Background:
Early detection of disease allows for more treatment options and often results in better outcomes. Canine cancer is unfortunately a disease that can stay well hidden for a long time before becoming clinically evident, far into development. The Cancer Risk Assessment (CRA) is a blood test to screen apparently healthy dogs for early signs of cancer and to evaluate if the dog is in a biological state that promotes the development of neoplasia.

Table of Contents

  • Understanding the CRA
  • When and how to implement CRA into practice
  • Interpreting results for your patients

Understanding the Cancer Risk Assessment

In the simplest terms, the Cancer Risk Assessment is meant to identify dogs which have an increased risk of cancer or disease in the coming months. Take a step back and the biggest value of the CRA is to help your team decide which dogs, when apparently healthy, should have additional time and resources dedicated to them, and which we have a high confidence of overall health.

Dedicate Time & Resources

Adding another way to check the health status of your patients will give your clients the peace of mind that we’re taking steps to identify hidden problems, intervening before they become serious, or confirming health.

Using CRA you can then dedicate additional resources only to those patients who need it.

Screening for Cancer Risk

CRA was developed based on a clinical study looking at 360 apparently healthy dogs.1 [Creating the CRA]. Screening patients for cancer risk is important to ensure the right dogs are getting the additional attention they need. In that study, all dogs were initially enrolled clinically healthy – no signs of disease or cancer. The aim of the study was to pick out the patients who would get cancer using a blood test.

By screening the apparently healthy dogs that come through the clinic using the Cancer Risk Assessment, you can identify which dogs needs additional workup or intervention. CRA creates a stratification – those with higher scores needing more immediate action.


When and How to Implement CRA

Any clinically healthy dog, coming in for routine checkup, could benefit from having a Cancer Risk Assessment done. We know this is not feasible many times due to financial constraints, results of other workup, or the owner just declines. Here are the patients who should be considered a priority:

  • Any dog over 5 years old, and especially over 10 years old.
  • High Risk Breeds (Golden Retrievers, German Shepherd, purebreds)
  • Dogs with cancer in their line/litter

Prioritizing this group is a good start, but the aim should be to screen all clinically healthy dogs for early signs of disease and cancer. The Cancer Risk Assessment is commonly an upgrade to a basic wellness panel offered by VDI: Canine Essential Wellness.

When appropriate, for dogs that require additional testing, add-on the CRA to the original test.

Starting with a Canine Essential Wellness panel, reduces the overall cost to most owners whose dog’s do not require the Cancer Risk Assessment at first. Again, allocating time and resources to those patients that need it. The Essential Wellness Panel also offers Vitamin D & B12 evaluations which have critical roles in the health of dogs.

Cancer Risk Assessment can also be added to our Canine Advanced Wellness panel or can be found included in the Canine Complete Wellness panel.


Interpreting Results

Often the first question that comes up with the Cancer Risk Assessment, or screening tests in general, is “what do I do when Cancer Risk is elevated?” The Cancer Risk Assessment returns scores from Very Low Risk to Highly Elevated Risk. First thing we say is Don’t Panic.

As with any bloodwork, screening or diagnostic, the rest of the clinical picture is required for interpretation and decision making. Absent that, let’s take a look at a few CRA Score outcomes:

Very Low Risk:
Patient should be considered healthy!

The majority of screening patients should fall into this category – providing your clients confidence that the dog is healthy and at low risk.

Low Risk:
Patient should be considered healthy, but chronic inflammation is begin to develop and should be managed.

A large minority of screening patients will fall into this category – providing your clients confidence that the dog is healthy and at low risk, but that we are actively managing long term health.

Elevated Risk:
Patient should be evaluated and watched closely for signs of disease. Manage inflammation. Retest is recommended.

A small minority of patients will fall into this category, and will alert owners to be proactive in identifying and resolving problems.

Highly Elevated Risk:
Patient should be evaluated immediately. Although Highly Elevated Risk is not diagnostic, there is a probability that disease is present and should be resolved. Retest interval should be shortened.

Very few screening patients will fall into this category, however they are the most vulnerable and should be attended to.

These guidelines are general in nature and do not reflect any additional clinical information available.


References:
  1. Selting, K. A., Sharp, C. R., Ringold, R. and Knouse, J. (2013), Serum thymidine kinase 1 and C-reactive protein as biomarkers for screening clinically healthy dogs for occult disease. Veterinary and Comparative Oncology. doi: 10.1111/vco.12052

Have more questions?

Feel free to contact VDI directly for case-specific interpretation, find out if CRA is right for a patient, or learn more about our other services. We’re always happy to have a chat.