Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG)

Abstract

Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.

Faecal immunochemical test: challenges and opportunities for cancer diagnosis in primary care

“…Safety-netting resources are expected from the ACPGBI/BSG group shortly. 13 NICE intend to update their guidance on symptomatic FIT by December 2023. 15 In the meantime, we should celebrate and adopt with confidence this pre-test technology that is acceptable to most patients, prudent, and improves early detection of bowel cancer.…”

“…The Association of Coloproctology of Great Britain and Ireland in conjunction with the British Society of Gastroenterology (ACPGBI/BSG) have just issued national FIT guidance based on consensus statements (including primary care views) backed by extensive evidence review. 13 The guidance clarifies a number of important clinical issues and is welcomed. It differs from NICE DG30 in that DG30 did not approve FIT in the presence of overt rectal bleeding, but recent evidence finds FIT’s sensitivity for bowel cancer is highest in this context.…”

“… 12 Therefore, for patients and their primary care teams seeking to understand and resolve symptoms, access to timely non-2-week wait/urgent suspected cancer specialist advice and/or management with appropriate additional tests must be available for those who test negative. 13 …”

British Society of Gastroenterology interim framework for addressing the COVID-19-related backlog in inflammatory bowel disease colorectal cancer surveillance

“…Using qFIT in this way is an untested strategyalthough similar COVID-19 adapted colorectal cancer pathways have been used for symptomatic patients using qFIT 20. Extrapolated from the work in symptomatic colorectal patients, a qFIT cut-off of 10 µg/g could be used to aid prioritisation 21. Patients who have a qFIT of ≥10 µg/g could be prioritised for more urgent procedures with further prioritisation if the level is ≥400 µg/g 22.…”

Progress and priorities in reducing the time to cancer diagnosis

“…A rapid development ensuing the publication of the Neal et al 2015 review, further accelerated by the need for non-invasive community-based risk stratification during the COVID-19 pandemic, is the implementation of Faecal Immunochemical Testing (FIT) as a triage test for patients visiting primary care with lower gastrointestinal symptoms. The success of this simple test, which is now backed by ample evidence for its effectiveness in symptomatic patients in primary care [11], highlights the considerable gap in similar community-based diagnostics to support patient triage in primary care. Substantial progress has been made to understand the risks associated with abnormalities in commonly used blood tests (e.g.…”