Author: Kayleigh Roberts, Senior Product Manager FIT, Alpha Laboratories Ltd.
FIT for All
When NICE DG56 was published in August 2023 it highlighted the benefits of FIT across a wider cohort of patients and updated its recommendations to state that “additional research is needed to evaluate methods to improve access, uptake and return of FIT in people aged under 40”.
A study1 has been published looking at European cancer mortality predictions, the results of which could potentially fuel a greater urgency for actioning this NICE recommendation. The paper by Santucci et al. concluded that whilst there is an overall decrease of colorectal cancer mortality amongst those aged 70 years and over, there are emerging trends of rising colorectal cancer in those under 50 years. This is due to lifestyle factors which have previously been linked to colorectal cancer, such as obesity, diabetes, lack of exercise, poor dietary habits, and excessive alcohol consumption.
The study used a 95% prediction interval (PI) to estimate the total mortality rate for the full year of 2024. Age-standardised rates (ASR) were used to account for different age distributions of the populations being compared.
The graph presents age-standardised mortality rates for those aged 25-49 years in the UK. The ASRs are calculated per 100,000 individuals.
The UK colorectal cancer mortality values show a predicted increase of 26.1% for men and 38.6% for women aged 25 to 49 years compared the equivalent aged EU population which has an estimated decrease of 2.42% in men and 8.52% in women for 2024.
High risk targeting
National bowel screening programmes in the UK have significantly improved patient outcomes as they have identified the population who have the highest risk of developing colorectal cancer. This includes non-symptomatic patients who may have low-risk adenomas, high-risk adenomas and neoplastic lesions in the bowel which could develop into cancer, as well as those with who may be in an early stage of colorectal cancer.
Typically, the risk, and subsequent prevalence, of bowel cancer has risen with age, therefore upon the roll-out of national bowel screening programmes in the UK, those in the highest risk age range were correctly targeted (60 to 74 years). However, in response to emerging trends and improved triaging for colonoscopy waiting lists through the use of quantitative FIT, screening programmes have been extending eligibility age ranges accordingly. Scotland and Wales now offer the test to all eligible people aged 50 to 74 years. Similarly, England and Northern Ireland are also looking to extend their age ranges, with England, currently at 54 to 74 years, in the midst of reducing this down through phased age extensions from 50 to 74 years.
This demonstrates a definitive downward trend in included age groups, and those being considered at “highest risk” being integrated into the different national screening services; thus, indicating that a potential need is beginning to be addressed following the availability of clinical evidence to support the use of FIT in the wider population.
Let’s make early detection the standard of care
A popular statistic for colorectal cancer states that “9 out of 10 people survive bowel cancer when it is detected and treated earlier on” however, the ‘Never Too Young’ campaign2 by Bowel Cancer UK has identified that 4 in 10 of people (<50 years) have had to visit their GP three or more times in order to be referred for further tests. Though younger patients are not currently eligible for screening, consideration of early-onset colorectal cancer should be given upon presentation of appropriate symptoms in primary care, particularly as early-onset colorectal cancer often presents more aggressively compared to the typical onset colorectal cancer3.
FIT is a simple, inexpensive, non-invasive test which can quickly triage ALL symptomatic patients through precise, high-quality analysis and reporting. Additionally, the implementation of FIT KITs, aka patient packs, has revolutionised patient home testing, making it easy to understand how to complete a FIT and simple to return to the laboratory for testing. In combination with highly sensitive, NICE recommended analyser technology, FIT results can be attained and returned to patients cost effectively and quickly, thus improving overall patient outcomes.
References:
1Santucci, C. (no date) ‘European cancer mortality predictions for the year 2024 with focus on colorectal cancer,’ Annals of Oncology [Preprint]. https://doi.org/10.1016/j.annonc.2023.12.003.
2Never too young (no date). https://www.bowelcanceruk.org.uk/campaigning/never-too-young/.
3Medici, B. et al. (2023) ‘Early onset metastatic colorectal cancer: current insights and clinical management of a rising condition,’ Cancers, 15(13), p. 3509. https://doi.org/10.3390/cancers15133509.
Bowel Screening Across the UK (2024) Image – CRUK_Bowel_cancer_screening_at_a_glance.pdf
