P392 How has the transition from FOBt to FIT changed the BCSP colonoscopy service?

Abstract

Introduction In 2019, the national bowel cancer screening programme (BCSP) switched its home stool test kit from a six windowed guaiac faecal occult blood test (FOBt), to a single sample semi-quantitive faecal immunochemical test (FIT). The FIT test is superior to FOBt,1 the transition to a single sample was expected to increase returns (uptake). A FIT cut-off = 120 µg/g was introduced so that endoscopy services weren’t overwhelmed. We evaluate the impact of this switch on the colonoscopy service. Methods Northamptonshire patients who returned a positive stool testing kit in 2019 had their data collated and analysed. Results Of 565 patients, 356 (63.0%) were male. 52 (9.2%) had colorectal cancer (CRC), 308 had polyps (54.5%). Overall; 340 (60.2%) had CRC &/or polyps. Conclusion The switch from FOBt to FIT has changed the profile of patients returning a positive test. The convenience of a single sample has presumably driven an increase in returns (uptake), the 120 µg/g FIT test threshold has increased positivity. The age & gender profiles, and CRC detection rate, are similar. There is a higher ADR, with a significantly higher number of larger (>10 mm) polyps detected & removed. In cases where polyps were identified, the mean number of adenomas removed is also significantly higher, and more likely be in the left side of the colon. This suggests that colonoscopists need to be prepared to perform more polypectomies, especially of larger polyps. Interestingly, 25.5% of the FIT test positive cases were patients who had not previously returned a FOBt kit. This group were younger, and were significantly more likely to be male, have more adenomas (especially larger ones), which were more likely to be in the left colon. CRC detection was slightly lower – this may be due to those patients with cancer presenting symptomatically having not had the protection of BCSP.2 References Moss S, Mathews C, Day TJ, et al. Increased uptake and improved outcomes of bowel cancer screening with a faecal immunochemical test: results from a pilot study within the national screening programme in England. Gut 2017;66:1631–44. Logan RFA, J Patnick, C Nickerson, on behalf of the English Bowel Cancer Screening Evaluation Committee, et al. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 2012;61:1439–1446.