Cervical cancer and critical illness insurance
Adam Higgs is head of research at Protection Guru
This week signals Cervical Cancer Prevention Week, a week where health services and charities such as Jo’s cervical cancer trust come together to raise awareness about cervical cancer and how it can be prevented.
Cervical cancer is the most common cancer in women under the age of 35, however there are many things that women can do to reduce their risk.
In this article we have asked our doctors to explain what this form of cancer is, the risks, how it can be prevented and how critical illness plans cover the condition.
What is cervical cancer?
Let’s start by considering what cervical cancer actually is and how it affects the body. Our doctors explain this below.
The cervix is part of the female reproductive organs and is the entrance to the womb from the vagina, often referred to as the “neck of the womb”.
Cervical cancer occurs when cells become abnormal in this area and can grow out of control.
If left untreated this can invade surrounding healthy tissue or spread to other areas of the body, a process known as metastasis.
As with most cancers, if this is caught at an early stage it will have a significant impact on the health implications to the sufferer.
Virtually all cases of cervical cancer (over 99%) are caused by a very common type of virus called Human Papilloma Virus, or HPV, which is sexually transmitted.”
HPV is able to infect the skin and the cells that line the inside of the body, such as those in the cervix.
It is extremely common and almost all sexually active men and women will come into contact with it at some point in their lives.
It doesn’t usually cause any symptoms, which is why it will often go unnoticed. There are over 100 different type of this virus, with 13 known to have a link with cervical cancer.
Certain HPV types also cause genital warts.
Risk factors for cervical cancer
As with many cancers, cervical cancer has a number of known risk factors that increase the risk of a female suffering from the condition. Our doctors explain these below.
The following are known risk factors:
• Genital HPV infection.
• Multiple sexual partners.
• Lower socioeconomic status.
• Combined oral contraceptive use.
Age, number of sexual partners and socioeconomic status are thought to increasing the risk of catching HPV.
Smoking and combined hormonal contraception probably make it more difficult for the body to clear the infection.
In terms of prevention, there is a vaccination which has proved effective in reducing the risk of contracting cervical cancer.
Unfortunately, this vaccine is only effective in certain circumstances so not viable for women above a certain age as our doctors explain.
The UK HPV vaccination programme was started in 2008, based in schools.
The 12-13 year old age bracket are vaccinated as it is only effective if given prior to exposure to the virus, which is from sexual activity.
There are three HPV vaccines available in the UK, which protect against two, four or nine variants of the HPV virus.
All three vaccines cover the two most commonly associated with cervical cancer, HPV 16 and 18.
Currently the NHS offers Gardasil (thought to cover against 70% of cervical cancer cases), although Gardasil 9 (covering for 90% of cervical cancer cases) is also available if purchased privately.”
As with all cancers, the earlier cervical cancer is detected, the better the outlook for the patient.
Cervical screening has been available for over 30 years and has proved to be an effective way of diagnosing the condition early when it is more treatable.
“Cervical screening (previously called a smear test) has been used in the UK since the late 1980s.
This is where cells are taken from the cervix with a small brush and looked at under a microscope to see if there any pre-cancerous changes to the cells. In the UK, all women aged 25–64 years are invited.
• Every 3 years from age 25–49.
• Every 5 years from age 50–64.
Recently, NHS cervical screening has changed, with the laboratory now checking for HPV first, and the cells only being examined under a microscope if this is found.
This has made the screening more effective, with the new HPV-based screening preventing 60–70% more invasive cervical cancers than the older method.
Incidence of cervical cancer
Cervical cancer is the commonest cancer in women under 35 years of age. In 2017, there were 3,101 cases of cervical cancer in the UK.
It is suggested that 99.8% may be preventable with immunisation and cervical screening, which is discussed above.
Cervical cancer is unusual when compared to other cancers as it affects younger age groups, with a peak age of diagnosis in women between 30-34 years.
There was a 25% decrease in incidence rates in the 20 year period from 1995 (likely representing the introduction of cervical screening), although it has plateaued in the last decade.
It is thought that the HPV vaccination programme will have a huge impact on the incidence of this cancer.
A recent research study following over 1.5 million women in Sweden over an 11 year period after HPV vaccination, showed the risk dropped by 63% by the age of 30.
Unfortunately, there will be no direct effect from the vaccination programme for those born before 1991.
Therefore, it is thought that the future cervical cancer cases over the next 30 years will be dominated by these women, who will have a relatively high risk throughout their lives.
The current market covers two main forms of cervical cancers as our doctors explain.
Main cancer definition
Invasive forms of cervical cancers are covered by an insurers main grouped cancer wording. This includes all stages from 1 to 4.
Critical Illness plans will pay 100% of the sum assured for a stage 1-4 cancer while Vitality’s serious illness plan will pay 25% for a stage 1 cancer, 50% for stage 2 and 100% for stage 3 or 4 (if the cancer progresses to a higher stage additional payments will be made and if booster is included they pay 100% across all stages).
This is good news, as the majority of cervical cancer is found in the earlier, more easily treated stages (around 75% are found at stage 1 or 2).
Carcinoma in situ
Secondly, there is a lesser payment wording for those that are found to have “carcinoma in situ” of the cervix.
This is a fairly dated term, but can still be used synonymously with the more commonly known condition called Cervical Intra-epithelial Neoplasia 3 (CIN3).
CIN means there are abnormal changes to the healthy cells of the cervix. It is not cancerous, but has the potential to change into a cancer.
There are 3 grades of CIN, depending on how deep the abnormal cells go into the surface of the cervix, with 3 indicating that the full thickness of the surface layer is affected.
CIN3 is being found more because of cervical screening. If abnormal cells are found, this may lead to a biopsy being taken and CIN being found.
If CIN3 is diagnosed, treatment is usually offered as there is a higher risk of this becoming cancerous.
Most insurers, put very strict stipulations on this wording, preventing a successful payment unless the whole cervix or the womb (hysterectomy) is removed.
These are very rarely needed, as there are very high success rates for the less severe forms of surgical treatments which are specifically excluded.
Therefore, although there are relatively high incidence rates, the benefits from the carcinoma in situ wording are relatively small.
As more children are vaccinated against the Human Papilloma Virus it is likely that over time the rates of cervical cancer will decrease.
In the interim, cervical screening is a very effective method of detecting the condition earlier when it is more treatable.
COVID-19 has meant that there are additional challenges for women attending screenings, which could lead to an increase in more invasive forms of the cancer as it may not be detected as early.
It is important that as many women as possible understand what they can do to help prevent the condition and to support this important cause or learn more you can visit the Jo’s Cervical Cancer Trust website.