Older-Age Screening Tests Coming Into Focus For Life Underwriters

The two other testing candidates are distinguished by the fact that one has been a major element in healthcare for decades while the other is the latest laboratory resource to attract interest in the industry's search for alternatives to the baggage-ridden ways of the past.

Hemoglobin (Hb) is the protein which transports oxygen in the bloodstream. Unlike most disease markers in the complete blood count (CBC), it can be performed within the constraints imposed by mobile paramedical specimen collection.

Hemoglobin defines the presence of anemia. Although too non-specific in terms of demarcating the cause of anemia to help underwriters in this regard, a growing volume of clinical studies show a powerful association between even borderline low Hb levels and significant older-age mortality.

Links between reduced hemoglobin levels and increased risk of death relate to various illnesses such as heart disease and cancer as well as to physical frailty.

The last of these, frailty, is particularly important because underwriters now appreciate the ominous risk impact of premature frailty. Adding inexpensive Hb determinations to other evidence of declining physical function should enhance the industry capacity to underwrite efficiently persons in their 70s and older.

The newest kid on the block is a blood lipid test with the imposing name of lipoprotein-associated phospholipase A2 (Lp-PLA2). In persons with (or at high risk for) coronary and/or cerebrovascular disease, Lp-PLA2 appears to be a strong indicator of future events such as heart attacks and strokes.

As with Cystatin C, further efforts are now underway to clarify how Lp-PLA2 might harmonize with the aforementioned tests to exceed by far the value of treadmills and electrocardiograms (ECGs) while also being 100% objective in how they relate to insurability.

A matter now under consideration on some quarters underscores the importance of defining a screening profile made up of appropriate components. Recent efforts to promote insurer deployment of a tumor marker known as carcinoembryonic antigen (CEA) pose a dire threat to underwriting credibility.

CEA, which is deemed clinically untenable to screen even high-risk subjects, could bring down the wrath of customers, physicians and others. The industry had a similar experience several decades ago with an ill-chosen marker dubbed TAA–a marker that resulted in healthy applicants being told they might have cancer and having to undergo expensive tests, to the dismay of their doctors. Those are sober realities the industry would be wise to dodge like the insidious bullets they are.