Breast Cancer Challenge!

Breast cancer has been a source of ongoing discussion and some great victories over the past five years in life insurance. Earlier detection and advanced treatment has helped underwriters take a more aggressive stance and provide better offers than ever before.

Having said that, they still seem to have some hangups. A case I am currently shopping highlights one of those areas where they seem to be a bit hung up on the original diagnosis and have skipped over the reality of the prognosis. This particular client has inherited the BRCA1 gene, also known as the breast cancer 1, early onset gene. True to its’ billing she was diagnosed with breast cancer at age 40.

Pathologically speaking she was diagnosed with infiltrating ductal carcinoma and DCIS, ductal carcinoma in situ. By definition DCIS is actually a stage 0 cancer since, being encapsulated, it cannot and has not spread. Here’s where the problem begins in my attempts to reason with underwriters. In her pathology report the DCIS is shown as being stage 3. Impossible? I really don’t know but I’ve forwarded that information to a pathologist client of mine with Baylor Medical Center for a second opinion.

The second complication comes with the fact that, according to her first pathology report, the surgeon only took one sentinel node. A sentinel node is a lymph node taken from the underarm nearest to the location of the breast cancer. If the sentinel is positive, the cancer has spread. In her case the only node they biopsied was benign. I know from personal experience (my mother’s recent breast cancer) that taking one node is, well, odd. Based on my conversations with oncologists and the study I’ve done, generally there are anywhere from 10-25 nodes taken.

Two years later she was seen due to swelling in the lymph nodes in the same underarm and this time they biopsied 16 nodes and found two that were cancerous and pathologically cancerous with the same stage and grade as her original breast cancer. Safe to say that they missed two by only taking one? Don’t know, but most underwriters are trying to paint this as a new round of breast cancer rather than an error on the original surgeon’s part. Again I am searching for a second opinion. This part of my job gets sticky because doctors don’t like to say that other doctors didn’t do their job quite they way they maybe should have.

And the last piece to this puzzle is that the client, due to family history and the presence of the BRCA1 gene which also happens to carry some risk of ovarian cancer, has had a double radical mastectomy and a hysterectomy, theoretically not leaving anyplace for the gene to cause problems in the future.

Bottom line. We started this search with all of the underwriters saying absolutely no to life insurance. In round two of my searches we were able to get a few underwriters to say they would be willing to offer insurance 3 years out from the last treatment. I am now loading the cannons with my second opinions and heading into round 3.