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BSG guidelines on faecal immunochemical testing: Are they 'FIT' for purpose?

Lookup NU author(s): Professor Colin ReesORCiD

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Abstract

© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. The use of faecal immunochemical testing (FIT) for patients with features of possible colorectal cancer (CRC) has increased significantly over recent years. The UK has been slower to adopt FIT than several other countries, especially in Scandinavia.1 Colonoscopy remains the 'gold-standard' test with high sensitivity and specificity, and allows biopsy of lesions and removal of polyps. However, endoscopy services in the UK (and internationally) are under huge pressure, with demand outstripping capacity, a situation exacerbated by the COVID-19 pandemic. Therefore, it is imperative to develop tools to stratify individuals at greatest risk of CRC, allowing those people to undergo definitive investigation. The patient's symptoms can do this to a limited extent, for example, rectal bleeding is a higher risk for CRC than diarrhoea. This principle underpinned the National Institute for Healthcare and Clinical Excellence (NICE) guidance, 'Suspected cancer: recognition and referral (NG12).2 This defined features of cancer equating to a cancer risk of 3% or below as low risk, and to be offered initial testing in primary care, with patients having a risk of cancer of greater than 3% defined as high risk, warranting specialist referral and definitive investigation. Further NICE guidance, 'Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care'3 recommended FIT in primary care for the low-risk population, and for those testing positive to be offered definitive investigation.

Publication metadata

Author(s): Rees CJ, Hamilton W

Publication type: Article

Publication status: Published

Journal: Gut

Year: 2023

Volume: 72

Issue: 10

Pages: 1805-1806

Print publication date: 01/10/2023

Online publication date: 16/09/2022

Acceptance date: 04/09/2022

ISSN (print): 0017-5749

ISSN (electronic): 1468-3288

Publisher: BMJ Publishing Group

URL: http://dx.doi.org/10.1136/gutjnl-2022-328201

DOI: 10.1136/gutjnl-2022-328201

PubMed id: 36113978

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