Insurance Update
May 2017
Issue No. 80
In this issue
Stopping skin cancer
 

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  A not-for-profit ministry of
Church of the Brethren Benefit Trust Inc.

Church of the Brethren Insurance Services provides the following products: dental, vision, basic life and accidental death & dismemberment, supplemental life and AD&D, dependent life and AD&D, retiree life, long-term disability, short-term disability, critical illness, and Medicare supplement for eligible Church of the Brethren employees .
 
Dental, vision, retiree life, and Medicare supplement coverage may also be available for eligible retired Church of the Brethren employees.
 
For eligibility information, call Connie Sandman at 800-746-1505, ext. 366, or contact your human resources representative.
 
Medical and ancillary plans (named above) may be available to Brethren-affiliated employer groups.
 
Long-Term Care Insurance is available for all members of the Church of the Brethren, their family and friends, and employees of Church of the Brethren-affiliated agencies, organizations, colleges, and retirement communities. 

Contact Us 
1505 Dundee Ave., Elgin, IL 60120
800-746-1505
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As the weather continues to warm, and the sunny days of summer draw closer, it is appropriate that we focus our attention on the effects of the sun. Did you know that a very high percentage of skin cancers are produced by exposure to the ultraviolet rays in sunlight?

Since May is officially Skin Cancer Awareness Month, this issue of Insurance Update offers some helpful information on skin cancer. It recounts the different forms and the treatment options. There is an explanation of why the sun is a danger but also why moderate amounts of sun are necessary. There are tips on what you can do to protect against the extremes of sun exposure, reviews of sunscreens, and guidance on how to read sunscreen labels. Finally there are several stories of people who have suffered serious skin cancers.

We also want to shine a light on short-term disability insurance - a product offered by Brethren Insurance Services that protects you immediately in the event of accident or illness, and may be more necessary than you know.

We hope you continue to find Insurance Update engaging and useful as you think about matters of health and wellness. And may spring continue to embrace you with warm breezes, entice you with colorful flowers, brighten your view with budding trees and vivid green lawns, and call you out into God's lovely outdoors. And once you are out in all that magnificence, may you remember the lessons of this issue and apply plenty of sunscreen.
 
Short-Term Disability Insurance -- a wise choice
Disability is more common than most people realize. Estimates vary between one-in-four and one-in-five for the number of workers that can expect to be disabled for three months or longer during their working life. Reliance Standard insurance company estimates that one in seven employees can expect to be disabled for five years or more. The prospects of sinking into poverty rise for people with a disability. Unexpected illnesses and injuries cause 350,000 personal bankruptcies each year and nearly 50 percent of all mortgage foreclosures.
 
In the March issue of Insurance Update we explained the benefits of long-term disability insurance. But to be fully prepared, you should also have a short-term disability policy. A sudden injury or illness can quickly put you into financial distress. If your injury is work-related and you have workers' compensation, the early weeks of your disability will be covered. But you may work for an employer who does not offer workers' comp. Further, most injuries and illnesses causing disability are not work-related and thus not covered by workers' comp. This is where short-term disability insurance will help you.
 
Short-term disability in contrast to long-term disability is just what its name implies. It provides benefits at the beginning of the disability and for a short time until other provisions can begin. On the other hand, long-term disability insurance does not provide benefits immediately, but the benefits last for a long time; LTD policies have an "elimination period," meaning payments begin after a certain period of continuous disability. For instance, the elimination period of the LTD policy offered by Brethren Insurance Services is 90 days. Some people have the financial resources to cover those initial weeks, but most people do not. They quickly exhaust their sick days and savings. This is where short-term disability insurance makes sense. An STD policy will cover you almost immediately.
 
Short-term disability terms vary, but with the policy offered by Brethren Insurance Services, payments begin on the 15th day of the illness or injury and continue for 11 weeks, thus covering almost all of the 90-day e limination period. The payments provide 60 percent of weekly earnings up to a maximum of $1,250 per week. Also note that the BIS policy includes maternity benefits.
 
 
The policy  does have a "pre-existing" period. Any sickness or injury for which you received medical treatment, consultation, care, or services, including diagnostic procedures, or for which you took prescribed drugs or medicines during the three months immediately prior to your effective date of insurance is not covered fo r the first 12 months in which the policy is in effect.
 
It is not difficult to see how valuable STD insurance can be. If your disabling injury or illness incapacitates you for a few weeks, STD will replace a sizeable portion of your pay check, so that when you are back on your feet, you are not in a financial hole. If your disability is long-lasting, you do not begin your long-term benefits with a large financial burden.
 
So STD added to LTD is a wise way of protecting yourself and your family from the effects of the unthinkable -- a serious and debilitating illness or injury. Think about these coverage options when making your benefit selections, and if your employer does not provide a group benefit through Brethren Insurance Services or another provider, it can still make sense for you to check out what options are available in the private market. 
Paying attention to skin cancer

Did you know that between 40 and 50 percent of Americans who live to age 65 will have either basal cell carcinoma or squamous cell carcinoma at least once? That is an extraordinary statistic considering that we hear more about other cancers than about skin cancer. Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon. In the U.S., over 5.4 million cases of non-melanoma skin cancer are treated each year in more than 3.3 million people. Further, did you know that about 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun? It is not surprising that the month of May is associated each year with skin cancer awareness.

Skin cancer is a broad term that refers to any type of cancer that begins in the cells of the skin, usually developing in the top layer of skin, also known as the epidermis. More specifically according to the Skin Cancer Foundation, it is "the uncontrolled growth of abnormal skin cells," occurring when "unrepaired DNA damage to skin cells (most often caused by ultraviolet radiation from sunshine or tanning beds) triggers mutations or genetic defects that lead the skin cells to multiply rapidly and form malignant tumors."

Basal cell carcinoma
The most frequent form of skin cancer is basal cell carcinoma. BCCs are abnormal and uncontrolled lesions in the basal cells, which line the deepest layers of the epidermis. They often look like open sores, or they can be red patches, pink growths, shiny bumps, or scars. They are caused by the cumulative effect of exposure to the sun or by occasional excessive exposure. BCC rarely spreads, but it should not be taken lightly. If not treated, it can cause disfigurement. More than 4 million cases are diagnosed each year in the U.S.

Squamous cell carcinoma
The second most common form of skin cancer is squamous cell carcinoma, which is uncontrolled growth in the squamous cells, which compose most of the skin's upper layers. SCCs appear in a variety of ways -- scaly red patches, open sores, elevated growths with a central depression, or warts. They may crust over and bleed. If allowed to grow, they can disfigure and become dangerous. They can be caused by cumulative UV exposure over a lifetime. Occurring anywhere in the body, they are most often found on areas exposed to the sun-the rim of the ear, lower lip, balding scalp, neck, hands, arms, and legs.

Melanoma
Melamoma originates in the pigment-producing melanocytes in the basal layer of the epidermis and can resemble moles and sometimes develop from moles. They are generally black or brown and are usually caused by intense, occasional exposure to ultraviolent rays, often leading to sunburn especially in people with a genetic predisposition.

According to the Skin Cancer Foundation, an estimated 9,730 people will die of melanoma in 2017. An estimated 87,110 new cases will be diagnosed in the U.S. in 2017. If treated early, a melanoma is almost always curable, but if not, it can metastasize. The estimated five-year survival rate for patients whose melanoma is detected early is about 98 percent in the U.S. The survival rate falls to 62 percent when the disease reaches the lymph nodes, and 18 percent when the disease metastasizes to distant organs. On average, a person's risk for melanoma doubles if he or she has had more than five sunburns.

Genetic factors
Atypical mole

Every article and scientific paper on skin cancer emphasizes sunlight and UV light exposure as the primary cause. But the etiology is a bit more complicated than that. According to the National Cancer Institute there are more than 100 types of tumors clinically apparent on the skin, and "many are known to have familial and/or inherited components, either in isolation or as part of a syndrome with other features." Though BCC and SCC, the most common non-melanoma skin cancers, are usually caused by the sun, there are also hereditary and genetic factors. In the case of melanoma, 5 to 10 percent of all cases arise in families where there are multiple cases. So it seems clear that there are several genes and hereditary syndromes associated with the development of skin cancer. It appears that genetics won't give you skin cancer, but they might create a predisposition.

People of color and skin cancer
Then there is a question often asked: Can people of color get skin cancer? The answer is yes, everyone can get skin cancer. It is true that many people of color are less susceptible to the UV damage of the sun and other forms of UV radiation because there are greater amounts of melanin, the protective pigment that darker skin produces. But darker skin can still be damaged by too much exposure. Further, there are other factors to consider. Darker-skinned people are more susceptible to acral lentiginous melanoma, an especially virulent form of melanoma that appears on the palms of the hands and the soles of the feet. With the more common forms of skin cancer, risk varies by ethnicity. Latinos, Chinese, and Japanese tend to develop BCC, while among African Americans and Asian Indians SCC is more frequent.

Treatment
Treatment for skin cancer varies with the form, the intensiveness, and aggressiveness of the cancer. This article lists some of the most frequently used treatment options. Surgical excision is used to treat many kinds of skin cancer. When the surgeon is experienced and the tumor is small, results are very good both medically and cosmetically. With cryosurgery, tumor tissue is destroyed by freezing. Liquid nitrogen is applied with a cotton-tipped applicator or spray device. No cutting is required. Curettage and electrodesiccation is like a combination of cutting and freezing, with a 95 percent cure rate. Radiation, for inoperable skin cancers, uses X-ray beams directed at the tumor with no need for cutting or anesthesia. Treatment continues several times a week for one to four weeks.

Mohs micrographic surgery
In the 1930s, Dr. Frederick Mohs developed a surgical technique that has stood the test of time and has come to be embraced by an increasing number of surgeons for an ever-widening variety of skin cancers. A thin layer of tissue containing the tumor is removed. While the patient waits, sections of this excised layer are mapped in detail and examined under a microscope in a laboratory on site. If cancer is present, the procedure is repeated in the area where the cancer cells were identified. The tissue mapping allows the surgeon to pinpoint where that is. Successive layers are taken until the last excised layer is cancer-free. This process has the lowest recurrence rates, highest cure rates, and best cosmetic results of any skin cancer treatment. 

Effect of the sun
But, of course the best treatment for skin cancer is prevention, and the first thing to consider is the sun, which has fallen from grace in recent decades, sadly. Once it was seen as the great bearer of light and health; now it is regarded by many as a danger. So which is it -- benefit or hazard, or both? And is the best prevention for skin cancer to make sure you are never exposed to the sun's UV rays?


Dangers
According to the information from the Skin Cancer Foundation cited earlier in this article, "about 90 percent of non-melanoma skin cancers are associated with exposure to ultraviolet radiation from the sun." And note again that "between 40 and 50 percent of Americans who live to age 65 will have either basal cell carcinoma or squamous cell carcinoma at least once." These are the two main non-melanoma skin cancers. So, almost half of all Americans living to retirement age will suffer the negative dermatological effects of the sun.

Though basal cell carcinoma and squamous cell carcinoma can be inconvenient and difficult, they are usually not killers. That distinction belongs to melanoma, which accounts for only 1 percent of cases of skin cancer but the vast majority of deaths. Again, according to the Skin Cancer Foundation, a study in the U.K. determined that about 86 percent of cases of melanoma are from exposure to the ultraviolet radiation from the sun. So there can be no denying that the sun can have a very deleterious effect on one's skin and one's health.

Benefits
But there is another side to this discussion. UVA rays, which have the longest wave length of ultraviolet rays and which are not filtered out by the atmosphere, stimulate the body to produce vitamin D. In Australia, an anti-sun-exposure campaign extended over many years has produced a populace in which 31 percent of adults now have vitamin D deficiency. When levels of this vitamin are low, the bones tend to lose calcium and become weaker. In moderate amounts, UVA rays also help prevent breast cancer, colon cancer, and prostate cancer.

The UVA rays stimulate the melanocytes in the skin to produce more of the brown pigment called melanin, which helps protect the skin against the rays and helps you tolerate more of the sun. So a tan can give protection, up to a point. Further, the sun triggers physical and psychological responses that are not fully understood. We know that people in climates where the sun rarely shines, especially in the winter, sometimes suffer from seasonal affective disorder. When they can get out into the sunlight, their spirits lift. Sunshine is often a motivator that invites people to go outdoors and be active.

Tanning
But the dangers of sunlight are real and even pervasive, and the tan that seems so healthful can be hazardous. It is the ultraviolet light that does the damage, and the evidence is so strong that many states have banned tanning salons. Tanning, or at least over-tanning, can have painful, lasting, and even life-threatening results. Prolonged exposure to the ultraviolet radiation of the sun results in burning by the ultraviolet B rays. The effect is that immune cells in the skin release histamine, which causes blood vessels to dilate and leads to acute inflammation. Anyone who has had bad sunburn knows what this looks and feels like. Some of the cells can be so badly injured that they die and flake away. Brown spots can appear. The burning can lead to basal cell carcinoma, which, while not usually malignant, can cause cosmetic problems.

But too much exposure can lead to malignant melanoma, which can spread and develop very rapidly, metastasizing to other parts of the body, becoming a killer. People who have been repeatedly over-exposed to the sun and have been sunburned from an early age are at special risk. Too much exposure over a long period of time will also speed skin aging and permanently wrinkle the skin. The blood vessels in the skin can become permanently dilated, and the skin can become thick and red.



To sun or not to sun?
So what is it to be? Well, we should all exercise more caution than we might think we should. But sun in reasonable amounts is healthful. Just don't stay out too long and don't get sunburned. Here are some things to remember in order to protect yourself against the sun: 
* Wear a hat with at least a three-inch brim.
* When outside between 10 a.m. and 4 p.m., seek out the shade.
* Cover your skin with clothing - wear a long-sleeved shirt.
* Use a broad spectrum (protecting against UVA and UVB rays) sunscreen with an SPF (sun protection factor) of 15 or higher. For extended outdoor activity use a water resistant, broad spectrum sunscreen with an SPF of 30 or higher.
* Apply two tablespoons of sunscreen to your body 30 minutes before going outside and repeat every two hours or right after swimming or heavy sweating.
* Keep newborns out of the sun.
* Always use sunscreen on children. They should never get sunburned.
* Stay away from tanning salons.
* Remember there are different "levels" of shade. You can get indirect or diffuse UV radiation even when you are in shade. Only deep shade (no sky visible, no UV penetration) gives you complete protection
* Beware of cloudy days. You can still receive UV radiation.
* Wear sunglasses year-round when you are in sunlight.
* Give yourself a head-to-toe skin examination every month.

Skin Cancer Awareness
Author Maud Hart Lovelace wrote in one of her books, "The sunshine was like powdered gold over the grassy hillside." It is unpleasant to have to acknowledge that something so rich and good, so life-giving as the sun can be the primary cause of a widespread form of cancer. But that is the reality of skin cancer. If there is anything that emerges from Skin Cancer Awareness Month, it is that the sun is not as benign as we may have wished, and that too often people forget to protect themselves from its deleterious effects. But as we admit this sobering reality, let us not forget that in proper amounts the sun can even help condition the skin to handle the sun's own rays. Of course, the sun is immutable. We cannot live without its light and warmth. So we must handle it with thoughtful attention. If we do that, we may enjoy this "powdered gold" on our skin during a long and healthy life.
Catch it early or your odds go way up
Stories of people with skin cancer
Not my face
Beautiful international model Zacki Murphy was alarmed to find a suspicious spot on her nose. She had worked with Avon, Cover Girl, Cosmo, Coty, Maybelline, Merle Norman, Revlon, Oil of Olay, L'Oreal and many others. Her face, hair, and body were her paycheck. Her head was spinning when her dermatologist did a biopsy and told her she had basal cell carcinoma.

She remembered days as a teen spent at the pool, using iodine and baby oil to amplify the sun's effect. When she was a cheerleader, bronzed limbs were much in demand; she and her teammates practiced at the beach, each trying to get the darkest legs. In college she sunned on the sorority house roof. She later dated actor George Hamilton, the "tan man," always in the sun or in his Rolls Royce convertible with the top down. And there were many times in her years of modeling that clients asked her to "get a little color" for photo shoots, which she often did with no sun protection. All this sun exposure was ill-advised for someone with Scottish-Irish fair skin.

The cancer on the tip of Zacki's nose was growing. Zacki's dermatologist recommended Mohs surgery and a sizeable amount of tissue was removed. The surgery was successful, but it had disfigured her nose. She was very self-conscious and unwilling to go anywhere. After six weeks, the doctor recommended scraping and polishing down the damaged skin layers with, of all things, sandpaper. A week later her dermatologist found another suspicious spot, did a biopsy, and found it precancerous. The dermatologist sprayed liquid nitrogen on the spot to freeze it (cryosurgery), and the lesion crusted and fell off.

Zacki Murphy is now cancer-free, but very vigilant. She writes, "Unfortunately, once you suffer sun damage, and especially once you've had a skin cancer, your odds of developing future skin cancers go way up, so I will always have to be careful, practicing sun protection, checking my skin head to toe regularly, and visiting my dermatologist two or more times a year to make sure we catch any new skin cancers early, when they're easily curable." 
  ( Click here for Zacki Murphy's full account.)
 
A family loss
Nicole Kinnumen noticed a large, strange-looking mole about the size of a quarter on the thigh of the tall blond man from Finland she began dating in 1999 while they were students at Eastern Michigan University. Mikko assured her he'd had it all his life and it was no big deal. In 2002 they married, and as time passed, they bought a house, welcomed two daughters, and acquired a dog. In 2011, the mole became an issue thanks to the dog, who inadvertently scratched it. The wound would not heal and Mikko saw a dermatologist who was immediately concerned. A biopsy showed that it was a melanoma at risk of spreading to the lymph nodes or beyond.

Mikko had surgery to remove the mole. A biopsy found no evidence that the cancer had reached the lymph nodes. The doctors and nurses were optimistic. Nicole and Mikko thought he would be fine.

But in the fall of 2012, Mikko began to feel sluggish and noticed that the lymph nodes in his groin were swollen. Doctors ran tests. Everyone was shocked to learn that the cancer had returned and had advanced. Just after Thanksgiving tests showed it had metastasized to other parts of Mikko's body. Nicole and Mikko learned that the five-year survival rate at this stage was only about 16 percent. In early December, they told their family and friends. They both managed to continue to work. Despite intensive treatments over the next three months, the cancer spread to the lungs. Mikko was more and more fatigued, and he began to have trouble eating and concentrating.

When he could not put words together, Nicole took him to the emergency room. The cancer had reached Mikko's brain. After trying radiation, the doctors said there was nothing more they could do. Nicole asked for hospice care at home. Mikko said goodbye to his daughters, Fiona, age 6, and Phoebe, age 3. He died on April 1, 2013, at age 35.

Nicole and her daughters have been surrounded by a network of loving friends and family. Mikko's best friend John has created a golf tournament in his name that raises thousands of dollars each year for the Skin Cancer Foundation. Though not particularly religious, Nicole talks to her daughters about their dad in heaven, and they like to think of him using a golden iPhone or peering down to watch his beloved Detroit Red Wings when he is not looking in on them.

In her darkest moments, Nicole is haunted by the thought that Mikko would still be alive if they'd had the mole checked and removed back when they got married. She now knows the five-year survival rate when melanoma is caught early is 98 percent. She knows she cannot go back, but now whenever she sees someone with an abnormal-looking mole, she urges that person to have it checked out.
( Click here for the full account of Nicole, Mikko, and family.)
 
Brady Bunch star survives skin cancer
Christopher Knight is well known for being an entrepreneur, game show host, and child star in the role of Peter Brady on the sitcom The Brady Bunch. However, few people know that he has been treated repeatedly for skin cancer.

Growing up in the 60s and 70s, Christopher spent countless hours outdoors in the sun, giving little thought to sun protection. His parents were of the generation that believed that sunshine and fresh air were keys to a healthy lifestyle. "There was no room for the idea that the sun was a source of ill health," said Knight, who, when not acting, was often at the beach with his family.

A UV photo test of his face showed shocking sun damage, but it was not visible in regular light, and he continued to enjoy being outside without protection from the sun. By the time Christopher was 55, the damage began to appear as actinic keratosis, rough scaly patches. He began topical treatment with 5-fluorouracilm, and he noticed an elevated red spot on his cheek that kept bleeding and healing. A biopsy showed it was basal cell carcinoma. The biopsy did not remove all the cancer and it was soon back. He had Mohs surgery, which had to be repeated. Today he is grateful to be left with no scars and a deep gratitude for Mohs surgery. He does not go to the beach as often, and when he does, he wears a hat and uses sunscreen. He is resigned to the fact that the sun can be a hazard.
( Click here for Christopher Knight's full account.)
 
A Haircut could save your life
The woman at the hair salon who washed Dr. Deborah S. Sarnoff's hair noticed a black spot on the doctor's scalp. Not able to see the spot in the mirror, Dr. Sarnoff asked the woman to take a photo with her cell phone. Dr. Sarnoff could see immediately that the lesion had most of the classic warning signs of a melanoma. She left her hair appointment and rushed to her office, which she shared with her husband who was a plastic surgeon.

Dr. Sarnoff knew that scalp melanomas are the most lethal of all melanomas because she is a distinguished dermatologist, the Senior Vice President of the Skin Cancer Foundation, someone who is constantly emphasizing the need for regular skin self-examination. She is a Mohs surgeon and she specialized in skin cancer, operating on more than 1,000 patients a year. Yet she did not know of her own possible melanoma. She wondered how she could have neglected herself.

She had the spot excised immediately and waited three days for the results of the biopsy to come back. The verdict - benign! Dr. Sarnoff delivered gift certificates and her thanks to the staff at the hair salon and began to spread the word about the important role hair stylists can play in catching scalp melanoma. 
( Click here for Dr. Sarnoff's full account.)
Choosing the best sunscreen
Sunscreens combine several ingredients to help prevent the sun's ultraviolet rays from reaching the skin. There are two kinds of UV rays. UVA have longer wave lengths, cause lasting skin damage and skin aging, and can cause skin cancer. UVB have shorter wave lengths, cause sunburn and skin damage, and can cause skin cancer. The Skin Cancer Foundation offers the following guidance on how to read a sunscreen label.
  • A broad spectrum sunscreen protects against both kinds of UV radiation.
  • The sun protection factor or SPF is a measure of the sunscreen's ability to prevent UV light from damaging the skin. Let's say it takes 20 minutes for unprotected skin to turn red. A sunscreen with an SPF of 15 should prevent the reddening 15 times longer or for about 5 hours. Sunscreens with an SPF of 15 or higher do a good job.
  • The words "water resistant" on the sunscreen label indicate that the sunscreen remains effective up to 40 minutes when you are swimming and 80 minutes if you are sweating. The FDA prohibits the use of "waterproof" or "sweatproof," since neither is possible.
  • Look for the Skin Cancer Foundation Seal of Recommendation
  • There are two kinds of active ingredients in a sunscreen: chemical and physical. "Chemical" ingredients like avobenzone and benzophenone work by absorbing UV and reducing its penetration. "Physical" ingredients like titanium dioxide and zinc oxide stay on top of the skin and deflect UV rays. Many sunscreens combine chemical and physical elements.
Consumer Reports is one of the most consistently reliable rating services for many products. Here are their top-rated sunscreen lotions, sprays, facial applications, and sticks. Following the Consumer Reports list is a ranking of "ultimate sun creams" by Cosmopolitan magazine in which sunscreens are evaluated for certain narrow special purposes.





Brain Puzzle
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Insurance Update -- monthly BRAIN PUZZLES -- just for fun!


CRYPTOGRAM

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Long-Term Care Insurance 
Brethren Insurance Services offers Long-Term Care Insurance
 
Eligibility for long-term care insurance benefits is determined by the inability to meet at least two of these six activities of daily living -- bathing, eating, dressing, toileting, continence, or transferring. Cognitive impairment can also trigger benefits.
 
It's difficult to think about the fact that a debilitating condition or a disabling injury might leave you unable to care for yourself, or that when you reach your twilight years, the time will come when you will need some extra care. Long-term care insurance makes sure that you will get the care you need. It helps assure that the cost of your custodial care will not eat up your savings. Finally, and this is one of the best things about LTCI, it can help protect your children and other relatives from having to use their resources to care for you.
 
Brethren Insurance Services offers Long-Term Care Insurance for all members and employees of the Church of the Brethren and their family and friends; and also for employees of Church of the Brethren-affiliated agencies, organizations, colleges, and retirement communities and their families and friends.
 
If you are interested in obtaining this coverage, contact Brethren Insurance Services at  insurance@cobbt.org or 800-746-1505 for a free, no-obligation proposal or  click here to request more information.