A summary of ‘Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham by C.Chapman et al., December 2019’

FIT technology has been shown to dramatically improve results when compared to the more traditional criteria that have been used in the past. This is of considerable importance when consideration is given to the finances, the enormous diagnostic capacity, pressures and patient outcome that the colorectal cancer (CRC) two-week-wait (2WW) pathway has demonstrated.

Pilot studies have demonstrated that it is essential to use a combination of FIT and additional tests such as those used for anaemia to identify particularly high risk groups who benefit from the rapid investigations that were mediated by the 2WW pathways, this can be effective at minimizing missed diagnosis, but can also provide patients with an increased confidence in the services that are being provided by the CRC 2WW pathway.

A novel approach has been suggested to use FIT as a stratification tool for the symptomatic population that are considered highly likely to develop colorectal cancer.

Between November 2017 and May 2018, 1947 FIT kits were evaluated with a mean age of 66.3 (mostly men, 44.4%). There was a healthy return rate of 91.4% (1702/1842) with a majority older cohort returning kits compared to the younger cohorts. In the study the clinical introduction of FIT yielded a reasonable performance that was consistent with the results of a previous pilot study (Chapman et al., 2019).

Patients were grouped in accordance with the FIT result based on a number of different cut offs: <4.0 µg Hb/g faeces, 4.0-9.9 µg Hb/g faeces, 10.0-149.9 µg Hb/g faeces, >150 µg Hb/g faeces. A significant proportion of patients with a FIT result of >150 µg Hb/g faeces (31/81) were diagnosed with a cancer, with Stage II and stage IV being the most prevalent disease stages. In contrast, of the 531 that went on for investigation after receiving a FIT result of <4.0 µg Hb/g faeces, only one Stage I colorectal cancer was found, further evidencing the very high negative predictive value of FIT.

The overall detection rate for colorectal cancer and significant bowel pathology in the positive pathway was as good as the straight-to-test pathway for FIT results of 4.0-149.9 µg Hb/g faeces and significantly higher in the rapid pathway for FIT results of >150.0 µg Hb/g faeces. Thus a symptomatic pathway that incorporates FIT appears to be more clinically effective than the pathways that are based on age and symptoms alone.

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  1. Chapman, C., Thomas, C., Morling, J et al. Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham. Colorectal Dis (2020);
  2. Chapman C, Bunce J, Oliver S et al. “Getting FIT”: A service evaluation of FIT and anaemia for risk stratification in the Two week wait pathway for Colorectal Cancer. BJS Open 2019; 3: 395–402.