European societies release joint guideline for use of FIT in colorectal cancer diagnosis
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The Association of Coloproctology of Great Britain and Ireland and the British Society of Gastroenterology have published a joint guideline for the strategic use of fecal immunochemical testing in people with suspected colorectal cancer.
“Evaluation in primary care of symptomatic patients with a potential diagnosis of CRC is challenging. Symptoms alone are unreliable predictors of those who may have a diagnosis of CRC and may therefore result in a high proportion of eligible patients not having access to diagnostic examination,” Kevin J. Monahan, FRCP, PhD, a gastroenterologist at the Wolfson Endoscopy Unit at St Mark’s Hospital and lecturer at Imperial College in London, and colleagues wrote in Gut. “Use of FIT offers considerable advantages over the use of symptoms, with a vastly superior positive predictive value for CRC.”
After conducting a systematic review of 13,535 publications, Monahan and colleagues developed 23 evidence and expert opinion-based recommendations for the use of FIT in people with symptoms of CRC. The guideline covers a range of topics, including recommendations for FIT use in a primary care setting, advice for clinicians regarding patient compliance, diagnostic accuracy of FIT and more. Highlights include:
- FIT should be used by clinicians in a primary care setting at a threshold of fecal hemoglobin (fHB) greater than or equal to 10 µg Hb/g to prioritize patients with clinical features of CRC for immediate investigation.
- Clinicians should follow-up with patients who do not have a FIT result to encourage test compliance.
- Patients with symptoms of suspected CRC may be managed in a primary care setting if fHB is less than 10 µg Hb/g. However, patients with persistent and unexplained symptoms should be referred for secondary care evaluation.
- FIT should be used for patients with iron deficiency anemia to inform referral urgency. Patients with persistent or recurrent anorectal bleeding should be referred for flexible sigmoidoscopy if fHB is less than 10 µg Hb/g.
- FIT may be used to stratify patients younger than 50 years of age with bowel symptoms suspicious of CRC.
- Researchers recommend that using FIT as a diagnostic triage tool can be safely implemented at the primary care level and that educational programs should be developed to facilitate this implementation.
“FIT provides an opportunity to effectively triage patients with bowel symptoms into two groups: those who require ‘fast track’ referral on an urgent suspected cancer pathway and lower risk patients who may potentially be managed in primary care,” Monahan and colleagues wrote. “The benefit of this stratification should be to reduce the fear of missed/delayed diagnosis of CRC, which is currently driving high referral rates for investigation, enabling more effective use of investigative processes with a focus on evaluating those with a significant risk of an underlying CRC diagnosis.”
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