FIT in Symptomatic Pathways: Ruling out bowel/colorectal cancer before the use of expensive, unpleasant and risky procedures.
For the health service, colonoscopies are expensive, time consuming and compliance is low. For the patient, both the colonoscopy procedure and the preparation are unpleasant, disruptive and not without risks. The vague symptoms presented in primary care could be indicative of a number of diagnoses, including cancer, but more often no organic bowel disease is found at all. >90% of colonoscopies carried out as part of the NG12 pathways for early cancer detection are negative for cancers. This results in a huge waste of resources in secondary care.
With FIT, the whole experience for the patient and the clinician is improved: cancers and pre-cancers can be effectively ruled out with a simple and non-invasive test and the patient can then be reassured (with a 99.7% NPV (Negative Predictive Value))*, and directed down alternative pathways. For patients with cancer/pre-cancer, the extremely high sensitivity of the test improves early detection rates and if caught early, the prognosis.
Over 25 testing centres across the UK have implemented OC-Sensor™ as the keystone to their symptomatic FIT service. STPs/CCGs, in line with the NG12 and DG30 guidelines from NICE, are starting to see the benefits of FIT become a reality as early stage cancer detection increases and the referral rate from primary care decreases. Triaging patients with FIT is reducing the burden on secondary care resources and starting to reduce colonoscopy waiting times for patients most in need.
Screening vs Symptomatic FIT
FIT is commonly used in screening around the world but it may also be used as an investigation in the diagnosis of colorectal cancer in certain symptomatic patients. It is important to note that there is a difference between screening and symptomatic FIT; not only does the cohort of patients eligible for the test differ but the testing cut offs and result interpretation are also different. Cancer Research UK have produced a good guide for this available here
OC-Sensor™ is approved by NICE (DG30) for use in symptomatic patient testing
DG30 recommends the use of OC-Sensor™ quantitative FIT in primary care to guide referral for suspected colorectal cancer in patients without rectal bleeding, who have unexplained symptoms, but do not meet the criteria for a suspected cancer referral pathway. Policy regarding the implementation of symptomatic FIT is defined locally.
The DG30 document is available here