Use of faecal occult blood tests in symptomatic patients

Abstract

director 4 , Michael Machesney chair 5 , Colin Rees vice president (chair of endoscopy) 2 , Stephen P Halloran member, bowel screening advisory committee 6 , Muti Abulafi chair 7 , Deborah Alsina chief executive 8

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

“…Use of FIT testing in colorectal low‐risk symptom pathways is likely to be controversial as was the introduction of gFOB by NICE in 2015 2,3 . However, patients and bowel cancer charities may be reassured by the improved performance of FIT compared to gFOB and with appropriate safety netting allow more rapid definitive testing for the at risk population 13 .…”

“…Since July 2017 the faecal immunochemical test (FIT) has been recommended by the National Institute for Health and Care Excellence (NICE) DG30 guidelines ‘to guide referral for suspected colorectal cancer in people without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer pathway’ 1 . Guidance on faecal testing has generated significant debate 2,3 . Concerns have been raised about delayed cancer diagnosis due to false negatives and the potential to increase demand on already stretched endoscopy service due to false positives 4‐6 .…”

Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms: Concepts and challenges

“…For example, Steele et al stated, inter alia, that the guidance was particularly worrying for people under 60 years with iron deficiency anaemia, that gFOBT should be used only in laboratories with dedicated staff and strict quality assurance and for population screening, and that anyone seeking advice about symptoms wishes reassurance that there is no serious disease but gFOBT is not sufficiently sensitive for this purpose and, because negative tests provide reassurance, diagnosis is likely to be delayed. 28 In response, Hamilton et al responded that half of patients with CRC did not meet the criteria for urgent referral under the previous guidance (CG27) and these patients, who were at low risk but did not have no risk symptoms, did badly, with longer times to diagnosis, more emergency admissions and higher mortality. NG12 sought to improve this and the specific guideline was based on six research papers on faecal occult blood testing (FOBT) in the symptomatic primary care population.…”

Straight‐to‐test colonoscopy for 2‐week‐wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high‐volume unit

“…The median time to first test from the referral date was significantly shorter in the STT group than in the OPA group [13][14][15][16][17][18][19] respectively; P < 0.0001, Kruskal-Wallis test]; however, there was no significant difference in median time to elective surgery from the referral date (50 days vs 57 days). All 10 patients who underwent elective surgery as their first treatment in the STT pathway did so within 62 days, but two of nine patients in the standard pathway missed this target.…”