Tag: screening

  • Understanding Ovarian Cancer: Early Detection, Genetic Testing, and Prevention

    Understanding Ovarian Cancer: Early Detection, Genetic Testing, and Prevention

    Every day, 11 women in the UK lose their lives to ovarian cancer. This disease claims more lives than all other gynaecological cancers combined. Tragically, most cases are diagnosed at an advanced stage—stage 3 or 4—where the survival rate for stage 4 is a mere 15%. However, if detected early, at stage 1, the five-year survival rate soars to 95%.

    Ovarian cancer is shrouded in myths and misconceptions, leading to a lack of awareness among both women and healthcare professionals about effective prevention and early detection methods. With advancements in science, we now have the tools to detect this disease early and, in some cases, prevent it altogether, significantly improving survival rates.

    This video is essential viewing for anyone with a family history of ovarian cancer, anyone with ovaries, or anyone who cares about someone with ovaries. Join us as we dispel myths, spread awareness, and empower you with life-saving knowledge about ovarian cancer.

    Genetics of Ovarian Cancer

    Let’s first talk about the genetics of ovarian cancer. 

    About 20% of ovarian cancers are caused by a genetic variant inherited from a parent. You might have heard people describing this as having inherited a “gene mutation” or “faulty gene”. 

    The most common genes involved in this are BRCA1 Or B-R-C-A-1 and BRCA2. 

    If you have inherited a harmful copy of one of these genes, we medically call this having a “pathological” variant. For patients, this might mean your risk of ovarian cancer might be up to 60% in your lifetime. BRCA1 and 2 are not the only genes which are linked to ovarian cancer, there are other genes which are less common and carry different risks. 

    Angelina Jolie famously shared her story of finding out about her BRCA 1 mutation in 2013 in the New York Times.  I think she really helped to open the conversation around genetic screening for lots of women. She had sadly already lost her mother to cancer, who was diagnosed with breast and ovarian cancer. Angelina Jolie chose to have risk-reducing surgery.  Since then many other women have followed in her footsteps, talking about their genetic mutations and surgical decisions such as Christina Applegate, Sharon Osborne and many not so close to Hollywood like me.

    So who should have genetic screening?

    I want to share the words of Dr Mary-Claire King, she is the scientist who first identified the BRCA1 gene in 1990. 

    She says “To identify a woman as a carrier only after she develops cancer is a failure of cancer prevention,”.

    I whole heartedly agree with her. Despite the passing of decades since the discovery of the BRCA1 gene far too many people only find out they carry a gene after a cancer diagnosis in themselves or someone they love.

    Over 95% of women who have inherited a harmful variant in BRCA1 or BRCA2 are undiagnosed in the UK. That’s hundreds of thousands of people who don’t know they are at high risk of cancer, ovarian cancer, plus breast cancer and more. 

    I am extremely fortunate to have been able to access private genetic screening. And I am passionate about bringing this option to more patients and am proud we are able to offer this at Coyne Medical. We can take a sample in clinic after talking through the options, we usually test for multiple cancer genes linked to several cancers including ovarian, breast, colon and more. We only test for genetic changes which are linked to proactive steps you can take to reduce your risk. Such as recommendations for extra screening or checks. 

    But I know that is not an option for all patients, so I was also delighted that in March this year, the guidelines on NHS funded testing were updated by NICE. They now recommend that anyone who has a family history of ovarian cancer in a first or second degree relative be considered for genetic testing.

     A first-degree relative is for instance parent or sister. A second-degree relative is much broader and includes grandparents, aunts, nieces or half-sisters. This includes relatives on either your mum or dad’s side of the family.  So if private testing is not an option for you do speak to your GP about the new guidelines. In the past it may be that you were denied testing on the NHS but could now be eligible.

    What if you don’t have any family history of ovarian cancer?

    Yes, you can still have genetic screening. Traditionally we have only screened patients with a family history. We know from large studies on breast and ovarian cancer that if we only use the family history criteria we will miss over 50% of people with a pathological mutation in BRCA1 or BRCA2.  So if you really want toif you want to get serious about optimising your cancer screening and prevention we think genetic screening is crucial. You don’t want to be one of the patients that only find out after they get cancer, knowing you might have been able to prevent it earlier. 

    Personally, I know the truth behind the statistics. I tested positive for a pathological variant in a gene called PALB2 in 2021. It puts me at increased risk of ovarian cancer and breast cancer. I did not meet the traditional criteria for genetic testing and would not have known without choosing to have private genetic screening. I feel incredibly lucky I found my gene mutation while I was completely healthy, instead of after having a cancer. I have been able to join Angelina Jolie in choosing preventative risk-reducing surgery. To know my risk and then take action to reduce my risk of cancer feels like a very special gift. I would love to see more women share this. 

    Could a family history of other cancers be linked to ovarian cancer?

    Yes, many of the genes that increase the risk of ovarian cancer are linked to other cancers.

    If your family history includes breast cancer, pancreatic cancer or prostate cancer. Those are all flags that you have a higher chance of having inherited a gene mutation. We would certainly encourage you to consider genetic screening. 

    And it’s not just women. We would also encourage men with a family history of these cancers to consider genetic screening. Finding a gene mutation will help us manage their health risks and cancer screening. But it will also potentially help their daughters, granddaughters, nieces, sisters…

    MYTH is that: “It doesn’t matter as there is no family history on my Mum’s side.”

    Wrong. You can inherit these gene mutations from either your mother or father. 

    Women who inherit from their Dad are more often missed. Men are less likely to get breast cancer and can’t get ovarian cancer. So for their daughter their family history often appears less worrying. The same is true for people from small families. A history of cancer in a grandmother or aunt on Dad’s side of the family, is often not talked about or not seen as a big risk factor. I would encourage everyone to find out the most they can about their family history. During the dark days of the first lockdown I started researching my family tree which has been fascinating. After I discovered that I had a gene mutation I searched in more detail and got a copy of my great grandmother’s death certificate, this showed she had died from breast cancer in her 40’s. I almost certainly inherited my mutation from her. So get talking to relatives if you can or use the wonders of the internet to do a bit more research. Of course, we focussed on ovarian cancer today but family history of all cancers as well as other diseases such as heart attacks are also really important information. 

    Do you have any Jewish ancestry?

    Having a parent or grandparent of Jewish ancestry is a big risk factor for inheriting a BRCA1 or BRCA2 genetic variant, up to a 1 in 40 chance. We would recommend all people with this risk factor use genetic screening to find out if they carry a high-risk mutation. The NHS has recently started a project offering testing for gene variants in only the BRCA1 and BRCA2 genes, as these are the genes which are more commonly mutated in those with Jewish ancestry, if you’re interested you can find out more about the project online and I’ll put the link to that in our notes. 

    How does finding a high-risk ovarian cancer gene help you prevent cancer?

    Some women will opt to have their ovaries and fallopian tubes removed. Especially if they have already entered menopause, you could say they are no longer serving any purpose so why keep them and add to your cancer risk? 

    The decision can be more difficult for younger women, for whom surgery will bring on an early menopause and impact on their choices for fertility. It is important that women in this scenario get the best advice on which option is best for them. And their options for pregnancy in the future. 

    There is a brilliant UK study called “Protector”, it is led by  Professor Ranjit Manchanda, who is a great advocate for increasing access to genetic screening for women. The study offers women who want to keep their ovaries the option of removing their fallopian tubes only initially, followed by removal of the ovaries at a later date. We know many ovarian cancers start at the end of the fallopian tubes where they meet the ovaries. The study wants to show this option can help women who wish to delay their surgery, so this option could help reduce risk without the negative impact of menopause in younger women. Both surgical options are big decisions, and need careful thinking through the pros and cons so each woman can find the right decision for her health. Thankfully the actual surgeries are usually laparoscopic or keyhole operations, and can usually be done as a daycase procedure. 

    Can I do anything else to prevent ovarian cancer?

    Yes, there are lots of factors we can focus on to reduce the risk of ovarian cancer. And they will also reduce your risk of lots of other cancers such as breast and colon cancer. Keeping a healthy weight and not smoking are the two biggest risk factors which you can control. The combined oral contraceptive pill also reduces risk, even if only taken for a short period of time. The protection from taking the pill also persists, so the positive benefit continues for several years after stopping the pill. For high-risk women though such as having a BRCA1 or 2 mutation the combined oral contraceptive increases the risk of breast cancer so it may not be suitable as an option. Breastfeeding is protective for ovarian cancer risk, with a 24% risk reduction. I know personally breastfeeding can be really challenging, certainly the hardest part of life as a new mum with my first baby. So I am really conscious of not adding to the mummy guilt with this but if you have a family history it is good to know that this choice could have a positive impact on your own health.  Having children reduces the chance of having ovarian cancer. Of course not alone a reason to have a baby! There has been a lot of concern about using talcum powder on the genital area and ovarian cancer, the evidence is mixed but it is sensible to avoid this. 

    Early Detection

    But now let’s think about early detection. For those cancers we can’t prevent, we need to diagnose them as early as possible. Early diagnosis is vital. Sadly two-thirds of women are diagnosed at a late stage.

    If we can diagnose women early at stage 1 the survival rate is over 94% at 5 years, versus only 16% for women diagnosed at stage 4. So how can we screen you for ovarian cancer and detect it early?

    For women who do not have a high-risk gene mutation we don’t routinely recommend all women using ultrasound or the CA125 blood test for ovarian cancer screening because the biggest UK trial didn’t show this could improve survival in women. They studied over 200,000 women over about 16 years, split into 3 groups, no screening, screening with an ultrasound scan and screening with an ultrasound scan and a blood test for CA125. The results showed women screened with an ultrasound and the CA125 blood test did seem to be diagnosed with cancer at an earlier stage, but they couldn’t show this saved a significant number of lives. We know the CA125 blood test is not perfect, it can give “false alarms”, as other conditions like endometriosis or fibroids can cause high CA125 levels too.  

    But the results were different in women who have are at “high risk” such as with a BRCA gene mutation, they are now recommended to consider regular screening with CA125 blood test and a special algorithm for monitoring their results called ROCA. The test has been available privately for some time but this is a new recommendation in 2024 for the NHS and not yet easily available nationally but hopefully this will change soon. The ROCA test has been show to detect ovarian cancer earlier, before symptoms appear. For high-risk women they can have this done 3 times a year, the results will be tracked and if a significant increase is noted this will prompt more tests. This might be a good option for high-risk gene carriers to consider, especially if you have decided against surgery or are waiting to have done at an older age. 

    Are there are any other ways of screening for ovarian cancer?

    Yes we now have a new blood test that can be used to screen for ovarian cancer. It uses a normal blood sample taken in the clinic and the laboratory to look for ‘circulating tumour cells’, (CTCs). When a cancer or ‘tumour’ starts to grow in the body some of the cells will get into the bloodstream called CTCs. The really exciting part of this is that these CTCs can be found in early-stage 1 cancers.  

    The blood test is called a Multi Cancer Early Detection test, we offer tests by Trucheck that can either focus on female cancers, including breast and ovarian cancer,  or we can screen for up to 70 solid organ tumours. We offer this test at Coyne Medical, always after a full consultation with the doctor to understand if it’s the right test for you. We always want to make sure that patients are up to date with their standard cancer screening as these newer tests should be seen as a great optional add-on. 

    Likewise we also use whole-body MRI scans as an add-on cancer screening tool. These scans from from head through the neck, chest and abdomen to the pelvis. In the pelvic area they can detect cysts or fluid which can indicate an ovarian cancer. In large studies of whole-body MRI the rate of detecting a cancer is 1 to 2% in healthy adults over 40, but this has to be balanced against finding small ‘abnormalities’ which can cause stress and need further checks. That’s why it’s important you go through the possibilities with your doctor before testing. As well as making sure your doctor is there to support you through the results and any follow-up.

     MYTH: “A smear test checks for ovarian cancer.”

    This is sadly common, about 1 in 4 women think this is true but sadly not. Cervical screening will not detect ovarian cancer. Though it is a really important cancer screening to make sure you are up to date with. 

    Knowing the symptoms is key for every woman

    Symptoms to watch for include:

    • Persistent increase in abdominal size or bloating (not bloating that comes and goes)
    • Persistent pelvic and abdominal pain
    • Unexplained change in bowel habits
    • Difficulty eating and feeling full quickly, or feeling nauseous
    • Needing to urinate (wee) more regularly

    Other symptoms can include tiredness, losing weight, pain during sex, and back pain. These can be symptoms of many other conditions too so don’t panic but see your doctor. Your doctor might check a blood test called CA125 and you may also need an ultrasound scan. 

    Knowledge is Power

    Knowledge is power, yet many women and doctors are not well-informed about ovarian cancer. A study by Target Ovarian Cancer found that less than 5% of women felt confident recognizing its signs. Surprisingly, many doctors also mistakenly believe that symptoms only appear in the late stages of the disease. 

    We’re committed to empowering women with the knowledge they need to make informed health decisions. If you know other women who could benefit from this information, please share it with them. Together, we can spread awareness and equip more women with the knowledge they need.

    Follow us if you’d like to learn more about disease prevention and early detection. 

    Cancer Research UK [https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/ovarian-cancer/mortality#heading-Zero] Accessed 8 May 2024.

     Chandrasekaran D, Manchandra R. ‘Germline and somatic genetic testing in ovarian cancer patients’. BJOG 2018: volume 125, issue 11, page 1,460. DOI: 10.1111/1471-0528.15225

    Evans, D.G., Shenton, A., Woodward, E. et al. Penetrance estimates for BRCA1 and BRCA2based on genetic testing in a Clinical Cancer Genetics service setting: Risks of breast/ovarian cancer quoted should reflect the cancer burden in the family. BMC Cancer 8, 155 (2008). https://doi.org/10.1186/1471-2407-8-155

    https://ascopost.com/issues/february-10-2015/dr-mary-claire-king-proposes-population-screening-in-all-young-women-for-brca-mutations/#:~:text=%E2%80%9CTo%20identify%20a%20woman%20as,Dr

    Manchanda R, Blyuss O, Gaba F, et al. Current detection rates and time-to-detection of all identifiable BRCA carriers in the Greater London population, Journal of Medical Genetics 2018;55:538-545.

    National Institute of Clinical Excellence. Ovarian cancer: identifying and managing familial and genetic risk, NICE Published 21/3/2024, [https://www.nice.org.uk/guidance/ng241] Accessed 8 May 2024.

    Beitsch PD, Whitworth PW, Hughes K, Patel R, Rosen B, Compagnoni G, Baron P, Simmons R, Smith LA, Grady I, Kinney M, Coomer C, Barbosa K, Holmes DR, Brown E, Gold L, Clark P, Riley L, Lyons S, Ruiz A, Kahn S, MacDonald H, Curcio L, Hardwick MK, Yang S, Esplin ED, Nussbaum RL. Underdiagnosis of Hereditary Breast Cancer: Are Genetic Testing Guidelines a Tool or an Obstacle? J Clin Oncol. 2019 Feb 20;37(6):453-460. doi: 10.1200/JCO.18.01631. Epub 2018 Dec 7. PMID: 30526229; PMCID: PMC6380523. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380523/

    Petrucelli N, Daly MB, Pal T. BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer. 1998 Sep 4 [Updated 2023 Sep 21]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1247/

    Ozanne EM, O’Connell A, Bouzan C, Bosinoff P, Rourke T, Dowd D, Drohan B, Millham F, Griffin P, Halpern EF, Semine A, Hughes KS. Bias in the reporting of family history: implications for clinical care. J Genet Couns. 2012 Aug;21(4):547-56. doi: 10.1007/s10897-011-9470-x. Epub 2012 Jan 12. PMID: 22237666.

    Metcalfe KA, Eisen A, Lerner-Ellis J, Narod SA. Is it time to offer BRCA1 and BRCA2 testing to all Jewish women? Curr Oncol. 2015 Aug;22(4):e233-6. doi: 10.3747/co.22.2527. PMID: 26300672; PMCID: PMC4530819.

    The NHS Jewish BRCA Testing Programme

    The Protector Study

    Cancer Research UK, [https://www.cancerresearchuk.org/about-cancer/ovarian-cancer/risks-causes] Accessed 9 May 2024.

    Collaborative Group on Epidemiological Studies of Ovarian Cancer; Beral V, Doll R, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet. 2008 Jan 26;371(9609):303-14. doi: 10.1016/S0140-6736(08)60167-1. PMID: 18294997.

    Babic A, Sasamoto N, Rosner BA, et al. Association Between Breastfeeding and Ovarian Cancer Risk. JAMA Oncol. 2020;6(6):e200421. doi:10.1001/jamaoncol.2020.0421

    Merritt MA, Green AC, Nagle CM, Webb PM; Australian Cancer Study (Ovarian Cancer); Australian Ovarian Cancer Study Group. Talcum powder, chronic pelvic inflammation and NSAIDs in relation to risk of epithelial ovarian cancer. Int J Cancer. 2008 Jan 1;122(1):170-6. doi: 10.1002/ijc.23017. PMID: 17721999.

    Cramer DW, Liberman RF, Titus-Ernstoff L, Welch WR, Greenberg ER, Baron JA, Harlow BL. Genital talc exposure and risk of ovarian cancer. Int J Cancer. 1999 May 5;81(3):351-6. doi: 10.1002/(sici)1097-0215(19990505)81:3<351::aid-ijc7>3.0.co;2-m. PMID: 10209948.

    Cancer Research UK, [https://crukcancerintelligence.shinyapps.io/EarlyDiagnosis/] Accessed 9 May 2024.

    Cancer Research UK, [https://crukcancerintelligence.shinyapps.io/CancerStatsDataHub/] Accessed 9 May 2024.

    Menon U, Gentry-Maharaj A, Burnell M, Singh N, Ryan A, Karpinskyj C, Carlino G, Taylor J, Massingham SK, Raikou M, Kalsi JK, Woolas R, Manchanda R, Arora R, Casey L, Dawnay A, Dobbs S, Leeson S, Mould T, Seif MW, Sharma A, Williamson K, Liu Y, Fallowfield L, McGuire AJ, Campbell S, Skates SJ, Jacobs IJ, Parmar M. Ovarian cancer population screening and mortality after long-term follow-up in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): a randomised controlled trial. Lancet. 2021 Jun 5;397(10290):2182-2193. doi: 10.1016/S0140-6736(21)00731-5. Epub 2021 May 12. PMID: 33991479; PMCID: PMC8192829.

    The Roca Test

    Zugni F, Padhani AR, Koh DM, Summers PE, Bellomi M, Petralia G. Whole-body magnetic resonance imaging (WB-MRI) for cancer screening in asymptomatic subjects of the general population: review and recommendations. Cancer Imaging. 2020 May 11;20(1):34. doi: 10.1186/s40644-020-00315-0. PMID: 32393345; PMCID: PMC7216394.

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides
  • 10 facts you need to know to prevent ovarian cancer or detect it early

    10 facts you need to know to prevent ovarian cancer or detect it early

    There are so many myths about Ovarian Cancer. For this Ovarian Cancer Awareness month, I’d love to share information to help educate as many women, and doctors on ovarian cancer. We need to use the latest science to make sure we prevent as many cancers as possible and diagnose any ovarian cancer as early as possible. 11 women die every day in the UK of ovarian cancer so every woman should know how to reduce their risk.

    1. Any family history of ovarian cancer matters

    About 20% of ovarian cancers happen because of a change or variant in a gene that has been inherited from a parent. You might also hear these called a “gene mutation” or “faulty gene”. 

    The most common genes involved in this are BRCA1 and BRCA2. If you have inherited a harmful, what we call a “pathological” variant in one of these genes you can have a risk of up to 60% of ovarian cancer in your lifetime. Other genes also increase your risk to lower levels. 

    Angelina Jolie shared her story of finding out about her BRCA1 variant in 2013, she helped to open the conversation around genetic screening. She sadly lost her mother to cancer due to the same BRCA1 variant. She chose to have risk-reducing surgery to reduce her risk of breast and ovarian cancer. She spoke powerfully of how grateful she was to reduce her cancer risk, likely by over 95%. 

    2. We need to offer more people genetic screening

    We estimate over 95% of women who have inherited a harmful variant in BRCA1 or BRCA2 are undiagnosed in the UK. That’s hundreds of thousands of people who don’t know they are at high risk of ovarian cancer, plus others including breast cancer. 

    If you have a family history of ovarian cancer it is sensible to consider genetic screening. Because for these groups screening gives the power of prevention. There are two main options for this. Some women will opt to have their ovaries and fallopian tubes removed. Especially if they have already entered menopause, you could say they are no longer serving any purpose so why keep them and add to your cancer risk? There is a brilliant UK study called “Protector” which offers women who want to keep their ovaries the option of removing their fallopian tubes. We think many cancers start at the end of the tubes close to the ovaries so this option could help reduce risk without the negative impact of menopause in younger women.

    3. Anyone can benefit from genetic screening

    Traditional criteria for screening only those with a family history will miss 50% of people with a pathological variant in BRCA1 or BRCA2. 

    So if you want to get serious about optimising your cancer screening and prevention we think genetic screening is crucial. 

    I know the truth behind these statistics. I tested positive for a pathological variant in a gene called PALB2 in 2020. I did not meet the normal criteria for testing and would not have known without choosing genetic screening. I feel incredibly lucky I found my gene mutation while I was healthy. I have been able to join Angelina Jolie in having preventative risk-reducing surgery. To be able to reduce my risk of cancer by over 95% feels like a very special gift and I would love to see more women share this. 

    4. A family history of other cancer could be linked to ovarian cancer

    The genes that increase the risk of ovarian cancer are linked to other cancers. If your family history includes breast cancer, pancreatic cancer or prostate cancer it is especially important to consider genetic screening. 

    We would also encourage men with a family history of these cancers to consider genetic screening, not just for their own health but because it could impact their daughters, granddaughters, nieces, and sisters..

    5. MYTH: “It doesn’t matter as there is no family history on my Mum’s side.”

    This is such a common myth. You can inherit these gene mutations from either your mother or father. Women who inherit from their Dad are more often not tested, that’s because their Dad is less likely to get breast cancer and can’t get ovarian cancer they are less likely to meet those rubbish “family history” criteria.  A history of cancer in a grandmother or aunt, who may have died before you were even born sounds less concerning than if it is your own mother but it is still a really important risk factor. 

    6. Jewish ancestry is a major RED flag to consider genetic screening

    Having a parent or grandparent with this ancestry is a big risk factor for inheriting a BRCA1 or BRCA2 genetic variant, up to a 1 in 40 chance. The NHS has recently started a project offering testing for gene variants which are more common in that background, if you’re interested you can find out more about the project here. You would also be eligible for our genetic screening which will screen not just BRCA1 and BRCA2 but also a wider range of genes linked to cancers which we can reduce or prevent. 

    7. There are things you can do to look after your health and reduce your risk

    There are lots of factors we can focus on to reduce the risk of ovarian cancer. And they will also reduce your risk of lots of other cancers such as breast and colon cancer. Keeping a healthy weight and not smoking are key. The oral contraceptive pill also reduces risk, as does breastfeeding. There has been a lot of concern about using talcum powder on the genital area and ovarian cancer, the evidence is mixed but it is sensible to avoid this. 

    8. Be symptom aware

    For those cancers we can’t prevent, we need to diagnose these as early as possible. Sadly two-thirds of women are diagnosed at a late stage. If we can diagnose women early at stage 1 the survival rate is over 94% at 5 years, versus only 16% for women diagnosed at stage 4. 

    Symptoms to watch for include:

    • Persistent increase in abdominal size or bloating (not bloating that comes and goes)
    • Persistent pelvic and abdominal pain
    • Unexplained change in bowel habits
    • Difficulty eating and feeling full quickly, or feeling nauseous
    • Needing to urinate (wee) more regularly

    Other symptoms can include tiredness, losing weight, pain during sex, and back pain. These can be symptoms of many other conditions too so don’t panic but see your doctor. They should consider checking a blood test called Ca125 and you may also need an ultrasound scan. 

    9. MYTH: “A smear test checks for ovarian cancer.”

    This is sadly common, about 1 in 4 women think this is true but sadly not. Cervical screening will not detect ovarian cancer.

    10. We can screen for ovarian cancer

    We don’t routinely recommend women use ultrasound or the Ca125 blood test for ovarian cancer screening because the biggest UK trial didn’t show this could improve survival in women, it is possible some women were diagnosed at an earlier stage. The test can also give “false alarms”, other conditions like endometriosis or fibroids can cause high Ca125 levels too. 

    We now have a new blood test that can be used to screen for ovarian cancer. It uses a normal blood sample taken in the clinic and the laboratory to look for ‘circulating tumour cells’, (CTCs). When a cancer or ‘tumour’ starts to grow in the body some of the cells will get into the bloodstream called CTCs. The really exciting part of this is that these CTCs can be found in early-stage 1 cancers.  

    The blood test is called a Multi Cancer Early Detection test, we offer tests by Trucheck that can either focus on female cancers or screen for up to 70 solid organ tumours. 

    Knowledge is power

    Many women and doctors lack knowledge of ovarian cancer. A study by Target Ovarian Cancer showed less than 5% of women were confident in knowing the signs of ovarian cancer. Many doctors also falsely believed women only get symptoms of late-stage ovarian cancer.

    We are passionate about giving women the knowledge and power to make the best choices for their health. If you think any other women in your life would find this useful then please share with them and hopefully, more women will be armed with knowledge. 

    DR LUCY HOOPER
    MB BS BSc MRCGP MA DRCOG DCH

    Lucy is a GP and co-founder of Coyne Medical. She graduated with honours from Imperial College London, trained at St Mary’s Hospital, and holds a Master’s in Medical Ethics and Law. Her clinical interests span women’s health, preventive medicine, and genomics, with a particular focus on using advanced biomarkers to build a more complete picture of long-term health.

    British Society for Genetic Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in BBC, The Guardian, Women’s Health, The Times and Tatler

    Book a GP Consultation

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides
  • Trucheck™ vs. Galleri®: Comparing Advanced Blood Tests for Early Cancer Detection

    Trucheck™ vs. Galleri®: Comparing Advanced Blood Tests for Early Cancer Detection

    Introduction – The Future of Cancer Screening with Advanced Blood Tests

    Cancer screening has taken a significant leap forward with the introduction of advanced blood tests like Trucheck™ and Galleri®. These innovative screening methods aim to detect cancer at its earliest stages, providing vital information for timely interventions and improved outcomes. In this blog, we will compare Trucheck™ and Galleri®, exploring their scientific principles, advantages, and considerations, to help you make informed decisions about cancer screening.

    How Do Trucheck™ and Galleri® Blood Tests Work?

    Trucheck™ – Detecting Circulating Tumor Cells (CTCs)

    Trucheck™, developed by Datar Cancer Genetics, focuses on detecting circulating tumour cells (CTCs) and circulating ensembles of tumour-associated cells (C-ETACs) in peripheral blood samples. By employing primary negative enrichment, Trucheck™ enables the survival of malignant cells while allowing non-malignant cells to undergo apoptosis (programmed cell death). The subsequent analysis of tissue-specific markers on these cells helps identify cancer types and their likely organ of origin. Trucheck™ offers high sensitivity, specificity, and an overall advantage in detecting over 70 solid organ cancers.

    Galleri® – Analyzing Cell-Free DNA (cfDNA) for Cancer Detection

    Galleri®, another groundbreaking blood test, detects over 50 types of cancer and predicts the origin of cancer signals with high accuracy. This test examines the methylation patterns of cell-free DNA (cfDNA) found in the bloodstream. Methylation patterns, which regulate gene expression, can be altered in cancer, contributing to tumour growth. By leveraging next-generation sequencing (NGS) and machine-learning algorithms, Galleri® analyses the methylation patterns of cfDNA to identify cancer-specific abnormalities. These patterns provide valuable information about the presence and origin of potential cancers.

    Accuracy & Sensitivity of Each Test

    Trucheck™ demonstrates an overall sensitivity ranging from 82.5% to 88.2% for different cancer types. It boasts a specificity of 99%, correctly identifying 99 out of 100 individuals without cancer. False positives occur at an estimated rate of 1% to 3% according to the studies available so far. Trucheck™ has been designed as a complement to, not replacement for, standard cancer screening, offering peace of mind to individuals with negative results while prompting further tests or referrals for those with positive results.

    Galleri®, as demonstrated in the SYMPLIFY study, achieved a sensitivity of 66.3% overall, ranging from 24.2% for stage I cancers to 95.3% for stage IV cancers. This demonstrates Galleri’s ability to detect cancer signals across various stages but that it is most reliable with later-stage tumours. With a positive predictive value (PPV) of 75.5% and a negative predictive value (NPV) of 97.6%, Galleri®shows promise in accurately identifying individuals with cancer. The test’s specificity stands at 98.4%, further enhancing its precision in distinguishing cancer from non-cancer cases.

    Availability & Cost – Which Test is More Accessible?

    Trucheck™ is available as a standalone test or add-on service for patients undergoing health screening at Coyne Medical and several other private clinics in London and beyond. It may not be covered by healthcare insurance or the NHS prior to a formal cancer diagnosis. Further diagnostic procedures and referrals prompted by positive results may require self-payment.

    On the other hand, Galleri® is currently being evaluated in clinical trials and is not widely available outside of these trials. The SYMPLIFY study demonstrated its potential in a cohort of patients referred for diagnostic investigations related to suspected gynaecological, lung, and gastrointestinal cancers. It is not currently available in the UK in private care. It is only available through NHS research trials. 

    Considerations and Future Implications:

    Both Trucheck™ and Galleri® have the potential to revolutionise cancer screening, but it’s important to consider certain factors. Trucheck™ offers a broader range of tests for different cancer types, while Galleri’s focus lies in detecting over 50 cancer types. Trucheck™ uses CTCs and their clusters as biomarkers, primarily for solid organ malignancies, whereas Galleri® examines cfDNA methylation patterns.

    While Trucheck™ and Galleri® boast impressive sensitivity, it’s crucial to understand that false negatives can still occur. Neither test can replace standard screening methods such as mammograms, colon cancer screening, or cervical screening. Additionally, the emotional impact and potential for anxiety associated with both tests’ results should be taken into consideration.

    Looking ahead, the development of advanced blood tests like Trucheck™ and Galleri® brings us closer to a future where early cancer detection becomes a reality. These tests have the potential to complement existing screening methods, offering individuals a comprehensive and personalised approach to cancer prevention and treatment.

    Trucheck™ and Galleri® blood tests represent groundbreaking advancements in cancer screening, utilising cutting-edge technologies and scientific understanding to improve early detection rates. Trucheck™ focuses on CTCs, while Galleri® examines cfDNA methylation patterns. Both tests demonstrate considerable accuracy and hold promise for transforming cancer diagnosis and treatment.

    It is essential to consult with healthcare professionals to determine the most suitable screening approach based on individual risk factors, age, and personal medical history. By considering these innovative blood tests alongside standard screening methods, we move closer to a future where early cancer detection becomes the norm, leading to better outcomes and improved quality of life. Trucheck™ cancer screening blood test is available at Coyne Medical. Learn more on our website here.

    Book a Cancer Blood Test in London at Coyne Medical

    It is essential to consult with healthcare professionals to determine the most suitable screening approach based on individual risk factors, age, and personal medical history. By considering these innovative blood tests alongside standard screening methods, we move closer to a future where early cancer detection becomes the norm, leading to better outcomes and improved quality of life. Trucheck™ cancer screening blood test is available at Coyne Medical.

    BOOK MULTICANCER EARLY DETECTION BLOOD TEST

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides
  • Trucheck™: Empowering Early Cancer Detection through Advanced Blood Screening

    Trucheck™: Empowering Early Cancer Detection through Advanced Blood Screening

    Can a Blood Test Really Detect Cancer?

    At Coyne Medical, we strive to provide our patients with the latest advancements in healthcare technology. In line with our commitment to offering the best screening options, we are excited to introduce Trucheck™, a revolutionary cancer screening blood test developed by Datar Cancer Genetics. Trucheck™ aims to detect cancer at its early stages which can potentially lead to improved outcomes, streamlined treatments, and reduced morbidity. In this blog, we will explore the features, advantages, and considerations associated with Trucheck™, shedding light on why it is a powerful addition to our health screening services.

    The Urgency of Early Cancer Diagnosis:

    The statistics on cancer are startling. 1 in 2 individuals born after 1960 will be diagnosed with cancer during their lifetime. Unfortunately, the majority of cancers (48%) are currently diagnosed at later stages (3 or 4). This often leads to more aggressive treatments and poorer outcomes. Detecting cancer early, specifically at stage 1, can significantly improve survival rates and make treatments more effective. Trucheck™ aims to address this critical need for early diagnosis by leveraging cutting-edge technology and scientific advancements.

    Understanding Trucheck™: The Science Behind the Test

    Trucheck™ is a cancer-screening blood test. It utilises the concept of circulating tumour cells (CTCs) and circulating ensembles of tumour-associated cells (C-ETACs) in blood samples. Through a process known as primary negative enrichment, Trucheck™ selectively allows non-malignant cells to undergo apoptosis (programmed cell death) while enabling the survival of malignant cells. These malignant cells are then analysed using multiplexed fluorescence immunocytochemistry (ICC) to identify tissue-specific markers associated with various different cancer types.

    The presence of CTCs alone is not diagnostic of cancer. Instead, a positive Trucheck™ result indicates a high risk of cancer, providing valuable information about the likely type of cancer (e.g., adenocarcinoma) and its potential organ of origin (e.g., lung). A positive result should prompt further tests or referrals, which may involve additional costs and might not be covered by private medical insurance or provided by the NHS until a formal cancer diagnosis is established. False positives, although relatively rare (estimated at 1% to a maximum of 3% in studies), can occur.

    The Test Procedure and Pre-Test Consultation:

    Detailed information about the Trucheck™ test, including its procedure, can be found on our website making it a valuable resource for patients considering this screening option. To ensure the best possible experience and outcomes, we offer pre-test consultations. During these consultations, we review the patient’s medical history, assess suitability, identify high-risk factors, and address any concerns or questions.

    Who Can Benefit from the Trucheck™ Cancer Screening Blood Test?

    Trucheck™ is suitable for individuals aged 18 and above who are asymptomatic or have minor symptoms not requiring urgent investigation. It is particularly recommended for patients who wish to take advantage of the opportunity to identify their risk of cancer at an early stage, aiding in timely diagnosis and treatment. The test selection varies based on age and gender, with options such as Trucheck™ Intelli (for over 40 years of age, detecting over 70 tumour types), Trucheck™ Breast (females over 40 years of age), Trucheck™ Prostate (males over 45 years of age), and Trucheck™ Colon (over 40 years of age).

    Advantages of Trucheck™:

    1. Early Cancer Detection: Trucheck™ has the ability to detect cancers at an early stage, even before symptoms manifest, leading to better treatment outcomes and improved survival rates.
    2. Comprehensive Screening: Trucheck™ Intelli offers a broad spectrum of detection, encompassing more than 70 types of early-stage cancer within the asymptomatic population.
    3. Sensitivity and Specificity: Trucheck™ demonstrates high sensitivity (e.g., 88.2% for Trucheck™ Intelli) in correctly identifying cancer cases, minimising false negatives, and achieving a specificity of 99% to reduce false positives.
    4. Minimally Invasive: Unlike invasive procedures or radiation-based tests, Trucheck™ involves a simple blood draw, making it a convenient and non-intrusive screening method.
    5. Peace of Mind: Negative Trucheck™ results provide reassurance, indicating a low chance of having an active malignancy.
    6. Targeted Follow-up: Positive results from Trucheck™ allow for fast-tracked and targeted follow-up, utilising imaging, biopsy, or other confirmatory methods, minimising unnecessary medical procedures and exposure.
    7. Comparative Advantage: Trucheck™ outperforms other cancer screening tests in terms of false positive rates, surpassing tests such as PSA testing, FIT testing, and mammograms. However, all of these tests are still an important part of screening for cancer. 

    Considerations and Limitations:

    While Trucheck™ offers significant advantages, it is essential to consider certain factors:

    1. Emotional Impact: The anticipation of results, as well as false positive or indeterminate outcomes, can lead to temporary anxiety for individuals and their families.
    2. Unproven Survival Impact: Although Trucheck™ aids in early diagnosis, further research is needed to demonstrate its impact on long-term survival rates.
    3. Complementary, Not Replacing Standard Screening: Trucheck™ does not replace conventional cancer screening methods, such as mammograms, colon cancer screening, lung cancer screening CT scans, and cervical screening. It is designed to complement these existing tests.
    4. Specific Cancer Types: Trucheck™ focuses on solid organ malignancies and cannot detect blood or lymphatic system cancers.
    5. Coverage and Costs: Trucheck™ may not be currently covered by healthcare insurance, and the costs associated with the test are privately funded by individuals. Additionally, following a positive result, further diagnostic procedures may require self-payment before a formal cancer diagnosis is established.

    With cancer being a prevalent and life-altering disease, the importance of early detection cannot be overstated. Trucheck™ provides a groundbreaking opportunity for individuals to proactively assess their risk of cancer and enable timely interventions. While acknowledging its limitations, Trucheck™ offers unparalleled advantages, including early cancer detection, comprehensiveness, convenience, and high sensitivity. At Coyne Medical, we believe Trucheck™ is a vital addition to our health screening services, empowering our patients to take control of their well-being and potentially improve their cancer outcomes and healthspan.

    It is really important to emphasise that Trucheck™ should be utilised alongside routine healthcare and standard cancer screening tests, ensuring comprehensive and holistic health monitoring. To learn more about Trucheck™ and its suitability for you, we encourage you to reach out to our expert medical professionals at Coyne Medical.

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cancer Health Guides

    Explore our other Health Guides

    Cardiovascular Health · Cancer · Longevity and Healthspan · Child Health · Men’s Health · Women’s Health · Nutrition and Lifestyle · Lab Tests and Results

  • Whole-Body MRI: “First Come, First Saved”

    Whole-Body MRI: “First Come, First Saved”

    For some time now, whole-body MRI (magnetic resonance imaging) has been used in the management of people with cancer to detect disease recurrence or progression. MRI is fantastic in this role because it is non-invasive and has no ionising radiation. Whole-body MRI has recently been used in people with genetic syndromes that predispose them to cancer. It is now being used to detect cancer in the general population before symptoms begin. 

    People diagnosed with cancer earlier are more likely to survive than those diagnosed later. Early diagnosis leads to better healthcare experiences. People diagnosed early have fewer treatment side effects and a higher quality of life than those diagnosed later. 

    What is a whole-body MRI? 

    Whole-body MRI uses very strong magnetic fields to create images of the body. A whole-body MRI does not actually check the whole body. Usually, the arms or legs are not included. This is because the chance of detection of a serious abnormality in the arms or legs is zero. The MRI scanner is a large, noisy, doughnut-shaped machine. The scanner that we use allows patients to watch Netflix while they are having their scan! 

    How long does a whole-body MRI take?

    Usually, a whole-body MRI takes around 90 minutes. Prior to the scan, safety questions are answered, and patients change out of their normal clothes into a comfortable gown and warm socks. As the scans use magnetic fields, certain people, for example, those who may have a pacemaker or metal fragments in their body, cannot have an MRI scan. For everyone else, a whole-body MRI is perfectly safe. 

    Why would you have a whole-body MRI? 

    Early detection of cancer is the main reason to have a whole-body MRI. In studies of whole-body MRI, the rate of cancer detection ranges from 0 to 10%. A review of studies into the whole body found that the pick-up of cancer was between 1 and 2%. By comparison, the detection rate of breast cancer using digital mammography is 0.8%. 

    What are the disadvantages of a whole-body MRI?

    Whole-body MRI is excellent at picking up cancer. It is also excellent at picking out lots of unnecessary detail. Indeed, very few whole-body MRI scans are entirely normal. However, only 30% of whole-body MRI scans detect findings that require further investigation to rule out a serious condition. Waiting for the results of additional investigations can be stressful in the short term. However, studies have found that these people did not have any increased stress in the long term. 

    A whole-body MRI is an extremely effective tool for detecting cancer. It is non-invasive and takes only 90 minutes. It can pick up a lot of unimportant abnormalities, which can increase short-term anxiety. However, in the long run, it is an incredibly valuable opportunity to detect cancer early. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Longevity & Healthspan Guides
  • Why Heart Disease Is Like Street Crime – CT Coronary Calcium Scores

    Why Heart Disease Is Like Street Crime – CT Coronary Calcium Scores

    Why Heart Disease Is Like Street Crime

    Broken windows theory was proposed in 1982 by Political Scientist James Quinn Wilson and Criminologist Geroge Kelling. The idea was that small crimes and misdemeanours inevitably led to serious crimes. This idea was taken on by New York Police Commissioner William Bratton. He cracked down on petty crimes and as a result, serious crime in New York fell. 

    Some people have a lipid profile that puts them at increased risk of cardiovascular disease. If you have a high Apolipoprotein-B (Apo-B) and high LDL particle number (LDL-p), for example, you are at higher risk of cardiovascular disease. This is because a high LDL particle number means that LDL is likely to break into the wall of the artery, cause inflammation and lead to coronary heart disease. It gets into the wall of the artery thanks to Apo-B. Having high Apo-B and LDL-p is analogous to living in a bad neighbourhood. If you have high Apo-B and LDL you are likely to have a break-in (to the arterial wall). Coronary calcium is a sign that damage has occurred in the arterial wall and reflects the body’s healing in response to damage. It is like having a boarded-up window after it has been smashed by a hooligan in a bad neighbourhood. We know from commissioner Bratton that broken windows inevitably lead to serious crime. In much the same way, coronary calcium is a signal that something serious is going to happen in the arterial wall. 

    Coronary artery calcium scoring (CACS) examines calcium deposits in the coronary arteries that occur during atherosclerotic plaque formation. The study takes around 10 minutes, doesn’t use contrast and the radiation dose is low (approximately 1 mSv). This amount of radiation is comparable to around two screening mammograms. The average person is exposed to approximately 2.7mSv radiation per year in the UK according to Public Health England. 

    Calcification in the arteries is due to the repair of the damage caused by the formation of atherosclerotic plaque. CACS provides an overall assessment of the amount of calcification, most commonly using the Agatston Score. As an interesting aside, Arthur Agatston not only developed the scoring system for measuring coronary artery calcium but also the South Beach Diet. 

    The initial evidence of the value of coronary calcium was provided by the landmark Multiethnic Study of Atherosclerosis (MESA). This was a study of 6814 individuals from four major ethnic groups. The study found a strong association between calcium score and adverse coronary events over almost 4 years of follow-up.  Subsequent studies have shown the benefit of calcium scoring in a variety of ages, sexes and clinical risk factor burdens.

    The addition of calcium scoring to our traditional risk estimation improves our identification of a patients chance of cardiovascular disease. It is particularly useful who allowing us to better understand who would and would not benefit from having medications to prevent cardiovascular disease such as statins or aspirin.

    A key advantage of calcium scoring is that while high scores are associated with elevated cardiovascular risk, the absence of coronary calcium is a negative risk marker that confers a good prognosis. This is what is known as negative predictive value. The negative predictive value of zero coronary calcium appears to be greatest in individuals at intermediate risk by traditional risk calculators. 45% of these patients will have CAC = 0, placing them at low cardiovascular risk and removing the need for preventive therapy such as statins. Conversely, the power of zero coronary calcium is limited in individuals who are already at high risk. Nearly 50% of fatal MIs occur in non-calcified areas of coronary arteries.  So even if the calcium score is zero, the patient may still need aggressive intervention if they live in a ‘bad neighbourhood.’ That is, even if they have a normal CAC but have very high ApoB and LDL-p. This is because they may have soft plaque and CAC does not show soft plaque.  

    European Society of Cardiology guidance on CVD prevention, dyslipidaemia, and chronic coronary syndrome have all recognised the important role of CACS in the CVD risk assessment on an individual patient screening basis. They advised that CACS may improve risk classification in patients without symptoms in the moderate or low-risk categories. At levels of risk above this, significant lifestyle changes and potential medications are indicated. 

    So, CACS, seeing the amount of boarded-up windows in your neighbourhood, can considerably improve our estimation of your risk of cardiovascular disease and can be extremely helpful in guiding decisions on preventative treatment. 

    DR J HUGH COYNE
    MBBS BSc PGDip (with merit) MRCGP DRCOG DCH

    Dr Hugh Coyne is a GP and co-founder of Coyne Medical, a private preventive health clinic at 660 Fulham Road, London. He trained at Imperial College London and has been in practice for over twenty years, with a particular focus on cardiovascular risk, metabolic health, and exercise medicine. After qualifying as a GP he went on to train in sport and exercise medicine, bringing a distinctly practical approach to prevention and long-term health.

    British Association of Sports and Exercise Medicine  ·  European Atherosclerosis Society  · 
    Independent Doctors Federation

    As seen in The Independent, The Daily Mail and Tatler

    Book a Health Screening

    For educational purposes. This article is written by a practising GP and is intended to inform, not replace a consultation with your own doctor. It does not constitute medical advice. A note on clinical guidelines: Coyne Medical is an independent private clinic. Our approach is guided by the best available evidence, tailored to each individual. This may go beyond standard NHS or NICE guidance, which is designed for population-level care and weighted by resource constraints.

    Read More Cardiovascular Health Guides