Faecal immunochemical tests in the COVID-19 pandemic; safety-netting of patients with symptoms and low faecal haemoglobin concentration – can a repeat test be used?

Benton, Sally C; Fraser, Callum G.

doi:10.1177/0004563220967569

Cited by 9 publications

(10 citation statements)

References 14 publications

(19 reference statements)

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“…44 Future research will be required to assess this expanding role of FIT outside the current NICE referral guidelines. With an increasing reliance on FIT as a triage tool for symptomatic patients in primary care, particular attention should be given to the application of repeat FIT (with optimum intervals and thresholds) 45 and the impact of using different cutoff points 33 : safety-netting will become even more vital to avoid missing cancer cases with a negative FIT result. [45][46][47]…”

Section: Discussionmentioning

confidence: 99%

Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study

et al. 2022

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ObjectivesThe faecal immunochemical test (FIT) was introduced to triage patients with lower-risk symptoms of colorectal cancer (CRC) in English primary care in 2018. While there is growing evidence on its utility to triage patients in this setting, evidence is still limited on how official FIT guidance is being used, for which patients and for what symptoms. We aimed to investigate the use of FIT in primary care practice for lower-risk patients who did not immediately meet criteria for urgent referral.DesignA prospective, descriptive study of symptomatic patients offered a FIT in primary care between January and June 2020.SettingEast of England general practices.ParticipantsConsenting patients (aged ≥40 years) who were seen by their general practitioners (GPs) with symptoms of possible CRC for whom a FIT was requested. We excluded patients receiving a FIT for asymptomatic screening purposes, or patients deemed by GPs as lacking capacity for informed consent. Data were obtained via patient questionnaire, medical and laboratory records.Primary and secondary outcome measuresFIT results (10 µg Hb/g faeces defined a positive result); patient sociodemographic and clinical characteristics; patient-reported and GP-recorded symptoms, symptom severity and symptom agreement between patient and GP (% and kappa statistics).ResultsComplete data were available for 310 patients, median age 70 (IQR 61–77) years, 53% female and 23% FIT positive. Patients most commonly reported change in bowel habit (69%) and fatigue (57%), while GPs most commonly recorded abdominal pain (25%) and change in bowel habit (24%). Symptom agreement ranged from 44% (fatigue) to 80% (unexplained weight loss). Kappa agreement was universally low across symptoms.ConclusionAlmost a quarter of this primary care cohort of symptomatic patients with FIT testing were found to be positive. However, there was low agreement between patient-reported and GP-recorded symptoms. This may impact cancer risk assessment and optimal patient management in primary care.

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Section: Discussionmentioning

confidence: 99%

Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study

et al. 2022

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“…A germane question is whether a repeat FIT after a finding of an increase in f-Hb could help decide whether more traditional surveillance protocols with colonoscopy should be initiated, although there is little available evidence on the possible roles of repeat FIT in any clinical setting. 19 It would also be of interest to investigate if serial f-Hb in patients with NAA and in AA, when f-Hb has fallen, could detect, at an early stage, development of neoplasia; early detection of lesions is another ideal attribute of a tumour marker. Such a strategy is used in IBD to predict recurrence of disease using serial faecal calprotectin measurements (with the patient acting as their own control).…”

Section: Discussionmentioning

confidence: 99%

Faecal haemoglobin concentration in adenoma, before and after polypectomy, approaches the ideal tumour marker

et al. 2022

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Background Polypectomy may be performed at colonoscopy and then subsequent surveillance undertaken. It is thought that faecal haemoglobin concentration (f-Hb), estimated by quantitative faecal immunochemical tests (FIT), might be a useful tumour marker. Methods Consecutive patients enrolled in colonoscopy surveillance were approached at two hospitals. A specimen for FIT was provided before colonoscopy and, ideally after 3 weeks, a second FIT sample from those who had polypectomy. A single FIT system (OC-Sensor io, Eiken Chemical Co., Ltd) was used to generate f-Hb. Results 1103 Patients were invited; 643 returned a FIT device (uptake: 58.3%). Four patients had known inflammatory bowel disease (IBD) and were excluded, leaving 639 (57.9%) with an age range of 25–90 years (median 64 years), 54.6% male. Of 593 patients who had a f-Hb result and completed colonoscopy, advanced neoplasia was found in 41 (6.9%); four colorectal cancer (CRC): 0.7% and 37 advanced adenoma (AA): 6.3%, and a further 127 (21.4%) had non-advanced adenoma (NAA). The median f-Hb was significantly greater in AA as compared to NAA; 6.0 versus 1.0 μg Hb/g faeces, p < 0.0001.134/164 (81.7%) of invited patients returned a second FIT device: 28 were patients with AA in whom median pre-polypectomy f-Hb was 19.2, falling to 3.5 μg Hb/g faeces post-polypectomy, p = 0.01, and 106 with NAA had median pre-polypectomy f-Hb 0.8 compared to 1.0 μg Hb/g faeces post-polypectomy, p = 0.96. Conclusions Quantitative FIT could provide a good tumour marker in post-polypectomy surveillance, reduce colonoscopy requirements and minimise potential risk to patients.

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“…These include the difference between the relative risk and relative odds, the need to estimate the absolute risk reduction that might be gained through this application of f-Hb, the importance of carefully assessing the expected and the accepted false positive rate together with the detection rate, the PPV and its relationship with the prevalence of the disease, and the need for careful assessment of the benefits and risks and burdens such as the impact of this application on the provision of additional health care. Ultimately, after appropriate prospective research, it is possible that the efficacy of these interventions could be monitored by the objective analyses of serial estimates of f-Hb using FIT, although little is known at the present time about the utility of this strategy, particularly in symptomatic patients [44]: the use of serial f-Hb in monitoring responses to interventions in individuals is, as yet, speculative.…”

Section: The Futurementioning

confidence: 99%

Faecal Haemoglobin Estimated by Faecal Immunochemical Tests—An Indicator of Systemic Inflammation with Real Clinical Potential

et al. 2021

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Multimorbidity is the major cause of ill-health and premature death in developed countries. The ability to identify individuals at risk of developing chronic disease, particularly multimorbidity, reliably, and simply, and to identify undiagnosed disorders, is vital to reducing the global burden of disease. This narrative review, the first of recent studies, demonstrates that raised faecal haemoglobin concentration (f-Hb) is associated with increased all-cause and cause-specific mortality and with longer-term conditions including diabetes, hypertension, cardiovascular disease, and psoriasis, and with probable intake of particulate matter. We and others have hypothesized that elevated f-Hb (measured using a faecal immunochemical test) has considerable potential to identify individuals at risk of, or who already have, early stage, undiagnosed chronic disease. If f-Hb does prove to be an effective biomarker for chronic disease and multimorbidity, individuals with detectable f-Hb, but without an obvious source of gastrointestinal blood loss, could benefit from further assessment and early intervention. To test this hypothesis rigorously, longitudinal data-linkage methodology is required linking colorectal cancer screening data, and data on patients presenting with lower gastrointestinal symptoms, with routinely collected health information.

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Faecal immunochemical tests in the COVID-19 pandemic; safety-netting of patients with symptoms and low faecal haemoglobin concentration – can a repeat test be used?

Abstract: Not applicable because this is an editorial

Cited by 9 publications

References 14 publications

Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study

Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study

Faecal haemoglobin concentration in adenoma, before and after polypectomy, approaches the ideal tumour marker

Faecal Haemoglobin Estimated by Faecal Immunochemical Tests—An Indicator of Systemic Inflammation with Real Clinical Potential

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