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Risk-stratified faecal immunochemical testing (FIT) for urgent colonoscopy in Lynch syndrome during the COVID-19 pandemic

Lookup NU author(s): Helen Hanson, Professor Sir John BurnORCiD, Dr David Nylander, Dr Tom Lee



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 The Author(s). Background: Lynch syndrome is a hereditary cancer disease resulting in an increased risk of colorectal cancer. Herein, findings are reported from an emergency clinical service implemented during the COVID-19 pandemic utilizing faecal immunochemical testing ('FIT') in Lynch syndrome patients to prioritize colonoscopy while endoscopy services were limited. Methods: An emergency service protocol was designed to improve colonoscopic surveillance access throughout the COVID-19 pandemic in England for people with Lynch syndrome when services were extremely restricted (1 March 2020 to 31 March 2021) and promoted by the English National Health Service. Requests for faecal immunochemical testing from participating centres were sent to the National Health Service Bowel Cancer Screening South of England Hub and a faecal immunochemical testing kit, faecal immunochemical testing instructions, paper-based survey, and pre-paid return envelope were sent to patients. Reports with faecal haemoglobin results were returned electronically for clinical action. Risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10μg of haemoglobin/g of faeces (μg/g) - scheduled within 6-12 weeks; and faecal haemoglobin greater than or equal to 10μg/g - triaged via an urgent suspected cancer clinical pathway. Primary outcomes of interest included the identification of highest-risk Lynch syndrome patients and determining the impact of faecal immunochemical testing in risk-stratified colonoscopic surveillance. Results: Fifteen centres participated from June 2020 to March 2021. Uptake was 68.8 per cent amongst 558 patients invited. For 339 eligible participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10μg/g and 60 (17.7 per cent) had faecal haemoglobin greater than or equal to 10μg/g. In the latter group, the diagnostic accuracy of faecal immunochemical testing was 65.9 per cent and escalation to colonoscopy was facilitated (median 49 versus 122 days, χ2 = 0.0003, P < 0.001). Conclusion: Faecal immunochemical testing demonstrated clinical value for Lynch syndrome patients requiring colorectal cancer surveillance during the pandemic in this descriptive report of an emergency COVID-19 response service. Further longitudinal investigation on faecal immunochemical testing efficacy in Lynch syndrome is warranted and will be examined under the 'FIT for Lynch' study (ISRCTN15740250).

Publication metadata

Author(s): Lincoln AG, Benton SC, Piggott C, Sheikh SR, Beggs AD, Buckley L, Desouza B, East JE, Sanders P, Lim M, Sheehan D, Snape K, Hanson H, Greenaway JR, Burn J, Nylander D, Hawkins M, Lalloo F, Green K, Lee TJ, Walker J, Matthews G, Rutherford T, Sasieni P, Monahan KJ

Publication type: Article

Publication status: Published

Journal: BJS Open

Year: 2023

Volume: 7

Issue: 5

Print publication date: 01/10/2023

Online publication date: 05/09/2023

Acceptance date: 20/06/2023

Date deposited: 11/10/2023

ISSN (electronic): 2474-9842

Publisher: Oxford University Press


DOI: 10.1093/bjsopen/zrad079


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Funder referenceFunder name
40tude Curing Colon Cancer Charity
Cancer Research UK
King’s College London Centre for Doctoral Studies Postgraduate Research (PGR) International Scholarship
Mast Group Ltd
National Institute for Health Research (NIHR) Oxford Biomedical Research Centre