FIT For Clinicians

Is Colonoscopy necessary

Endoscopy departments are under increasing pressure to meet the demands for colonoscopy services to diagnose patients with a wide range of abdominal symptoms. Waiting lists are long which can mean that potentially some patients with bowel cancer are delayed in receiving a diagnosis and treatment.

Publications support the Faecal Immunochemical Test (FIT) for haemoglobin (Hb) as a rule out test for cancer with a negative predictive value (NPV) of 100% using a cut off concentration of 10μg Hb/g faeces.

The research (1) also supports a NPV of 94.6% for High-Risk Adenoma (HRA), 93.5% for Low-Risk Adenoma (LRA) and 94% for Inflammatory Bowel Disease. It also demonstrates that with an increased severity of disease a higher faecal haemoglobin (f-Hb) concentration is detected. Thus FIT enables management of the patient pathway and most effective use of resources based on appropriate evidence.

Proposed Patient Pathway
(click for larger view)

Personalised Medicine

All patients are different and present with a range of symptoms and risk factors. The additional information provided by FIT testing can help determine the optimum management of each individual.

Resource Management

Waiting times for endoscopy resources are increasing. Performing an initial FIT test to categorise the patient could, with confidence, predict those for whom colonoscopy is not appropriate. This would remove 40% of patients from waiting lists, significantly improving the turn-around time for those remaining, and ensuring their treatment is optimised and actioned sooner.

Screening in the Asymptomatic Population

Using FIT technology, such as the HM-JACKarc automated system, within a screening programme, enables the adjustment of positive cut off concentration. This helps to control the number of referrals for colonoscopy within the limits of available resources. In addition, the specificity of FIT eliminates false positives caused by dietary factors, ensuring positive results are a true indicator of pathology.

Reference

  1. Low faecal haemoglobin concentration potentially rules out significant colorectal disease, PJ McDonald, et al.
    Colorectal Dis. 2013 Mar;15(3):e151-9. doi: 10.1111/codi.12087

Key Things to Know About FIT

There are significant differences between each use of FIT which are important for health professionals to be aware of.

This includes the threshold for all abnormal results; e.g, a patient might test normal following screening, yet receive an abnormal result, requiring further action, when tested symptomatically.

The ‘Key Things to Know About FIT’ documents from Cancer Research UK highlight these for Scotland, England, Wales and Northern Ireland:

Scotland

England

Wales

Northern Ireland

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