Family history and prostate cancer: What underwriters need to know

09 March, 2026

Protection Underwriting

With March being Prostate Cancer Awareness Month, Zurich’s Nicky Bray explains why family history is important – and how it is assessed in underwriting.

Prostate Cancer Awareness Month puts a spotlight on one of the most common cancers affecting men – and a recurring point of confusion in underwriting: what insurers really mean by ‘family history’.

“Some people provide far too much information about distant relatives, while others provide very little and don’t understand why we ask the questions we do,” says Nicky Bray, chief underwriter at Zurich.

“We don’t require a full family tree. We’re trying to understand whether there’s a significant inherited risk that could affect someone during the term of the policy.”

For underwriters, the focus is not on every condition that has ever appeared in a family, but on patterns that suggest an increased likelihood of early diagnosis or death.

Why family history matters

Family history has long been part of insurance underwriting, but recent research has underlined just how influential genetics can be in shaping both longevity and disease risk.

Heritability accounts for around 55% of human lifespan, according to a large genetic analysis published in Science earlier this year¹. Researchers analysed data from twins and siblings born across several decades in Scandinavia and the US.

Meanwhile, a Swedish population study published in 2024 found that each additional decade of parental lifespan was associated with a roughly 22% lower risk of all-cause mortality in their children, as well as reduced risk of hospitalisation across multiple disease categories².

For underwriters, the relevance of family history is straightforward: it helps to determine whether an inherited risk could affect someone during the term of a policy.

“We’re looking for patterns that suggest someone may be more likely to develop a serious condition earlier in life,” says Bray. “That’s why age at diagnosis is so important. Conditions that appear at a younger age are more likely to have a genetic component and are more relevant from an underwriting perspective.”

This is why Zurich focuses on diagnoses or deaths before the age of 65. Earlier onset can signal inherited susceptibility, whereas conditions that emerge later in life are more often driven by ageing or environmental factors.

“We’re not interested in every illness that has ever occurred in a family,” adds Bray. “We’re interested in information that genuinely helps us assess risk fairly and consistently.”

What Zurich means by ‘family history’

One of the most common sources of confusion for clients – and advisers – is what insurers mean when they ask about family history.

Zurich’s application question focuses on natural parents, brothers and sisters, and on a defined list of medical conditions. By ‘natural’, Zurich means biological relatives. This includes half-siblings but excludes adopted or step-siblings.

“The reason is simple,” says Bray. “We’re assessing inherited risk. If you don’t share DNA with someone, their medical history doesn’t tell us anything about your own genetic risk.”

This distinction matters particularly in blended families or where a client has been adopted. Where an applicant genuinely does not know their biological family history, the question should be answered as ‘unknown’.

“If someone has no knowledge of their biological parents or siblings, there’s nothing for us to assess,” says Bray. “We shouldn’t penalise for a risk we can’t evidence.”

The list of conditions itself focuses on those most associated with genetic influence, including certain cancers, cardiovascular disease, diabetes and neurological disorders.

In addition, the application includes a broader catch-all question asking whether there is any other condition in the family for which the applicant has been advised to have ongoing screening or follow-ups.

“That question is there to pick up rarer inherited conditions that don’t fall neatly into a standard list,” says Bray. “Some of these conditions are uncommon, but they can still have a significant impact on future health and life expectancy.”

For applicants, what matters is clear, accurate information about first-degree biological relatives, the condition involved and the age at which it occurred.

Why prostate cancer is a key case study

Cancer of the prostate – a small, walnut-sized gland located just below the bladder, which produces fluid for semen and begins enlarging from around the age of 40 – is the most common cancer in men, claiming the lives of more than 11,000 men each year, according to Prostate Cancer UK³.

With no national screening programme and often no clear early warning signs, despite campaigns designed to raise awareness, many men are diagnosed at a later stage than they could be.

Early symptoms can be subtle or easily dismissed. As the prostate enlarges, men may notice changes in urination – such as difficulty starting, a weak flow, or needing to urinate more frequently at night – symptoms that are often attributed to ageing or benign prostate enlargement rather than cancer.

Prostate cancer is one of the most heritable cancers. Twin studies suggest that around 57% of variation in risk is genetic⁴, and men with a father or brother diagnosed with the disease have a two- to four-fold higher risk^5,6,7, particularly where a brother is affected⁸.

Family links are not limited to prostate cancer alone. Breast and prostate cancer are known to co-occur in families⁹, reflecting shared inherited pathways such as BRCA gene mutations.

From an underwriting perspective, prostate cancer sits in a distinctive position. While it is a major driver of critical illness claims, it does not always have a corresponding impact on life expectancy.

“Prostate cancer can be very treatable,” says Bray. “In many cases, people don’t actually die of prostate cancer. They die with prostate cancer, from something else entirely, such as heart disease or stroke.”

That does not mean the condition is benign. Treatment can have a profound impact on quality of life, with side effects including urinary problems and sexual dysfunction. As a result, prostate cancer accounts for a significant proportion of critical illness claims, even where long-term survival prospects are relatively good.

Risk also rises sharply with age. Prostate cancer primarily affects men over 50, and the likelihood of diagnosis increases as men move into their 60s and beyond. Family history further amplifies that risk, particularly where close relatives have been diagnosed at a younger age.

“This combination of age and inherited risk is what makes prostate cancer particularly relevant for underwriting,” says Bray. “It’s common, it’s closely linked to family history, and with the average age of customers buying insurance increasing in line with buying houses and starting families later, it often emerges during the years when people are likely to hold protection policies.”

This helps explain why family history has a greater impact on critical illness cover than on life insurance.

Prostate cancer in practice: when Zurich pays

Critical illness definitions for cancer can appear highly technical, particularly when they refer to grading systems and staging codes. Prostate cancer is no exception.

At the centre of the definition is the Gleason score, which measures how aggressive the cancer cells look under a microscope. The highest score is ten. High-grade cancers with a score of nine or ten are generally twice as aggressive as those with a score of eight¹⁰.

Under Zurich’s core critical illness policy, the full sum assured is paid where prostate cancer has been histologically classified with a Gleason score of seven or above, or where it has progressed to a specified clinical stage following prostatectomy (removal of the prostate).

Where the cancer is less advanced, Zurich provides a separate partial payment. This applies to tumours classified with a Gleason score of six that have progressed to at least a defined early stage and have required active treatment to remove or destroy tumour cells. In these cases, the policy pays the lower of £25,000 or 25% of the sum assured.

Tumours under active surveillance or observation are not covered under this additional payment definition.

“The grading and staging language can look intimidating,” says Bray. “But in practical terms, we’re distinguishing between lower-risk, slow-growing cancers and those that are more advanced or clinically significant.”

This distinction reflects the reality of prostate cancer. Many low-grade cancers are monitored for years without progressing, while higher-grade tumours are more likely to require definitive treatment and have a greater impact on health and lifestyle.

For advisers, the key point is that prostate cancer is clearly covered under Zurich’s critical illness policy, with defined thresholds that align with clinical severity.

“Definitions exist to make sure claims are assessed consistently,” adds Bray. “They’re not there to catch people out. Where the cancer meets the agreed criteria, we pay.”

How family history affects outcomes

While prostate cancer is a major driver of critical illness claims, the way family history feeds into underwriting is often misunderstood.

For life insurance, a family history of prostate cancer typically has no impact on premiums.

“Because prostate cancer is often treatable and does not always shorten life expectancy, we don’t load life cover purely on the basis of family history,” explains Bray. “The bigger impact is on critical illness cover.”

Underwriting outcomes for critical illness policies depend on a combination of factors: how many close relatives have been affected, their age at diagnosis and the age of the applicant.

Where there is a single first-degree relative diagnosed before age 65, younger applicants will often still receive standard rates. As the applicant gets older, however, the likelihood of developing prostate cancer themselves increases – and underwriting reflects that rising risk.

“This is one area where the pattern can feel counter-intuitive,” says Bray. “With some hereditary cancers, such as breast cancer, risk falls as you get older because the disease tends to appear earlier if it’s genetically driven. Onset of prostate cancer happens much later in life, so the effect of the extra risk from the family history works the other way round. The closer you get to the age at which a parent or sibling was diagnosed, the more relevant that family history becomes.”

Where there are two or more first-degree relatives diagnosed with prostate cancer before age 65, ratings increase as the applicant moves further into the higher-risk age range. For Zurich, this entails a premium increase for applicants aged 30 to 49, which then increases for applicants between ages 50 and 59, and higher again for those aged 60 and over.

Where there is a strong family history, Zurich may also exclude the additional payment for less advanced prostate cancer, while still offering full cover for more advanced cases under the core definition.

“In practical terms, that means the customer is still insured for the more serious forms of the disease,” says Bray. “However, it costs more, because the likelihood of a claim is higher.”

For advisers, the reassurance is that even where family history leads to higher premiums or limited exclusions, cover is still available.

“We’re not looking to decline customers’ applications based on family history alone,” adds Bray. “Our aim is to offer cover that reflects the risk fairly and pays out when it’s most needed.”

There is also growing evidence that awareness of family history can influence health outcomes. Research from the Institute of Cancer Research suggests that men with a strong family history of prostate cancer often have better survival once diagnosed, likely because greater awareness leads to earlier diagnosis and treatment¹¹.

For advisers, this reinforces the value of family history discussions not just for underwriting, but for longer-term health.

Practical takeaways for advisers

For advisers, the key to handling family history well is clarity – both in what you ask for and how you explain it to clients.

Focus on first-degree, biological relatives

When collecting family history, concentrate on biological parents, brothers and sisters (including half-siblings). Step-relations and adopted relatives are not relevant from an underwriting perspective because they do not share DNA.

Capture what matters: condition, relative and age

The most important details are:

which relative(s) were affected
the condition involved
whether it was diagnosed, or resulted in death, before age 65

Over-collecting information about distant relatives rarely helps and can slow down underwriting.

Explain why age matters

Conditions that appear earlier in life are more likely to have a genetic component and are more relevant to underwriting. Helping clients to understand this can make the questions feel more logical and less intrusive.

Be clear with adopted or ‘unknown’ histories

If a client genuinely does not know their biological family history, record this accurately. Insurers cannot assess – or load for – risks that cannot be evidenced.

Set expectations on outcomes

For prostate cancer, family history does not usually affect life insurance premiums. It may, however, influence critical illness pricing or features, particularly as clients approach the age at which relatives were diagnosed.

Stress the importance of disclosure

Accurate disclosure protects the client. Under-disclosure can lead to retrospective changes at claim stage, while clear upfront information helps to ensure the policy performs as expected when it is needed.

As Bray puts it: “We’re not trying to make cover harder to obtain. We want to offer fairly priced cover and pay claims in the way that customers and advisers expect.”

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