The insured female is 30 years old, and the critical illness insurance is 500,000. I was told by health that breast nodules were found in 20 15. 12 units. She went to the hospital for treatment, and the doctor told her that it didn't matter and didn't do anything. The physical examination report of 20 15. 12 unit was submitted. B-ultrasound of breast: left breast nodule with unknown nature. Considering the possibility of proliferative nodules, BIRADS type, bilateral mammary glands showed proliferative changes, and no obvious swollen lymph nodes were found under bilateral armpits.
Reflections on underwriting
1, what is a breast nodule?
2. Which breast nodules are benign and which are malignant?
3. What methods can clarify the nature of breast nodules?
Risk interpretation of breast nodules
The following diseases are common in breast nodules:
1) Breast diseases: Breast diseases are hyperplasia of mammary glands. According to the characteristics of mass, breast diseases often find multiple nodules with different sizes and unclear boundaries in both breasts at the same time or successively, which can be promoted.
2) Breast fibroadenoma: Breast fibroadenoma is mostly single, with clear boundary, neat edge, smooth surface and mobility.
3) Breast cyst: Breast cyst is a swollen lobule formed when breast tissue is aging, and the lump is smooth and movable.
4) Intraductal papilloma of the breast: Intraductal papilloma of the breast often touches a round soft mass with a diameter of 0.3 ~ 1 cm under the areola or at the edge of the areola, and is often accompanied by nipple discharge.
5) mammary duct ectasia: mammary duct ectasia, also known as plasma cell mastitis, often takes a lump as the first symptom, with uneven edge and unsmooth surface, mostly located in the deep part of areola, often within 3cm in size.
6) Breast tuberculosis: At first, breast tuberculosis was mostly isolated nodules, and gradually formed one or several lumps with unclear boundaries, which easily adhered to the skin.
7) Breast cancer: Only a few breast masses are cancers, and most breast masses are solitary nodules with irregular edges, most of which are hard and often adhere to the skin.
All breast nodules are benign except breast cancer. Benign breast hyperplasia generally does not become cancerous. Only when atypical hyperplasia occurs, the chance of canceration will increase, and the chance of canceration of breast fibroma is very small. In the past, the incidence of breast cancer in elderly women was much higher than that in young women.
However, statistical data and clinical consultation in recent years show that the younger age has become the incidence trend of breast cancer, which is closely related to the accelerated pace of life of modern women, the increased pressure of work and employment, late marriage and late childbirth or no childbirth, and no breastfeeding after childbirth.
The family factor is 5%~ 10%. Women with a family history of breast cancer should have regular self-examination every month (usually 7- 10 days after each menstrual cramp) and see a specialist every three to six months. Generally speaking, women over 40 must have a molybdenum target every year. Clinically, to truly clarify the nature of breast nodules, we must rely on pathological examination, that is, through surgical resection plus pathological examination, or through puncture pathology of breast nodules. However, the possibility of applying this method to insurance inspection is very small, because these inspection methods are traumatic and cannot be accepted by insurance customers. In this case, the nuclear insurance personnel often arrange customers to do some imaging examinations, such as mammography and breast B-ultrasound, to help judge the benign and malignant nodules.
At present, BI-RADS grading can often be seen in mammography and B-ultrasound reports, so what does BI-RADS mean?
BI-RADS is a "breast image reporting and data system" established by American Radiological Society. At present, it is widely used in the world, but the examination report of breast lesions is more standardized.
1 grade: negative
Grade 2: benign
Grade 3: It may be a benign change, and short-term follow-up is recommended.
Grade 4: suspicious abnormality, biopsy should be considered.
Grade 5: highly suggestive of malignant tumor, which should be treated appropriately.
Grade 6: malignant by biopsy.
Discussion result
Underwriting requirements:
Breast nodules:
Surgical history within 2 years, requiring discharge summary and pathological report.
More than 2 years and less than 5 years of surgical history, requiring a questionnaire survey.
According to health advice for more than 5 years. Physical examination is required in all cases.
If there is no need for discharge summary and pathological report for more than 2 years, the physical examination is unilateral mastectomy, which is treated as breast malignant tumor.
Underwriting review
There is a clear annotation on breast nodules in Chinese Re-education Manual, which can be used as the basis for annotation of breast nodules combined with BI-RADS classification of breast.
B-ultrasound showed hypoechoic nodules, which were clearly classified by BI-RADS.
Breast nodules reach BI-RADS 2 or 3, life insurance is on the verge, and serious diseases and medical insurance are excluded, except for breast diseases;
For example, BI-RADS 4, life insurance, critical illness insurance and medical insurance are all postponed;
Underwriting review
? If there is no BI-RADS classification for B-ultrasound, any of the following items shall be met in the description: life insurance, serious illness and medical insurance are postponed, and the rest of life insurance is on the verge of bidding, except for serious illness and medical insurance: except for breast diseases;
1) Breast nodules reach 1 cm or more.
2) The boundary of breast nodules is blurred.
3) Breast nodules have blood flow signals.
4) There is calcification in the nodule.
5) Axillary lymph node enlargement.
I was told that the nodule had been removed before, and it was proved benign by pathology, with a medical history of more than 2 years. For example, B-ultrasound of breast has been submitted in the last six months, and no abnormalities have been found, except for breast diseases in life insurance and critical illness insurance; If nodules are found, no physical examination will be arranged within 2 years, except for life insurance and serious illness, except for breast diseases in medical insurance;
The breast puncture report was submitted and proved to be benign. The puncture result was nearly 6 months, and no operation was performed. Life insurance: temporary, except for serious illness, except for breast diseases; If the puncture result is more than 6 months, it is necessary to check breast B-ultrasound, and put forward opinions according to the results of breast B-ultrasound;
B-ultrasound shows that cystic nodules or cysts of the breast, regardless of size, are in danger of life insurance except for serious diseases, and are in danger of medical insurance except for breast diseases.
Underwriting conclusion
There is no clear comment on nodules in the manuals of Ruizai and Muzai, but it is mainly aimed at breast masses with definite nature. However, Zhong Zai's handbook has a clear annotation on breast nodules, which can be used as the annotation basis combined with the BI-RADS classification of breast.
The client's left breast nodule, whose nature needs to be investigated, is considered as a proliferative nodule, which may belong to BIRADS III class, so it is aimed at serious diseases except breast malignant tumor and its metastatic cancer and breast carcinoma in situ.