my view

Kathryn (53:19):

Because the things, I don’t want more exclusions, but Well,

Matt (53:22):

I was going to say by raising that, you may now of course the industry think, oh my goodness, Kathryn Knowles, this is a whole nother, don’t do

Kathryn (53:31):

That. Yeah, let’s not do that. But no, it’s just obviously there needs to be reason. It’s just one of those things. We do do quite a lot of stuff in terms of thinking and I there, I think I heard someone wants say, well actually genetically there’s more of a genetic link for breast cancer within family than there is prostate cancer. I can see that. But it’s just one of those things where as a woman looking at things and you’re just like, hang on a minute kind of thing.

Matt (54:03):

It could well be though that statistically the dreaded statistics word that there are not a lot of men under the age of 60 who are actually diagnosed

Kathryn (54:18):

Possibly not. Maybe it is more

Matt (54:20):

Cause of the nature of prostate cancer and therefore it becomes statistically insignificant.

Kathryn (54:29):

Possibly

Matt (54:29):

That doesn’t necessarily underwriters and the guys that come up with the rating, so mixture of underwriters, claims, people I should add as well, and actuaries.

Kathryn (54:39):

There’s lots, yeah,

Matt (54:41):

They don’t just think that statistic means this. They will look at a statistic and say, well, is that reasonable? Does that make sense? They might talk almost down to a consultant in that particular field. And all I can say is I do know of, I certainly know of a father and son, her father was diagnosed with prostate cancer. His son went for a test because of that, and he added as well, and he was a young chap, but his father wouldn’t have been under age of 60.

Kathryn (55:19):

So

Matt (55:19):

From a disclosure perspective, he would’ve been Okay,

Kathryn (55:23):

So you wouldn’t needed to say about the deb, but you needed to say about yourself.

Matt (55:27):

Oh, sorry, after the fact. Yeah, just give me you a brief example, not a specific example. Yes, you’d have to told Tom the insurer about himself. Yeah, very much so. Absolutely.

Kathryn (55:38):

The thing is, I’m sure there’s

Matt (55:39):

Reasoning age of 60.

Kathryn (55:40):

Yeah, there’s always going to be reasonings from that, but it’s just as an advisor sometimes you see something and you’re just like, I just wonder what the reasoning is. It’d just be nice to have an answer on that. So that’s really, really useful to have. With that, Matt,

Matt (55:51):

I’m not sure if I’ll give you an answer though, Kathryn, so the answer’s, sorry. No, no, no, no. It’s a feeling of what I would do logically after all these years. However, I’m going to find out for you.

Kathryn (56:03):

Thank you, I appreciate that. Hopefully get an update on a further one.

Matt (56:07):

Yeah, absolutely. Absolutely. I’ll find out for you what

Kathryn (56:11):

The answer

Matt (56:12):

To that is or the best thinking that’s possibly available at the moment is Yes,

Kathryn (56:18):

Absolutely. So I have a case study, so case study for everybody. So somebody in their late forties, a gentleman, and this person actively had prostate cancer. Well, no, I was going to say no. So they’d had prostate cancer and they also had another condition. I’m not going to detail it because I just feel like it could be too identifiable, but there was another condition as well that affected the premium, so I’m giving the final premium. Please bear in mind that that’s not just a premium in relation to having had the prostate cancer. It is also to do with something else that did affect the amount. So for this person, the prostate had been removed five months before terms were offered. So that’s just to give you a bit of a timeframe in terms of we’d had the diagnosis, but the surgery had been done about five months since then.

(57:01):

And so obviously in terms of indication, we had indication from underwriters probably about three to four months after surgery, but as with anything, you have to wait for the GP reports. So for this person, the Gleason score was initially six, and their PSA reading was 7.7 and they were the readings that were taken eight months before terms were offered. The PSA had dropped to not 0.1 by the time that the terms were offered. So that’s a huge drop in that PSA reading for this person based upon their needs and everything. Life insurances arranged at 50,000 pounds over 17 years, and the premium was approximately 22 pounds per month, and that 22 pounds, as I say, it is a mixture of a rating due to having had the prostate cancer and also something else. So if it had just been the prostate cancer, it would’ve been even less than that.

(57:55):

So there we go. That is our case studies and everything today. I hope everybody that you found this useful. Thank you, Matt, as always for joining me and giving me your insights. Next time, we have Lisa Balboa with me again, and she’s joining us from Hannover we, and she’s going to be talking about things in insurtech, how the insurance world and health technologies are changing, how it’s potentially going to help us in terms of underwriting applications and providing long-term health support to policy holders. As always, if you want a CPD certificate for having listened to this, please visit the practical hyphen protection.co UK website where you can get a CPD certificate. Thank you to our sponsors, the Okta members. Thank you so much for your time, Matt, it’s been lovely to speak to you. My

Matt (58:37):

Pleasure. My pleasure as always.

Kathryn (58:40):

Thank you. Bye

Matt (58:41):

Bye.