FIT for Bowel Cancer Screening

Bowel Cancer Treatment Rate

Around 16,000 people in the UK die of bowel cancer every year, making it the second biggest cancer killer.

It is the fourth most common cancer in the UK with around 41,000 people diagnosed annually.

The majority (95%) of bowel cancer cases occur in people over 50, but it can affect anyone of any age.

The lifetime risk of developing bowel cancer is 1 in 14 for men and 1 in 19 for women.

However, if diagnosed early, more than 90% of bowel cancer cases can be treated successfully and the five year survival rates for bowel cancer have doubled over the last 40 years.

Screening aims to select people with no symptoms who are most at risk of developing bowel disease.

In England, Wales and Northern Ireland people over the age of 60 are invited to take part in bowel screening. In Scotland, screening starts from age 50.

The screening programmes have used the guaiac based Faecal Occult Blood Test (gFOBt), to look for hidden blood in faeces. The test is sent to the participant’s home and requires them to smear two small samples of poo, using the cardboard sticks provided, onto the test card. This needs to be done three times over a two week period (21 days in Northern Ireland and Scotland), before sending the card back to the screening centre.

However, advances in diagnostic technology will greatly improve the screening programmes over the coming years.

Public Health Minister, Jane Ellison announced in June 2016, that gFOBt will be replaced by the faecal immunochemical test (FIT) due to the many advantages that it brings. In Scotland gFOBT has already been replaced by FIT and the first invites for screening using the new FIT test were sent out on 20 November 2017.

The Benefits of FIT for Bowel Cancer Screening: 

  • Detects intact haemoglobin and early degradation products using monoclonal/polyclonal antibodies to globin
  • Greater clinical sensitivity
  • Detects more adenomas
  • Easier to collect the faecal sample using a method that is more acceptable to people invited for screening, promoting increased uptake
  • No diet or drug interferences
  • More specific for lower GI bleeding
  • Easier analysis using a single sample tested on automated systems
  • Advocated in many publications and most new guidelines
  • Users can select cut off for age, gender, colonoscopy resources
Bowel_Cancer_Screening_Saves_Lives Bowel Cancer Screening Saves Lives

Trials of FIT for screening have shown a big impact on uptake, with a 7% increase overall [1]. It increased uptake in groups with low participation rates, such as men, ethnic minority populations, and people in more deprived areas. The prediction is that by using FIT 200,000 more people will participate in bowel cancer screening and more lives will be saved. Currently only 58 per cent of people complete a kit when sent it. The independent Cancer Taskforce has set an ambition of 75 per cent uptake across England by 2020, and the new test will help achieve this.

Reference

  1. Moss S, et al. Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England. Gut 2016;0:1–14. http://gut.bmj.com/content/66/9/1631