Abstract
PurposeFaecal Immunochemical Test (FIT) has proven utility for Colorectal Cancer (CRC) detection in symptomatic patients. Most studies have examined FIT in symptomatic patients subsequently referred from primary care. We investigated associations between CRC and FIT in both referred and non-referred symptomatic patients.MethodsA retrospective, observational study of all patients with a FIT submitted Aug 2018 to Jan 2019 in NHS GG&C was performed. Referral to colorectal/gastroenterology and decision to perform colonoscopy were recorded. FIT results were grouped as f-Hb < 10/10–149/150–399/ ≥ 400 μg/g. The MCN cancer registry identified new cases of CRC. Covariables were compared using the χ2 test. Multivariate binary logistic regression identified independent predictors of CRC.ResultsA total of 4968 patients were included. Raised FIT correlated with decision to refer (p < 0.001) and scope (p < 0.001). With 23-month median follow-up, 61 patients were diagnosed with CRC. These patients were older (median 69 vs 59 years, cancer and no cancer respectively, p = 0.001), more likely to be male (55.7% vs 42.1%, p = 0.033), and to report rectal bleeding (51.7% vs 36.1%, p = 0.013). FIT (< 10 µg/g 8.2% vs 76.7% and ≥ 400 µg/g 55.7% vs 3.8%, p < 0.001) and anaemia (45.9% vs 19.7%, p < 0.001) were associated with CRC. On multivariate analysis, age (p = 0.023), male sex (p = 0.04), FIT (≥ 400 OR 54.256 (95% CI:20.683–142.325; p < 0.001)), and anaemia (OR 1.956 (1.071–3.574; p = 0.029)) independently predicted CRC. One patient (0.04%) with a negative FIT and normal haemoglobin had CRC.ConclusionGP referral and secondary care investigation patterns were influenced by FIT. The combination of normal Hb and f-Hb excluded CRC in 99.96% of cases, providing excellent reassurance to those prioritising access to endoscopy services.
Highlights
Colorectal cancer is the 4th most common cancer in the UK, with approximately 42,000 new cases and 16,500 deaths each year [1]
The NICE DG30 guideline recommends that the faecal immunochemical test (FIT) be used to guide referral for suspected colorectal cancer in patients with lower risk lower GI symptoms [7]
We aimed to examine associations between colorectal cancer diagnosis, symptoms, faecal haemoglobin concentration, and anaemia in patients both referred and not referred from primary care following the introduction of FIT into a symptomatic lower GI referral pathway
Summary
Colorectal cancer is the 4th most common cancer in the UK, with approximately 42,000 new cases and 16,500 deaths each year [1]. Cancer Guidelines [3] have similar recommendations in terms of high risk lower gastrointestinal symptoms which should trigger an urgent suspicion of cancer referral. These include rectal bleeding with no obvious cause, persistent change in bowel habit (> 4 weeks, diarrhoea), palpable. The NICE DG30 guideline recommends that the faecal immunochemical test (FIT) be used to guide referral for suspected colorectal cancer in patients with lower risk lower GI symptoms (those without rectal bleeding but other unexplained symptoms that do not meet urgent suspected cancer pathway criteria) [7]. We aimed to examine associations between colorectal cancer diagnosis, symptoms, faecal haemoglobin concentration, and anaemia in patients both referred and not referred from primary care following the introduction of FIT into a symptomatic lower GI referral pathway
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