Skip to main content
The Actuary: The magazine of the Institute and Faculty of Actuaries - return to the homepage Logo of The Actuary website
  • Search
  • Visit The Actuary Magazine on Facebook
  • Visit The Actuary Magazine on LinkedIn
  • Visit @TheActuaryMag on Twitter
Visit the website of the Institute and Faculty of Actuaries Logo of the Institute and Faculty of Actuaries

Main navigation

  • News
  • Features
    • General Features
    • Interviews
    • Students
    • Opinion
  • Topics
  • Knowledge
    • Business Skills
    • Careers
    • Events
    • Predictions by The Actuary
    • Whitepapers
    • Moody's - Climate Risk Insurers series
    • Webinars
    • Podcasts
  • Jobs
  • IFoA
    • CEO Comment
    • IFoA News
    • People & Social News
    • President Comment
  • Archive
Quick links:
  • Home
  • The Actuary Issues
  • July 2022
General Features

Screen refresh: Could the HPV DNA test affect critical illness claims?

Open-access content Wednesday 6th July 2022
Authors
Stephen Tseng
David Lu

Stephen Tseng and David Lu discuss the WHO’s recommendation on replacing the cervical smear test with an HPV DNA test, and what it could mean for critical illness insurance

web_p21_Screen-refresh_CREDIT_shutterstock_1911963175.jpg

Cervical cancer is a leading cause of female cancer. 

In 2020, an estimated 604,000 women were diagnosed with cervical cancer worldwide, and about 342,000 women died from the disease. In November 2020, the World Health Organization (WHO) launched its global strategy to accelerate the elimination of cervical cancer as a public health problem by scaling up the human papillomavirus (HPV) vaccination, screening with a high-performance test, and helping women with a positive screening test or cervical lesion to manage their conditions appropriately.

WHO recommendations

The WHO strongly recommends replacing the cervical smear test with an HPV DNA test for cervical pre-cancer screening. It recommends that all women start at age 30, with regular screening every five to 10 years. The cervical smear test is a cytological test that checks whether cells in the cervix are abnormal, while the HPV DNA test is a molecular test that identifies high-risk carcinogenic HPV genotypes, especially HPV16 and 18. A positive HPV DNA would indicate that the woman is at higher risk of getting cervical cancer.

The HPV DNA test could detect high-risk carcinogenic HPV genotypes when cells are still normal, thereby allowing earlier intervention. Cytological or histological diagnoses may not be necessary in the screening and treatment protocols.

For the HPV DNA test itself, the WHO suggests using upper vaginal samples, either self-collected (at home or in-clinic) or taken by a healthcare provider (in-clinic). Many countries have simultaneously introduced the HPV-based screening and the self-sampling approach, and the COVID-19 pandemic and associated social distancing have accelerated the introduction of self-sampling. The pandemic is changing the perspectives of self-sampling as a primary screening method for all women in many countries.

Compared with the cervical smear, which needs to be done in-clinic by a trained medical professional, self-sampling can feel less embarrassing and less intrusive. It can also be less uncomfortable physically, as the sample can be collected with a swab.

“The HPV DNA test could detect high-risk carcinogenic HPV genotypes when cells are still normal”

Impacts on insurance

The WHO’s recommendations will have impacts on health insurance – particularly critical illness markets.

A carcinoma in situ (CIS) is a group of abnormal cells that remain in the place where they first formed, without spreading. They may become cancer and spread into nearby normal tissue. Many critical illness policies include a CIS benefit, with different payout ratios (percentages of face amount) in different markets. The higher the CIS payout ratio, the higher the recommendation’s impact on the market will be. This is because more CIS findings are expected after HPV DNA tests are adopted, as they are more sensitive than cervical smear tests. Commonly seen payout ratios in different markets include 25% in the UK, 10~25% in Canada and 20~30% in China. In Korea it is generally 10%, but 20~100% is increasingly seen due to sales pressure faced by insurers.

Adverse impacts will also be greater in policies with an additional CIS payout design than in those with an accelerated payout. An additional payout is paid on top of the final sum assured, so if a policyholder claims under CIS and then develops another malignant cancer, they would be paid out the partial benefit at the point of CIS diagnosis, followed by the full sum assured at the time of the cancer diagnosis. (While the chance of developing cervical cancer after proper management of a pre-cancer lesion is very low, the policyholder may still develop other malignant tumours.) Accelerated payouts are an acceleration of a part of the final sum assured. If a policyholder claims under CIS and then develops malignant cancer, they would be paid the CIS benefit at the point of CIS diagnosis, followed by the remaining sum assured at the time of the cancer diagnosis. Markets where additional payout design is common include the UK, Canada and China. In Korea, the benefit is usually sold as an optional rider (so, again, additional to the main benefit).

The earlier detection and intervention that are likely to follow from the recommendation will mean reduced cervical cancer cases in the long run. This counterbalancing effect in morbidity savings will be more apparent in whole-of-life and longer-term products, and may be entirely lacking in a term product. This effect is therefore more likely observed in markets such as China (mostly whole-of-life) than the UK (mostly term).

Higher anti-selection, especially when a direct-to-consumer self-sampling test is available, is to be expected in term products. Potential customers who are aware of their own infection may take out a policy due to the high leverage (high ratio of sum assured to premium). This is particularly likely in markets where underlying HPV prevalence and awareness are high – for instance in Northern European countries. Policy applicants can also withhold information on a positive finding at the underwriting stage if test results are not available on medical records. (Notably, they are available on medical records in the UK pilot study.)

For medical reimbursement plans, whole-life medical expenses should fall, as the cost of screening and treating cervical pre-cancerous lesions is much lower than that of treating later-stage cervical cancer.

Table 1

Claims assessment

The new WHO guideline allows a decision to treat a suspected pre-cancer lesion based on a positive HPV DNA test only, without cytological or histological confirmation. In fact, we may only know 
that the HPV DNA test is positive without knowing whether it is a true pre-cancer lesion, or if the cells are still normal. Histopathology or cytology is a standard requirement for critical illness claims, but may not be necessary under the new WHO guidelines. If insurers were to continue with current guidelines and decline positive high-risk HPV DNA tests without histopathology, the practice could pose a reputation risk. On the other hand, if an insurer was to change its claims practice, 
the potential impact on pricing would have to be considered.  

Risk mitigation strategies and product design suggestions

Consideration of HPV DNA test results

The HPV DNA test is an effective risk selection tool because of its higher sensitivity. A prospective insured with a negative HPV DNA test is a better risk than a prospective insured with a negative cervical smear – so a better pricing offer could be considered given a negative HPV DNA test, even without a cytology report for critical illness or female cancer products, especially when the woman has been HPV-vaccinated. This is particularly true for customers of term products with a shorter coverage period, as the selection effect will gradually taper off.

Relative magnitudes of risk reduction that can be assessed through sensitivity or specificity of both HPV DNA and cervical smear tests are as follows:    

table 2

Limits on pre-cancer lump sum payments

A smaller sum-assured cap on pre-cancer benefits will help to control increased claims due to both additional and accelerated incidences of CIN2/3. As some of the positive HPV DNA cases have normal cytology, insurers need to consider the insurable interests of such cases and make proper benefits and pricing adjustments. On the other hand, morbidity savings from lowered cervical cancer claims in the long run may partially compensate for this. 


Stephen Tseng is senior pricing innovation actuary, Life and Health Products at Swiss Re

David Lu is chief medical officer, Asia at Swiss Re

Image credit | Shutterstock
ACT Jul22_Full LR.jpg
This article appeared in our July 2022 issue of The Actuary .
Click here to view this issue

You may also be interested in...

web_p18-20_Wear-and-share_CREDIT_Shutterstock_1009058053.jpg

Wear and share: the capabilities of wearable technology

Lisa Balboa, Tim Smith and Etienne van Wyk share their thoughts on the emerging claims prevention capabilities of wearable technology
Wednesday 6th July 2022
Open-access content
web_p24-26_Bringing-data-to-mind_Mental-health-and-data_Illustration_CREDIT_Getty-1307270547.jpg

Bringing data to mind: understanding mental health

Lisa Balboa, Maryse Nashime, Serena Soong and Joe Wilson assess how data use could help to progress actuarial understanding of mental health
Wednesday 6th July 2022
Open-access content
web_p27_An-end-to-underwriters_CREDIT_iStock-1219172362.jpg

An end to underwriters? The challenges of machine learning

Is machine learning a threat to the underwriting practice? Reza Hekmat and Balint Bone consider this possibility and its challenges
Wednesday 6th July 2022
Open-access content
web_p42_World-view_City-of-Malawi_CREDIT_Istock-1319000450.jpg

Worldview: Malawi

There is plenty of potential for the actuarial profession in this East African nation, says Edwin Mulenga
Wednesday 6th July 2022
Open-access content
web_p36-37_A-winning-proposal_General-insurance-Flooded-farmlands_CREDIT_Istock_1237827986.jpg

A winning proposal: insuring against flood damage to crops

Sze Won Tan and Kin Hoe Lee explain the innovative insurance solution they proposed for the problem of flood damage to crops, which won the SCI ASEAN Green Research Hackathon
Wednesday 6th July 2022
Open-access content
web_p40-41_Currency-conversion_Coin-cloud-abstract_CREDIT_Getty_1369169431.jpg

Currency conversion: attitudes to cryptocurrencies

Nicky Witras provides an overview of attitudes to cryptocurrencies in different countries, and explains why institutional investors have been slow to invest in this asset class
Wednesday 6th July 2022
Open-access content

Latest from Health care

yf

Animal crossing: the threat of zoonotic diseases

Prachi Patkee and Adam Strange discuss what the rising threat of climate-driven communicable disease means for insurers
Wednesday 30th November 2022
Open-access content
hb

Boiling point: the effect of rising temperatures on future mortality

As quantifying climate risk exposure becomes increasingly important, Dan Gill, Rajinder Poonian and Alex Harding investigate the effect of rising temperatures on future mortality
Wednesday 2nd November 2022
Open-access content
vb

Interview: Professor Paul Dalziel on changing the focus of economies from growth to wellbeing

Paul Dalziel talks to Alex Martin about the true purpose of economics and the lessons we can draw from the 2019 New Zealand wellbeing budget
Wednesday 2nd November 2022
Open-access content

Latest from General Insurance

td

Brain power

The latest microchips mimic cerebral function. Smaller, faster and more efficient than their predecessors, they have the potential to save lives and help insurers, argues Amarnath Suggu
Wednesday 1st March 2023
Open-access content
bl

'Takaful' models of Islamic insurance

Ethical, varied and a growing market – ‘takaful’ Islamic insurance is worth knowing about, wherever you’re from and whatever your beliefs, says Ali Asghar Bhuriwala
Wednesday 1st February 2023
Open-access content
il

When 'human' isn't female

It was only last year that the first anatomically correct female crash test dummy was created. With so much data still based on the male perspective, are we truly meeting all consumer needs? Adél Drew discusses her thoughts, based on the book Invisible Women by Caroline Criado Perez
Wednesday 1st February 2023
Open-access content

Latest from Technology

gc

Free for all

Coding: those who love it can benefit those who don’t by creating open-source tools. Yiannis Parizas outlines two popular data science programming languages, and the simulator he devised and shared
Wednesday 1st March 2023
Open-access content
td

Brain power

The latest microchips mimic cerebral function. Smaller, faster and more efficient than their predecessors, they have the potential to save lives and help insurers, argues Amarnath Suggu
Wednesday 1st March 2023
Open-access content
dty

Can we embrace a circular economy?

With our pull on the planet’s resources, are we bold enough to embrace a circular economy? The potential benefits are not just material, argues Travis Elsum
Wednesday 1st February 2023
Open-access content

Latest from General Features

yguk

Is anybody out there?

There’s no point speaking if no one hears you. Effective communication starts with silence – this is the understated art of listening, says Tan Suee Chieh
Thursday 2nd March 2023
Open-access content
ers

By halves

Reducing the pensions gap between men and women is a work in progress – and there’s still a long way to go, with women retiring on 50% less than men, says Alexandra Miles
Thursday 2nd March 2023
Open-access content
web_Question-mark-lightbulbs_credit_iStock-1348235111.png

Figuring it out

Psychologist Wendy Johnson recalls how qualifying as an actuary and running her own consultancy in the US allowed her to overcome shyness and gave her essential skills for life
Wednesday 1st March 2023
Open-access content

Latest from July 2022

web_p34-35_A-new-metric-system_CREDIT_shutterstock_2039592782.jpg

A new metric system for climate change

Michael Sher discusses key climate metrics and how to use them effectively to reduce climate change
Wednesday 6th July 2022
Open-access content
web_p30-31_Commons-purpose_Businessman-with-briefcase-watering-can_CREDIT_Ikon_Patrick George_00029384.jpg

Commons purpose: the organisations and networks behind climate-related governance

Neil Mitchell examines the structures behind the governance of the climate commons through a social network analysis
Wednesday 6th July 2022
Open-access content
web_p10_News_Council-election-results_CREDIT_iStock-1145240412.jpg

Council election results

The results of the election to the IFoA Council were announced at the IFoA’s Annual General Meeting on 15 June.
Wednesday 6th July 2022
Open-access content
Share
  • Twitter
  • Facebook
  • Linked in
  • Mail
  • Print

Latest Jobs

Senior Pricing Associate

Scotland / England, London
Up to £60000 per annum
Reference
149081

Outside IR35 - Reserving Contract - 6-8 months

London (Central)
Daily rate contract - outside IR35
Reference
149079

Actuarial Analyst - Longevity Reinsurance

England, London
Up to £55000 per annum
Reference
149080
See all jobs »
 
 
 
 

Sign up to our newsletter

News, jobs and updates

Sign up

Subscribe to The Actuary

Receive the print edition straight to your door

Subscribe
Spread-iPad-slantB-june.png

Topics

  • Data Science
  • Investment
  • Risk & ERM
  • Pensions
  • Environment
  • Soft skills
  • General Insurance
  • Regulation Standards
  • Health care
  • Technology
  • Reinsurance
  • Global
  • Life insurance
​
FOLLOW US
The Actuary on LinkedIn
@TheActuaryMag on Twitter
Facebook: The Actuary Magazine
CONTACT US
The Actuary
Tel: (+44) 020 7880 6200
​

IFoA

About IFoA
Become an actuary
IFoA Events
About membership

Information

Privacy Policy
Terms & Conditions
Cookie Policy
Think Green

Get in touch

Contact us
Advertise with us
Subscribe to The Actuary Magazine
Contribute

The Actuary Jobs

Actuarial job search
Pensions jobs
General insurance jobs
Solvency II jobs

© 2023 The Actuary. The Actuary is published on behalf of the Institute and Faculty of Actuaries by Redactive Publishing Limited. All rights reserved. Reproduction of any part is not allowed without written permission.

Redactive Media Group Ltd, 71-75 Shelton Street, London WC2H 9JQ