Our first case is a case of an abnormal screening test, specifically a Pap test. Screening tests are not done for cause, i.e., symptoms and signs of illness, but are performed because the incidence and the morbidity and/or mortality of the disease being screened combine for a worse outcome than if the population was not screened.
This determination is weighed against the accuracy of the screening test or procedure, the potential of bad outcomes from complications that might arise from procedures that might follow a positive screening result and the effectiveness of treating the disease earlier rather than later when it becomes symptomatic. There are hundreds of screening guidelines put forth by medical specialty societies and the US Preventive Services Task Force (USPSTF) for everything from Abdominal Aortic Aneurysm to Zika infection.
Inevitably we see cases in underwriting where the applicant has had an abnormality in a screening test and the follow-up testing is in progress or has been inconclusive. Those individuals are often postponed, while other applicants with similar characteristics who are not undergoing screening tests sail through the underwriting process without a second thought.
Every case is unique, and the risk should be assessed based on the facts. But, we would encourage underwriters to consider the applicants’ compliance with medical advice and probable outcome when calculating the overall risk.
Dr. Regina Rosace presents our second case of a young person with eosinophilic esophagitis. And finally Dr. Kadouch shares an Interesting EKG in our Puzzler.