DISCLAIMER
The below is the personal account of Gemma Willsher our co-founder and practice manager. Gemma is not a doctor, and this is intended as a personal opinion piece and not medical advice. If you would like to explore any element of this with one of our doctors please do not hesitate to get in touch. You can also download our Trucheck Explainer Document by clicking here.

How it began

When we learned of the Trucheck’s Intelli blood test, a new cutting edge cancer screen that looks for 70 different forms of cancer, which collectively account for 81% of cancer diagnoses globally, including several aggressive cancers, I instantly knew that it was something our patients would be interested in. Winchester GP prides itself on sourcing the very best treatment for our patients at each stage in their health care journey. Regular patients at our practice will already have experienced our lack of hesitation to seek a specialist opinion. And this continuous search for quality also extends to diagnostic testing, where for example, back in the depths of the covid pandemic, we were one of the very first practices nationally to offer a laboratory analysed Covid Antibody test- (remember those?!!) But fast forward to the present day, and quite rightly, thoughts return to the C-word that never went away- Cancer.

The C- Word

Cancer is an emotive subject. Mention it to anyone and if they have not experienced it directly themselves they are more than likely to have lost someone close to it, or know someone who has been through it at some point. And this is no wonder, as according to Cancer Research, the current lifetime risk of developing cancer for someone born since 1960 is 50%. Literally, a coin toss! In the face of these ‘even’ odds, the options for screening so far have been extremely limited. We have FIT testing for bowel cancer, HPV screens for cervical cancer, and mammography for breast cancer, all of which are undeniably helpful. But even if we all engaged in those programmes religiously we would only have covered a handful of the dozens of forms of cancer out there. For the remainder, we have to rely on symptoms prompting us to go to the doctor, and the relevant investigations being ordered. Add on to this the fact that for some cancers there can be a significant time between a tumour developing and symptoms developing, and it seems pretty clear that we need a new approach that is both more comprehensive and able to catch cancers at a far earlier stage.

Trucheck Intelli is a gigantic step towards that goal. It is a ‘liquid biopsy’ blood test and works by looking for Circulating Tumour Cells (CTCs) in a blood sample. When we were in the process of vetting the test, we talked to the team at the provider, Datar Cancer Genetics at length - both the scientists and managerial staff - and were impressed across the board. They explained to us in depth how the test works, but to summarise: When a tumour develops within the body, it starts to shed circulating tumour cells (CTCs) in to the blood stream pretty much straight away. The test uses a new cutting edge process to kill off all of the non-cancerous cells in it, and then take a good long hard look at whatever is left standing - that would be the CTCs. And because CTCs retain the hallmark features of their organ and tissue of origin, it is possible from this process to identify not only the presence of cancer, but also the likely organ and tissue of origin. To put it another way, this test takes a haystack, blows away all of the hay, until only the needle is remaining. This is why we knew we wanted to offer it in our practice.

Who should take the test, and how often?

Trucheck tells you what is going on in your body up to the point at which the blood is taken. You could conduct it once in a blue moon, and it would give you useful information each time. But much of the test’s benefit lies in its ability for early detection- to buy you time. Trucheck can literally take back much of the head start that cancer can get by developing silently. And the earlier a cancer is detected, the greater the range of treatment options available - and the less invasive they are likely to be. In other words, to get the most benefit out of Trucheck, it needs to be conducted regularly, and precisely at the point where you don’t ‘feel’ like you need it all. This is where I step forward.

My personal Trucheck journey

It is one thing to co-found and manage a doctors practice- and look for exciting new testing developments to offer our patients. But quite another to actually experience those services first hand. In recent years, (and touching wood!) I have had the good fortune not to need the medical profession so very much.

In terms of my cancer risk, I have dutifully attended my smear tests, and done (most) of the right things in terms of managing my lifestyle factors: Stopped smoking shortly after university, normal BMI, moderate alcohol (unless it’s a party!), fanatical sunscreen wearer, regular exerciser…. But when it comes to my family history, I have blood relatives on both sides of the family who have succumbed to particularly aggressive and difficult to treat cancers.

Pancreatic cancer features on both sides, and it was only picked up when it had spread to the liver… never a good thing. It turns out that there is not a particularly strong familial link for that kind of cancer, (unlike breast cancer, for example) but still, the experience of seeing their 'number come up', and how devastating the prognosis was by the time it was diagnosed, was enough to persuade me. That, and the fact that I have threatened my children that I will still be hanging round aged 100, making a thorough nuisance of myself - I am a woman of my word!

What is involved?

In terms of the process of the test, it is incredibly straight forward. A short consultation with one of our GPs to ensure I understood exactly how the test works, and that I was a suitable testing candidate (no previous cancer diagnosis, no current potential cancer symptoms). They explained that with any laboratory test, there is a small margin of error, but that the Trucheck Intelli has a sensitivity and specificity of 99% i.e. that the false positive and false negative rate of the test is 1%. There’s also a very small chance of the test coming back as ‘equivocal’ or ‘indeterminate’ - both of which would simply mean the test has to be re-run free of charge to get a definitive result. Last but not least, it’s important to remember that the test looks for 70 different cancers- not absolutely all cancers. In particular it does not look for blood cancers (e.g. leukaemia) because the CTCs that the test looks for are only associated with solid organ malignancies. And once I’d signed my for my understanding and consent, I was booked in for the sample to be taken. Side note to fans of breakfast: this test has to be conducted on a fasting sample- so make sure that you book an earlier blood test appointment! Samples have to reach the laboratory within a short number of hours, so a bespoke courier is arranged for each batch of samples - and having waved my sample off, it was just a matter of waiting.

The Suspenseful Wait

Salute the 3 IVF miracles! (They’re a bit bigger these days… )

As a veteran of 2 rounds of (thankfully successful) IVF treatment, I have some significant experience of suspenseful waits for very important and momentous medical news. I am pleased to confirm that the wait for my Trucheck result was far less turbulent. In fact, I would go so far as to say that the process was so smooth as to be pretty ‘forgettable’ (unlike the all consuming hamster wheel of scans and prodding and poking that is IVF) I can honestly say that for the vast majority of the time the impending results didn’t cross my mind at all. There were still a few times when it popped in to my head. I turned 47 in the intervening period, and another birthday, whilst a cause for celebration, always brings a few ’mortality’ thoughts for me also. On occasion I caught myself imagining ‘what if’ the results were positive? How would I feel? Would I wish I hadn’t taken the test at all? Was looking so very closely a bit like prodding the hornets nest? Certainly we have had some patients take the view that they would prefer to ‘leave sleeping dogs lie’ - and of course one can only respect each individual’s personal take on this. But I take the view that however, ‘bad’ a finding of cancer might feel initially, it would still effectively amount to the gift of a 'fighting chance'. After all, I could be embarking on, and perhaps even concluding treatment before I had even been aware there was a problem otherwise.

The Results

Two weeks to the day later, my results came in - they came in to our practice in protected email format (although we always call our patients personally with their results) and suddenly it all felt very real again. I could actually feel my heart pound as I opened it up, and then a tangible surge of relief to see the all clear! A really surprisingly elated feeling - I had never thought I had cancer, but to be told with a really high level of certainty that I didn’t have any of the 70 target cancers was a source of what I can honestly call JOY! And although the test can only give a snap shot of what is going on at the time, I now have a ‘line in the sand’ - So if something came up in the following year, it would be very new indeed. In my mind that means that the benefits compound each time the test is repeated.

It will therefore come as no surprise to you that I will be getting the test again- annually for sure. In my mind it makes total sense- it is not ‘cheap’ but there again in any given year I pay considerably more for insurance policies that cover me for things that are statistically far less likely than a cancer diagnosis. And while many of those policies will help to support me if I’m completely incapacitated (or worse) it feels good to invest in something where the goal is to stop that disaster scenario even occurring. So thank you Trucheck Intelli. Thanks to you, if my number does come up, I aim to smile in the face of cancer and come out the other side.

Cheers to that!