Hello everybody and welcome to our webinar this evening. I'm Catherine Bell from the webinar Vet, and tonight I am here to chair our session, which is brought to you thanks to the very kind sponsorship from Vevolition. So huge thank you to the team there.
Tonight we are joined by Doctor Tom Butera. For those of you who may not know our speaker, let me introduce him before we get started. Tom has over 40 years' experience in equine and small animal health, alongside a strong track record in veterinary business development and management.
Since 2016, he has held leadership roles at Mars Veterinary Health, overseeing divisions such as Pet Partners, Barnfield Pet Hospitals and VCA. He has played a key role in acquiring over 60 general and specialty animal hospitals. Prior to Mars, Tom was co-founder, board member, and chief medical officer of Pet Partners LLC, which operated 68 hospitals across 32 US states.
His business leadership position helped pet partners get in shape for acquisition by Mars in 2016. So huge welcome Tom, thank you so much for joining us. Thank you, Catherine, and I appreciate very much that the nice introduction reminds me of.
My white hair, what I've done in the past, so. Oh, thanks very much, Tom. Well, just one last thing from me before I pass over.
Just a quick reminder to everybody, if you do have any questions for Tom, please just pop them into the Q&A box, and we will make sure that we've got some time left at the end to run over them. And that's it from me. So thank you, Tom, over to you.
Thank you again, Katherine, and good morning, good afternoon and good evening. Wherever you may be from different parts of the world listening to us this evening, we certainly very happy that you're joining us and I hope we're very hopeful that you will find this both interesting and motivational to help you get more involved with early detection and cancer screening. Both myself and my veterinary team and the volition team as a whole are very passionate about cancer screening and early cancer screening, because what it does for us is it, it, it identifies a different population of dogs that we're looking at.
We are looking at healthy dogs. These are, these are dogs that are immunocompetent. Versus four-legged friends that are sick and present with cancer, and they are immunocompromised.
So hopefully, with the early detection of cancer screening and in particular the use of the new Cvet test, we can find a way to improve treatments. Lower costs to treat and hopefully have much longer quality of life for our pets. That's really the goal and the mission of all of us that are involved with volition veterinary, and one of the keys to establishing that is through an early cancer screening test.
And I'm gonna take you on about a 45 minute journey. Of what the new Qvet cancer test is about. We're gonna talk about what it is.
We're going to talk about how to use it, and we're also gonna tell you how to incorporate it, consider incorporating it into your veterinary hospital. And some common questions that come up that veterinarians have given back to us about how to utilise it even better. So with that said, let's go ahead and get started and start chatting about the new Cvet cancer test.
I've been with volition since May of 2021. We've had Communications, webinars, conversations, and presentations all over the world, and we continue to do that with the passionate mission of trying to save more dogs' lives. We know that many of you who are attending this this evening have had those tears in the exam rooms and unfortunate, have been unfortunate witnesses to having to put dogs to sleep way before their time.
And then also to cry with the with the pet owners. With having to do that. We are trying to address that issue.
We're trying to address that issue to try to save these dogs' lives sooner and earlier, so that we can have longer pet lives and also be able to lengthen the relationship, that loving relationship that the pets have as family members with those pet parents. So how is cancer detected today? There are 4 basic areas where we frequently see cancer.
And how it's detected. Some cancers may develop quickly, showing no signs, of course. Not all symptoms of cancer are the same.
Pet owners may choose to wait out symptoms, we know that frequently occurs. Is that, well, you know, he's not feeling well, he's not quite moving around the way he used to. Maybe he, maybe he's just not feeling good.
Let, let's just wait it out. Let's just see what happens. And then unfortunately, when those types of situations occur where, where pet parents are waiting, dogs are often brought in once symptoms have worsened, or once symptoms have developed.
And therein lies the reason why we want to address that population of pets when they are healthy, and when they're jumping around, when they're not showing any clinical symptoms of illness. Canine cancer today, almost 50% of dogs over the age of 10 will develop cancer. That is an amazing amount of cancer that is going on in our dogs, and obviously we're seeing a significant amount both on the human side as well.
There's approximately 6 million new cancer diagnoses a year in the US alone. Hemangiosarcoma and lymphoma make up almost a third of those cancer cases diagnosed. We're talking about close to 2 million of just those that those two hemopoietic diseases.
That's just a phenomenal rate and a phenomenal number of cases that we deal with. HSA and LSA account for more than 50% of cancers that are treated by veterinarians. So not only do they make up a third of it, we spend half of our time treating those two particular hemopoietic nasty diseases.
And cancer, unfortunately, is frequently diagnosed late. It requires costly, invasive procedures and expensive treatments. These are the things that we are trying to address and hopefully trying to improve on.
The value of screening. Let's talk about the value of screening. Frequently what we do is we see healthy cells in animals, and then they become, then they morph.
To abnormal cells when there is an illness developing, and then they get to a pre-invasive stage when they are not the animal is not showing clinical symptoms externally, but the cellular development and the cellular death going from healthy to abnormal cells is progressing. This is the time where screening becomes most important. This is when you want to start to screen the pets before they show clinical symptoms, before they get to invasive cancer.
Which is when we get into early diagnosis and we start to see swollen lymph nodes, we start to see we're not appetite anymore, swollen abdomens. You know what I'm talking about in terms of the classical symptoms. And then you get the symptom onset which just starts to progress.
And unfortunately, that's many times when we begin to see these pets coming into the veterinary hospital. And by that point in time, unfortunately, they are frequently exhibiting metastatic cancer. Here comes the new Cvet cancer test.
This is a very, very exciting test. It's an accessible test, meaning it could be run in any reference lab in the world. It is an it's an Eliza-based test.
It also can be run in a point of care test in your hospital, and I'll talk about that in a little bit. It's very affordable to the pet owner, and it's very easy to use. And we will go through those pieces right now, so we, so you can understand how easily this test is and what this test is.
Let's talk about how does this test work. First of all, any of the veterinarians in the crowd, maybe you remember learning about nuclearomes, maybe not, but obviously I remember hearing about them, but I didn't, I really didn't have an education about them till I actually joined volition. And what we have here is a chroma nucleosomes basically, you can see here in the slide, you have a you have a chromosome matrix.
And the chromosome matrix is basically made up of proteins, and these proteins are wrapped with DNA. You can see chromosome is number one. You also see the the nucleosome which is wrapped by the DNA strand, which is number 3, and that formulation, that collection of the protein with the DNA strand formulates a nucleosome.
When you have high cellular turnover in the bloodstream, and this usually occurs when you have cancer, or you have an acute inflammatory condition like pancreatitis or some other or GI crisis of some sort. This can lead to an increased concentration of nucleosomes in the bloodstream. What is happening is you are seeing cellular turnover or cellular death.
These nucleosomes, as you see here at #2, break off of the chromatin matrix and they circulate into the bloodstream. When they circulate into the bloodstream, they start to elevate in numbers. They can be captured by antibodies which are tailored very specifically to detect those nucleosomes, and then what we do with the new vet cancer test is we quantify these circulating nucosome levels in the bloodstream.
So we actually have a quantifiable number of what that number is, whether low, high, mid-range, and we'll get into how that, how that is portrayed in terms of the diagnostic profiles that we. That the test provides us. Clinical evidence We have a peer-reviewed and published case series of 662 dogs.
Just so you know, Volition currently has 5 peer-reviewed papers, on nucleosomes and the use of the new Qvet cancer tests in, in canine. We actually, interesting enough, just put us out our first feline paper as well, in the early stages of feline research. And in this particular paper, you're gonna see we had 662 dogs, 134 of them were healthy, 528 were with cancer.
With 97% specificity, and what that means just as a reiteration for all of us, that means 3% false positives, which is a very small number. We wanted to make sure that we had a test that had very few false positives, and with 97% specificity, we certainly do. As you see on the right here, 76% of systemic cancers, in particular, lymphoma, and angiosarcoma, and histiocytic sarcoma, which comprise a significant portion of those hemopoietic diseases, we have a detection rate or a sensitivity rate of 76%.
50% of all cancers that we have researched and in the subsequent slides, you will see that we, we did significant research on the seven most common cancers. When you put the hemopoietic cancers together with the more solid tumours like mast cell or melanoma, our overall detection rate was about 50%. That is also consistent with some of the work that's been done by the DNA sequencing, by some of our colleagues with DNA sequencing, in terms of this is a this is a liquid biopsy test, so consequently, we see those nuclearsomes in the bloodstream, where you have greater circulation with lymphoma, hemangiosarcoma, and histocytic sarcoma, you're going to get a higher level of sensitivity.
Solid tumours, there's not as much blood flow, but when obviously you develop solid tumours and instead they they start to develop into metastasis, then obviously the rate goes up significantly. So let's talk about that a little bit. Here you're going to see the 7 cancers you, you're going to see here, the 7 cancers that I'm specifically speaking of Doctor Heather Wilson Robles did so much work for us.
She was the head of, head of oncology at Texas A& Texas A&M Veterinary university. Lymphoma, hemangiosarcoma, histiocytic sarcoma, melanoma, osteosarcoma, mast cell tumour, and soft tissue sarcoma. Those are the seven most common cancers that we see in dogs, and you will see here lymphoma is 77% sensitivity, hemangiosarcoma 82%, histiocytic at 54%, and then.
Also, you can also see a difference between histiocytic sarcoma and bone, which was less 20% because it's more encapsulated, more difficult to reach, but the visceral, the visceral histiocytic sarcoma was at 62%. Melanoma is at 43%. Mast cell tumour in the different grades, whether it's 12 or 3, has different variations, and then you will also see osteosarcoma is about 35%.
When osteosarcoma becomes metastatic. And starts to get into other organs, and there's organ failure, then the values of the new que will go significantly higher. So when that dog comes in with an encapsulated hock or a limb location where there's specifically swollen in that area but are not showing clinical symptoms of metastatic disease, then you're more inclined to probably see a lower number of about 35%.
So, but the seven common cancers when you put them all together, we're at around 50%. So let's talk about how do you submit a sample? How does this work?
Remember, this is a liquid blood biopsy test. You draw 2 to 5 mLs of blood from a peripheral or a jugular vein. You immediately fill it into an EDTA tube with that blood and gently invert it about 10 times.
We don't want to shake it, we want to just gently invert it. Spin the sample in-house, and most of the time veterinarian centrifuges are quite adequate for doing this. You want to do it within the first hour of that blood collection, and you want to spin it for about 10 minutes.
Typically the blood button setting on your centrifuges is ample enough centrifugation power to do that. After that spin is done, remove the plasma. Be careful not to go into the buffy coat, because in the buffy coat are many nucleosomes because that's where white blood cells are.
80% of 80% composition of white blood cells are nucleosomes. So if you go into that, you're going to stimulate that to get into the plasma, which could inadvertently raise the nucleosome value higher than it should be. So just be careful with your pipette.
And then make sure you store the sample in the refridge. And then you can have it picked up within 24 hours. When you're sending it to the courier to your reference lab, just make sure when you put the ice pack in, you don't put it on top of the sample because you want to keep it cool, but you don't want it to freeze.
So putting the ice pack next to it, as opposed to on it, would be a very good idea. And results based on the reference led that you're using, will come back in 1 to 3 days. Where can you find this?
Now, I know we have attendees from all over the world, and again I say hello to all of you. These are the, these are some of the labs and some of the countries we're in currently 22 countries. Antech is in the US, they're in Australia, New Zealand, Hong Kong, Singapore, and most of the countries in the EU, VET Lab, Poland and Czechoslovakia.
Portugal and Spain through DNA tech, services that that area quite well. Fujifilm in Japan, services a great predominant portion of Japan. IDEX, of course, with reference to the new Q in both the US and Canada.
And then in the UK and Ireland, we have nationwide laboratories, VPG and also Taiwan. We have Vita Genomics and there's another lab that's going to get ready to offer that as well there. So you can see there's, there's worldwide distribution here in a number of labs.
I've not mentioned all of them here, but these are the predominant ones and shows you the breadth of availability of this test on a worldwide basis. Point of care testing. The other thing to remember too, we have Antech, which has an element I + instrument which can be placed in your hospital, and you can get results provided to you in 6 minutes.
It's, it's a wonderful machine. It has 4 or 5 other assays on it, something with progesterone, TSH, cortisol, and C-reactive protein, and then also new Q. But this is a machine you can contact your antech rep, and it's an instrument that you can have in your hospital and get an answer within 6 minutes.
Interpreting results. Let's talk about interpreting results now. A very important piece, when you're getting the results back, you've gone through the sampling now, it's gone to the reference lab and you get a number back.
What are we looking at? First of all, our test will come back in 31 of 3 levels. It will come back in the low risk level, which is green.
You'll get a number that will come back. The low low risk level is consistent with those found in healthy animals over the age of 1 and all genders. So with that, you're gonna maintain your wellness check schedule and you're gonna continue to educate the pet parents about early cancer signs.
Then you have the high risk level, the orange zone. The new cancer test results at this level are consistent with an increased risk of cancer in healthy animals over the age of one year and all genders. And again, we'll talk about the actions that you would take during that period of time if you get a high number back, you're going to review medical history, you're going to check for lumps, swollen lymph lymph nodes, signs of pain, we're looking for elevated white blood cell counts indicating potential inflammation.
And then you have the caution zone, we frequently call this the grey zone, although it's yellow. In this particular case, the new Qvet test result may have a number of contributing factors here as to why it's in the grey zone, and we will go over those in the subsequent slides. In this particular case, the recommendation frequently is going to be to retest it with the fasted patient within 4 weeks.
To remember, there is no fasting required. With with our test, it is only when you potentially do a retest that it would be a good idea to consider fasting for 3 to 4 hours, but on an initial test, there is no fasting requirement at all. Let's talk about the green level.
Now, here, the new vet cancer test results of the green level are consistent with those found in healthy animals. Again, as I mentioned, over the age of one year and all genders, you'd want to maintain your regular wellness checks and educate the pet owners on early cancer signs, and you'd want to retest in the next visit that you see them. Reading emotions, this is important.
This is meant to be. This is meant to be positive news. It's meant to be a positive message.
Screening is a positive message. It's similar to what people go through with the women go through a mammogram on an annual basis, men go through a PSA test. You've also for prostate, you also heard obviously about colorectal disease as Cologuard.
These are all screening tests. They are not diagnostic tests. Just like the new Cuvet cancer test is a screening test.
It's meant to be a positive message. There doesn't have to be a tremendous amount of time being spent with the, with the pet parent if they're coming in for their vaccines, or if they're coming in for an annual wellness visit, if it's not something that you do. I know in many parts of the world, we have a lot of dogs that come in for annual vaccines.
That's a really good time to bring up this . Topic of, you know, you're coming in for vaccines. It's a golden retriever, it's 8 years old.
Why don't we take this very affordable test and just, just double check to make sure things are well, and cancer is not, coming up. And I think you'll find because it's so affordable, it's a very easy and relatively brief conversation to have as part of that, that, as part of that, examination. You want, of course, make sure you monitor for new lumps and bumps and for changes in behaviour at the home, of course, when these dogs come in.
Let's go to the orange level. In the orange level, the new Cuvet cancer test results are consistent with an increased risk risk of cancer in healthy animals, one year and above. Let's talk about interpreting results here a little bit.
The actions to take. If you get a high number come back, it's not something that you have to rush into doing your diagnostic workup. Take a pause, take a breath, review the medical history for previous inflammatory conditions, any surgeries that have recently been done, or a familial cancer history on that dog.
Make sure we're absolutely doing a really thorough physical exam. Let's do an anal exam. Let's make sure we're, we're checking all the lymph nodes.
Make sure we're inquiring in terms of the history of the dog. Have there been any setbacks recently? Has there been any abnormal behaviour?
These are really important things to ask and to engage with the pet parent about when you're, especially when you're coming back in an orange level. Consideration of doing additional blood work, maybe something that you may want to consider doing if you get a high number coming back. In addition to that, discuss the plan with the pet parent.
It's really, really important. It's really important to know the level of anxiety that potentially your pet parent may have. Some pet parents are gonna be very aggressive, they're gonna know dogs, they're gonna know friends that have lost golden retrievers or German shepherds to cancer or to lymphoma, and they're gonna want to get very aggressive about doing a lot of diagnostics or going into the diagnostics then.
There are other parents that maybe they wanna kind of wait a little bit, or they wanna stage your diagnostics. Maybe you wanna do some blood work initially. Maybe you just wanna do some chess films, or some abdominal films, and then maybe you can consider ultrasound and other imaging at a later time.
So it's really, really important on this orange level to be the adult in the room with the pet parent, having a, a substantive conversation with them about what the next steps could be. Even a consideration. To run the test again in a week or two to see if in fact it is still high.
That will obviously give even more reason to pursue some of these diagnostics that we're potentially talking about. But do take a pause, have a really good interaction with your pet parent, and really be able to move and work collaboratively with them on next steps. Communicating results.
Here on the orange level again, moderate to significant elevation of blood nucleosomes. Remember, this is a screening test. High risk does not equal a cancer diagnosis, but this tells us something is going on internally to be investigated.
There are some points here that we have identified which are critically important for you to remember, and these are frequently questions that we get by our colleagues. First of all, You can put, if you have a, if you have less of an anxious client or maybe cost is a is an issue, which certainly could be, you may want to consider rechecking the vet cancer test in 2 to 4 weeks, at least at that point in time, if it comes back again, even if the pet parent decides not to pursue additional diagnostics, at least you're preparing them. Cause the last thing all of us, you know, when we're hit with a loved one or one of our one of our pet, one of our beloved pets is hit with cancer, it takes time to process that.
It, it's a lot to, it's a lot to take in. So, taking some time, going through that with a clear understanding, and working with that pet parent, at least it prepares them for the future, even if they elect not to do diagnostics, or even if they elect not to treat. Frequently, when they have a week or two to think about these things, they will come back to you and say, you know, doctor, I think I would like to do some of this cause I'd like to see what we potentially can do at an earlier stage.
So it's really important to think about that. Please don't ignore a high new Q value. Remember.
New cu with when you have cellular death. In a healthy animal, you, if you get a high new value in a healthy animal, chances are fairly high that it's probably related to cancer. It has to be diagnosed, but in a healthy animal that looks completely normal, it's probably leaning in towards cancer.
But remember it also, you can get a high new value if you have an acute inflammatory condition going on. I use acute pancreatitis or bronchitis or something like that, that can also elevate it. So you can don't ignore it.
What I would suggest is, if newque may be hot. Two things to remember on a high newQ value. New Q may be high before scanning images actually demonstrate the cancer.
Or it could be an underlying inflammatory condition. Our test picks up stages 1 through 5 with lymphoma, and it also picks up stages 1 through 3 with hemangiosarcoma. So if we're in stage 1 or 2, it's possible that we're not gonna see any imaging signs from X-rays or ultrasound of a node being enlarged and metastasis in the lung field.
That's not to say that the test is not working. The test may be early, so that's where you may want to recheck again in a reasonable period of time, to what you think would be effective to do so. Also, too, if in fact you go through your some some of your staging diagnostics and you still have a high value, there is probably some sort of inflammatory condition going on, which is causing cellular death, and you need to pursue things further.
So this, these are really important points to remember. If you get a high new key value, something is going on. Don't ignore it.
At least address it along the lines of what we've been talking about in terms of further workups. Interpreting results in the caution zone. Now, when the new Qvec cancer test comes back in the yellow level or the grey zone, most frequently, most frequently, it's incorrect sample collection or sample handling.
You pulled the blood, you kept it in your pocket, it didn't centrifuge it within the first hour, or you centrifuged it too much. You didn't put it in the. Refrigerator, the pipette went into the buffy coat and pulled out some white blood cells.
These are things that commonly happen because we're all very busy when we're doing our veterinary work during the course of the day. That's very possible that that could be going on. So frequently that number comes back in the grey zone, if in fact, one of those things might have occurred.
If you have a slight elevation in nucleomes, it could also still be some underlying condition. Where the dog may have had a little bit of a GI upset, not enough to cause clinical symptoms, but just wasn't quite feeling well. Repeat that test again in, in 2 to 4 weeks.
And suggestion is to retest a fasted sample, ideally just to make sure that there's no lipids or anything else that could potentially elevate the nuclear zone values. So it's important, those particular cases that come back in the grey zone, or the, it's important to retest them probably in 2 to 4 weeks and see if in fact it goes back to the normal zone or it remains elevated or possibly goes into the high zone, because maybe it's in the early stages. In which case, at that point in time, you'll want to talk about the diagnostic pursuits that we talked about earlier with reference to the high level.
If that second test comes back, still in the grey zone or the caution zone, or has migrated into the high zone, then go back to the diagnostic stag in the conversation that I discussed earlier in the ozone. If in fact it comes back in the normal level, and maybe something, some acute inflammatory process that was underlying may have passed, in which case you educate the pet parent about early cancer signs and reschedule another test because we recommend this be done on a biannual basis in about 6 months. So the new Qvet cancer test.
Recommended for all dogs over the age of 7 years of age, and for younger dogs aged 4 and older with an increased risk of with an increased risk of cancer. You can see all the numbers of dogs that are here, Labradors, French bulldogs, golden retrievers, miniature schnauzers, Siberian huskies, Pyrene mountain dogs also mixed breeds that have some of these breeds in them are also susceptible to. Predisposed early cancer.
You know, there's too many golden retrievers and, and shepherds, I'm sure that all of us have seen that we've put to sleep at the age of 3 to 4 years of age, and, you know, we wish we could have had something. We wish we could have done something or seen or detected it earlier so that we didn't have to go through that. So it's important to remember that, especially even if you're giving those annual vaccines when they come in.
These are the predisposed breeds, and you might lean in and think about those dogs that are over 7 years of age, because remember what I said earlier in an earlier slide, when they're over 10 years of age, 50% of them, we lose to cancer. So on your older dogs in those areas in those parts of the world where you only have them come in for vaccines, or you only have them come in if they're potentially ill, you might think about looking at those dogs that are over 7 years of age, cause that's that group is really going to be high for getting cancer, and that may be something where you start there and then eventually start thinking about using it in predisposed breeds. Incorporating the new Quebec cancer test into your practise.
This technology becomes an indispensable part of our diagnostic protocols, allowing us to provide a higher standard of care and peace of mind to the families who trust us with their pets. This is by Doctor Oscar Peaz Castro. He's a veterinarian and founder of the Coral Way Animal Clinic in Miami, Florida.
We thought we'd share that with you. This testimonial from him is representative of many, many testimonials that we get from veterinarians that are using the new. Q had cancer test.
In your veterinary hospital workflow, how do you perform well, let's talk about incorporating this into your practise. How do you perform wellness exams? Do you routinely use blood work panels, who collects the blood work on the patients and who communicates the results?
It could be different in every practise. I know many techs will go ahead and go into the room and carry on everything until the veterinarian comes in. Does the tech usually pull the blood and do the blood work.
It's just important to know this because this is part of your workflow. The successful key. These are these pieces are really important.
The successful key to early cancer detection is to build the new Quvet cancer test into your hospital's workflow and standard of care. It's really important, especially with the number of doctors that I've had the wonderful opportunity to oversee and provide mentorship in, in my veterinary career. You have to have the entire team on the same page.
You can't have Doctor A coming in recommending UQ and Doctor B not recommending UQ or one tech recommending it, another tech not. It's a team effort. We know that with reference to vaccines, we know that with reference to exams, we know that with reference to blood work.
Everybody has to be on the same page. It comes to standard of care, critically important to having any test, not just NOQ, but any test that you want to bring in or any treatment you want to bring in, that's for well animals, it's important to have everybody on the same page. That's why I mentioned here, tested every wellness visit or tested every annual vaccine for dogs that come in for that, or if they're coming in for a dental.
You know, or a procedure like that. Test them then at that point in time, this point, or they're coming in for otitis externa. There's other things they could come in for, which I'll mention later, where you could run the new cube because they're not showing clinical signs of general malaise or general illness.
This recommendation, it's really important, at least 2 times per year at a minimum, especially for those dogs over 7 years of age, and also for those predisposed breeds. It's also important to incorporate this into your practise management software, and the reason we bring that up is so that you can really age, breed, and identify those dogs or patients that may be ones that you really want to reach out to. So, really, really important to do that.
Veterinary team alignment. Ensure the staff understands and communicates that this is a screening wellness test for healthy senior dogs and predisposed breeds. The vast majority of these tests were gonna come, will come back in the normal range, probably close to 90% of them.
Review and compare the new QVEt cancer test result. If you are doing wellness, a wellness panel, and if you are offering preventive care panels, look, it gives you the opportunity to look at new Q and compare it to some of your other blood work and see if there's some things that are going on alkaline phosis, there's some thrombocytopenia going on is. A globulin increase, it's nice to be able to see that, especially in a, in a healthy case, to give you some indications that oh jeez, the new que is a little elevated here, and I've got some of these other chemistry indices going up.
So that's why doing it with a wellness panel is really good because you get some off you can compare it to some of your other blood work. Again, the standard collection protocol for the test, 2 to 5 mLs blood into an EDTA tube, spin the separate sample within the first hour for 10 minutes, place the plasma in a non-additive tube. Like a a clot tube that has nothing in it, or in Europe and in other parts of the world, it could be a different colour tube, just make sure there's no additive in it at all, and then refrigerate for pickup.
Building awareness. Just so you know, as prevalent as cancer is in our profession, the awareness and use of screening tests in the veterinary industry is still in the early stages. We are in 22 countries.
In 2024 alone, we sold over 120,000 new Qvet tests, and as I mentioned earlier, it's, it's can be compared on the human side to a mammogram, Cologuard test, a PSA test in humans. You can use that as part of your discussion with the pet parent, but most of them understand that on the human side. It's really important to identify a screening champion, someone in your practise, whether it's a tech, a doctor, or a front desk receptionist, who really, really is giving oversight to newQ and reminding the team to go ahead and make sure that we're doing that test on the appropriate dogs.
We have some waiting room posters that are available through the reference labs that we talked about. You can ask your reference lab for these. This is a waiting room poster on new vet that you can share.
We also have building awareness for pet parents. Here's pet parent leaflets that can also be given to them, which gives some nice information about newQ. These are available through your reference labs.
We also have them on our website, as well for, to be obtained. Now, affordability. Key, key, key point.
The test has to be affordable. It's a volume repeat test. This is a test.
It's a volume test. It's done repeatedly. It must be priced affordably.
Those who are seeing the greatest success have integrated into the wellness offerings, and usually they're pricing it to the pet parent less than $75. If you think about the number of wellness tests or the number of well animals that you see or the number of animals that you vaccinate on the on an annual basis, you can see where this test can really be a return on investment, because you're going to do a lot of tests, and 90% of them are going to come back normal. So this can really be a good practise revenue stream for your practise.
Let's go through a few case studies. Bell, 5 year old female spayed golden retriever. Came in for an exam, presenting for an annual check, and doing very well at home.
She's been a little bit more tired than usual, but a puppy was just introduced at home. She's got, she showed some slight thrombocytopenia, about 134,000, otherwise normal, chemistry panel, mild elevation and ALP, and then urinalysis, no significant findings. Unfortunately, the new Q test came back at 187 nanograms per mL, which is in the high zone, and it's consistent with an increased risk of cancer in healthy animals.
Confirmatory diagnostics should be pursued and discussed along the lines of what we talked about. The owner, what to do next. The owner agreed to do an abdominal ultrasound, thoracic radiographs.
There was a cranial mediasinal mass on the thoracic films on the, on the, abdominal ultrasound, splenomegaly with several severely modelled appearance, morphine cytology on both sides was taken. Unfortunately, you know where this is going. High grade lymphoma was diagnosed and then Bell did go in for treatment and survived for a period of time, but the new Q test picked this up on what appeared to be a perfectly normal dog.
Let me talk to you about Benjamin, 9 year old Labrador Labrador retriever and Boomer, his buddy, at 6 years old. These are two dogs, that, there's a message that's going to come out of this in terms of identifying dogs and people that know about other dogs or their own situation where they've had dogs that they've lost to hemangiosarcommary lymphoma, and that that means they really should be looking at the other siblings, and they should be talking to the other people that have dogs that are in similar situations. With Ben, he was a 9 year old.
Male castrate Labrador. He was diagnosed with a splenic angiosarcoma in April of 2023. Splenic mass was found after a positive onto canine test.
Splenectomy was performed, treated with five doses of doxorubicin. There was a follow-up ultrasound at the DBM suspecting peritoneal peritoneal meta metastasis, and unfortunately it was referred to the oncologist. In this particular case, Doctor Sue Ettinger, on October 16, 2023.
The exam was pale pink, membranes, rest of the exam was normal, full workup and run the new cuvet cancer test. Unfortunately, Benjamin came back with 255 nanograms per mL. Results of the orange level, remember, increased risk of cancer with healthy animals over the age of 1 year of age.
Confirmatory diagnostics should be pursued. We've talked about this in the previous slides. What do we do next?
Aspirt was non-diagnostic. Based on new Q and anaemia, resumed meta metastasis. Started on oral palladia, planned to monitor with newcu, did well for about two months.
The anaemia resolved. On the follow up December 11, 2023, the new cu was elevated to 311. Chest X-rays, no metastasis noted, the abdominal ultrasound, the retro retroperitoneal mass was still there.
No effusion. Unfortunately, December 18th, Benjamin was presented for vomiting, lethargy, anaemia, moderate thrombocytopenia, and he was put to sleep shortly thereafter. The moral of the story is.
We have a 6 year old now partner to Benjamin Boomer. Who was presented on March 2024 for cancer screening. Well, obviously, the pet parents of Boomer and Benjamin wanted to get Boomer checked now to see what he was doing and make sure that they didn't experience the same situation they just went through with the unfortunate experience with Benjamin.
So, Boomer was presented. For a new Q test, and you can see here, power suggestion and relationships increases new Q screening. Those pet parents that have been had experience with other pet parents that have lost their dog to hemangio or lymphoma or cancer, or in their own families, really utilise that and leverage that to get some of your some of those people in because once they know about it, a blood test that's affordable, they will bring them in and have it run.
And that's what I'm talking about the power of suggestion and relationships increasingly to screening. So plan full screening, run the new Qvet cancer test. It was diagnostics on Boomer, revi chest reds, no metastasis, normal, abdominal ultrasound, age-related kidney changes.
Nuvet cancer test was submitted, came back less than 15 nanograms per mL, which is normal, low risk, obviously very happy clients about that, consistent with those found in healthy animals, but you'd want to continue to monitor Boomer biannually. Boomer, next recheck was on November 19th, which was 6 months that 7 months later, he had CBC normal, chemistry panel, urinalysis, less than 15 nanograms, chess films, everything again looked good. On July 7th, just a few, a couple of weeks ago, Boomer had another test again six months later, with new Q score less than 15 nanograms.
Baxter, who they have brought into the family now, will be old enough to start screening once he's fully grown. This pet owner testimonial was is is very dear to our volition team's heart. When my husband and I were faced with the diagnosis of manic sarcoma for our beloved 9 year old chocolate lamb, Benjamin, we were devastated.
But thanks to Doctor Sue Ettinger and the new QVvet cancer test, we were able to provide Ben with the best possible treatment and a few extra precious months with him. This experience showed us the importance of early detection, and we now, we now use the new Qvet cancer test proactively twice a year for our eight year old black lab, boomer. We plan to do the same thing once our one year old chocolate lab, Baxter is old enough.
Rebecca and Gary Fagan, Holmes, New York. I think that says it all. Another dog I wanted to go over in a few minutes here, Bowie, seven year old male castrated Bernese mountain dog.
Presented in May 2024 for physical exam, to the Arizona Animal Hospital, Doctor Brett Cortis in Arizona. Physical exam otherwise normal. Owner reported small traces of blood in the urine.
A geriatric profile was ordered, a K9 TSH select, and a new cuvet cancer test. Diagnostics, CBC was normal, chemistry panel, elevated protein and globulins. Unfortunately, we saw that Doctor Corda saw that urinalysis 3 + 3 + RBC otherwise normal.
The new Cvet cancer test came back at 183.2% in the orange zone. Abdominal ultrasound, mass found on the left kidney, the whole kidney was excised, pathology, renal carcinoma.
This is Doctor Brett's commentary. Unfortunately, the cancer had already spread and Bowie passed, but that made me a believer in the new Qvet cancer test, especially because of his breed and his age. What if we checked him 6 months earlier?
Would we have found the disease early? Could we have caught it before it spread? That was a pivotal moment for Doctor Cortis and for many of our colleagues who are using the new Qvet cancer test.
We can now be proactive instead of reactive. It's important with cancer screening to be proactive, to try to avoid so many of the things we're talking about and extend these dogs' lives, because it's, as we said in the beginning of the of the talk, it will, it will improve other treatments, it will make it more cost effective, and also extends the life of that pet. We need to be proactive and proactive means running an early cancer screening test.
It means running something that's very affordable, and we're talking about the new Q vet cancer test. Frequently asked questions. I'm just going to wrap up with this as a summary, and here we are.
Will this test specify the type of cancer the dog may have? No. But it does detect the percentage of systemic cancers, lymphoma, hemangiosarcoma, and histiocytic sarcoma with high specificity around 97%.
And we said that, but our data suggests potential detection of other common cancers. Remember the other 5, the other 4 we talked about mast cell tumours, osteosarcoma, oral melanoma, and soft tissue sarcoma. How do I communicate a high result to the pet owners?
Only a very small percentage of results would be expected in the high range, so it's meant to be a good message, but if it comes back in the high range, there needs to be a conversation and a high result in a perceived healthy animal is certainly suggestive of cancer, but it requires further clinical investigation on your part. Does the baseline nucle value level offer any prognostic in insights? No, it doesn't.
If you get a high nucle value that comes in at 187 or one that comes in at 640, that does not imply that the dog with the 640 is more ill and more advanced than the one that has the 186, because again, you have cellular death that just may have been the time that that was taken and the nuclear zones were higher at that particular case, but it is not a prognostic indicator. How can I price this most effectively? Hospitals who have the highest pet owner compliance have integrated into their wellness offerings, preventive panels, or annual vaccines.
Part of the annual vaccine that's a perfect time to do it, and in particular, senior pets because those over 78 years of age, that's where we're getting 50% of them are dying of cancer. That's a real easy time to start it. And when you bring it into your hospital, use it on your staff's dogs.
Use it on the doctor's dogs initially, so you get comfortable with it, and you get more comfortable when talking to the clients about it. That's a really good thing to think about. Please remember to price it reasonably to the pet parent, especially when combined into their wellness plans.
This is a volume repeat screening test. If you do wellnessams exams, and if you do a lot of vaccines, you see animals that are healthy, you're going to get a pretty strong return on investment, even at charging less than $75 per test, because it's a screening test and a lot of dogs qualify to have that done. Can I run this test on a sick patient?
No, but this is important, guys, but our current research suggests managed conditions like atopic dermatitis, otitis externna, hypothyroidism, osteoarthritis, or routine non-infectious dental disease, for example. None of those are acute inflammatory conditions. They're chronic conditions.
You get a release of nucleols when you have an acute inflammatory condition which causes symptomatic illness in the dog. These particular things will end up presented to us all the time. We should not elevate and will not elevate a new vet cancer test erroneously.
Summary, integrate this into your existing veterinary hospital workflows, build the awareness with the veterinary team first, then your clients, price it affordably, go for the repeat volume of healthy dogs coming in for the wellness visits, create an additional ROI for your practise, and let's try to save more pets. Of course, this is not a perfect test. It's a screening test, but it's highly affordable.
It's something we can all do, and it's something hopefully that's going to prevent us from saving some of those dogs. That we didn't have a chance to do earlier. And bringing this to the awareness of your of your pet parents and your clients is really, really important.
And I think you'll be happier knowing that you really provided a service to these pet parents and saving some of the lives you saw some of the testimonials that we shared with you, it makes a difference. You can make a difference, we can make a difference. Let's start doing cancer screening detection early and hopefully you'll be using the new Qvet cancer test.
With that, thank you so much for your attendance. Hopefully, this was informative for you, and I think this is a time when we'll do a little Q&A. Thank you ever so much.
That was an excellent presentation, super innovative stuff and the testimonials were incredible to read as well. So thank you so much. You'll be pleased to hear we have some questions coming through already.
So some of these might have come through a little bit earlier in the presentation, but I'll run through them and if you don't mind answering them, please, that would be fantastic. OK, so first question is, what breeds in particular should we use the testing, and are there any breeds we should not use the testing? Yeah, there, there was a list of the breeds in one of my slides that shows, you know, goldens, German shepherds, Berene mountain dogs, .
You know there's a host of those large breed dogs that are there. Also too, they should all be tested early because unfortunately, many of them develop cancer but eat frequently before the age of 5 or 6. Also too, many of the multi-breed dogs that have mixed breeds, we have golden mixed with noodle or you have beagle mixed with others.
There's so much cross breeding going on. We have found that those breeds as well develop cancer just as frequently as those that are purebreds. So as far as dogs that shouldn't be, we, our recommendation is any dog over the age of 7 years of age, cause it also happens in very small dogs as well, maybe not quite as frequently as your large breed, but also in your small dogs, but all dogs over the 7 years, over 7 years of age should be tested.
Brilliant, that's great, thank you. We've got somebody who is listening in from Poland and is asking, is the test available here? It is through vet lab.
They have a wonderful reference lab with Vet Lab, and they are in Poland, and they are running a lot of tests on a weekly and a monthly basis to just reach out to vet lab. Fantastic. There was a slide as well, wasn't there, Tom that you had with, yeah, OK, fantastic.
So yeah, that'll be on the recording as well if anybody else wants to check back and see whether you can get hold of it. And, can this test be used in cats? It, it cannot be used in cats yet, but we just wrote our first paper on the use of nucosomes.
We identified the ability to identify nucleosomes in cats, and hopefully by the end of this year going into the 2026, we will have a test for cats. So we're working on it. Stay tuned.
Fantastic. Watch this space. Exactly.
Brilliant, another question is coming from Erin who is asking, would IBD be a chronic illness which wouldn't be expected to create a false positive? Yeah, IBD, you know, is a really trucky and if they're talking about canine IBD now as opposed to IBD and feline, I'm assuming they're talking about canine. Inflammatory bowel disease, you know, is very tricky if the dog, here's the bottom line with it.
If the dog is showing acute indications with IBD, acute symptoms. Then you're going to have an elevation nucleosomes. Now, differentiating it from acute pancreatitis or something else because frequently in IBD you frequently get also concomitant acute pancreatitis.
The bottom line is this test is not going to identify IBD but if in fact the dog was presented with clinical signs, which is not when you should use this test, you should not use it when the dog is showing clinical symptoms. But if it's an IBD that's underlying and the dog is showing, is not showing clinical symptoms and comes in for a test that has a very low level of early stage IBD but doesn't show acute symptoms, then our test could potentially still be used to see. Sometimes those cases will come back potentially in the grey zone and you're getting that zone where that test is still elevated and that's where you probably have to start getting into more diagnostics and start getting into differentiating cancer from IBD.
Fantastic, thank you, Sam. There's a couple of questions that have come in all around the same sort of theme, so how do we differentiate between cancer and inflammatory conditions? Yeah, it's a great question.
The bottom line with this is, and I mentioned this earlier, if this dog that's coming in. Is a predisposed breed. Or is over 7 years of age.
And looks to you to be healthy. Whether it's coming in for vaccines and you're just doing a physical exam, or whether you're actually doing blood work on it. If you get blood work, if that particular animal, if they come back with a high level of new cue.
In that healthy animal. Chances are relatively strong that when you do additional diagnostic work, you are probably going to find a form of cancer in that case. And the reason I mentioned it is because the dog is predominantly healthy.
If that dog comes in over 7 years of age and is showing clinical symptoms of acute illness. Your new Q value most likely will be high, but it probably is not related to cancer. It is probably related to that inflammatory condition that may be going on, in which case, that's why this initial screening test is not meant to be used on sick animals showing clinical symptoms.
So, if in fact it's a healthy animal, you get a high number, chances are pretty high and strong that it's going to be the pathway is going to lead you to cancer. But don't use it on an animal that is clinically showing symptoms of being ill. Fantastic.
Thank you, Tom, that's brilliant. Just a few more if that's OK. There's lots coming in.
Daniel's asking why the difference in fasting between the first test and the retest? Yeah, it's a great question. Initially when this test first came out, because we recently we initially did the work on Frozen.
All research is done on frozen samples, on frozen samples. There was a few, there were a few, there were a few tests that came back that were a little bit elevated, and we, we had to do subsequent tests on fresh samples, and we found on first samples, it was not necessary to do fasting during that point in time. That's the reason why we recommend no fasting is needed when that dog comes in for an initial test.
If in fact that dog comes in for a subsequent test, you're repeating it. It's in the grey zone, or you've decided with the client that you're gonna run another test on the high zone to see if it comes back high. It's a good idea to fast the pet for about 4 hours in that particular case, and the reason is you might get a little bit of leakage from maybe some lipids that the dog may have eaten, which could potentially elevate nucleosomes a little bit.
So in that particular case where you're looking for a recheck. It would be a good idea to just fast it for about 4 hours, which is pretty easy to do. You just have the dog come in in the afternoon, and have it come in first thing in the morning.
That's the difference. But it's only when you're talking about that retest cause you're trying to eliminate any possibility of that test coming back erroneously, a little bit higher than it should. And you don't want any lipids potentially being in there from eating, and that's that's the reason for the suggestion.
A lot of veterinarians don't do it, but there's a suggestion for it. It's not something you have to do, but it's a recommendation that we have. Fantastic.
We have had another question. Can you run the test with chronic dermatitis dogs, and are any drugs going to affect how the test reads? Yeah, anything that's, anything that is a controlled chronic disease.
Where the dog is not showing clinical symptoms of that disease and is not producing, you know, cellular death or turnover, like the ones that I mentioned, hypothyroidism, dermatitis, ectopic dermatitis, you know, these are all chronic diseases. It's not going to affect the test, so you can certainly run that. But there was a second part to that question, Katherine, if you want to just give me that, that I wanted to answer.
Yeah, sorry, where's it gone? They're coming in thick and fast. There's a second part to it, which I wanted to address.
Yes, found it. So it was, are any drugs going to affect how the test. Prednisone, prednisone potentially could affect, generally speaking, if the dog is on prednisone for whatever that case may be, whether it's a skin related condition, it's controlling IBD, it's controlling some sort of a GI situation, it would be recommended to take that dog off of prednisone a minimum of 7 to 10 days.
Before, running this test, cause it's possible that prednisone could interfere with nulizo elevation, cause prednisone is an anti-inflammatory drug. So, generally speaking, if the dog is on prednisone, you know you're gonna run it, it would be good to take it off of prednisone if you can, or get it down to a really, really low dose over a 7 to 10 day period of time prior to test. Fantastic, I think we've got time for one more.
Do you think performing the test directly in the clinic, ensuring better sample quality and faster turnarounds would drive higher adoption? Without question, you know, without question, because if your team is very aligned with it. You, you, what you find is that the hospitals that have it in-house are using it for their wellness visits.
They're using it for those older dogs that they're suspicious about. And when you can give, you know, the other thing about a reference lab, obviously, you still have to give the client, I'll have it back the next day or two, right? There's a possibility.
Most circumstances, that's, that's not an issue. But if you have a particular dog, a particular breed, or a particular animal that you're concerned about, having an immediate answer. Within 6 minutes is something that probably would promote higher use, but obviously, you know, using it in the reference lab and then bringing the point of care in when the team is ready for it, they are very complimentary with each other.
Fantastic. I well, Sam, thank you so much again for joining us. It's been a wonderful session this evening.
I'd just like to also say a huge thank you to our Sunset volition for their continued support. For those of you who may not know this, it has been the second recent webinar with the webinar there. If you did miss the first webinar, which went live earlier this year in May, it isn't too late to catch the recording on demands.
So Dawn has just very, very, kindly popped the link into the chat box for anybody who would like to catch up on that. There's also an email address on the screen right now, so if anybody has any questions, please feel free to send the questions over. We have sadly run out of time, but there were lots of questions, so do reach out via that email address if there's anything else that you would really like to run over.
The recording of today's session will be available in the next day or two on the webinar vet's platform, and we will email you once the recording is ready. Final favour please that we'd just like to ask before everybody leaves is that we'd really appreciate it if you could fill in the survey just to give some feedback on how you found the session and if there's anything else that you wanted to ask Doctor Tom or the olician team. And that's it from me.
So huge thank you. Thanks again, Tom, really enjoyed the session. Thank you very much.
Thank you everybody. Take care everyone. Thank you.
You too. Bye bye.
