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Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer
  1. Ruth M Ayling1,
  2. Michael Machesney2
  1. 1 Clinical Biochemistry, Barts Health NHS Trust, London, UK
  2. 2 Surgery, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Ruth M Ayling, Clinical Biochemistry, Barts Health NHS Trust, London, UK; ruthayling{at}clinicalbiochemistry.org.uk

Abstract

Aims Colorectal cancer (CRC) is the fourth most common cancer in the UK. Following National Institute of Clinical Excellence (NICE) guidance for faecal immunochemical testing (FIT) (DG30), we introduced a service for the measurement of faecal haemoglobin (fHb) in symptomatic patients in line with the 2017 update of the NG12 guidance. The purpose of this study was to audit the use of FIT, focussing on the indication for request and referral for diagnostic tests as recommended in NICE guidance.

Methods Testing was rolled out after careful introduction with extensive education led by the local Cancer Alliance and reinforced by the laboratory. After 6 months, the outcomes of all patients tested were reviewed.

Results 1203 samples were received, of which 894 (74.3%) were suitable for analysis. Of these, 482 (53.9%) actually met the criteria for FIT analysis stipulated in our patient pathway. Eight patients were diagnosed with CRC; fHb was detectable in all and was ≥200 µg/g in seven and <10 µg/g in one. 217 patients underwent gastrointestinal investigations, and the sensitivity and specificity of FIT for CRC were found to be 87.5% (95% CI 46.6% to 99.7%) and 52.6% (95% CI 45.6% to 59.6%), respectively. Patients with anaemia were more likely to have fHb ≥10 µg/g.

Conclusions These findings suggest benefits from the introduction of FIT in terms of more efficient use of diagnostic investigations, while revealing initial problems relating to familiarity with a new test. This merits further intervention with education and awareness programmes for Primary Care and further audit.

  • colorectal neoplasms
  • diagnosis
  • gastroenterology
  • gastrointestinal neoplasms

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Footnotes

  • Handling editor Tahir S Pillay.

  • Contributors RMA and MM were both involved in setting up the clinical service and in its evaluation and the authorship of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Deidentified patient data would be available on reasonable request from https://orcid.org/0000-0003-4662-2502.

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