Using symptoms alone to select patients for colorectal cancer investigation leads to many people being referred by their GP for further investigation who do not end up receiving a cancer diagnosis. Not only does this put strain on NHS resources but it creates unnecessary worry in people who do not have cancer.
Non-invasive faecal immunochemical tests (FIT) that detect blood in patient stool samples have been recommended by the National Institute for health and Care Excellence since 2017 to guide the referral of patients with unexplained symptoms for colorectal cancer investigation. Previous studies by University of Oxford researchers showed that FIT is a very accurate test that GPs can use to select symptomatic patients at highest risk of colorectal cancer and that blood tests appear to provide little if any additional information to FIT alone when prioritising patients for colorectal cancer referral.
During the COVID-19 pandemic, FIT has increasingly been used as a triage tool for patients presenting to primary care with suspected colorectal cancer symptoms. However, the deployment of FIT has been relatively ad hoc.
The Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) jointly commissioned a new guideline, published in the journal Gut, to provide an evidence-based framework for the best use of FIT in the diagnostic pathway for people with symptoms or signs of a suspected colorectal cancer diagnosis. The guideline development group included Oxford gastroenterologist Professor James East (Translational Gastroenterology Unit, Nuffield Department of Medicine) and GP Dr Brian Nicholson (Cancer Research Group, and Nuffield Department of Primary Care Health Sciences). In total, 23 evidence and expert opinion-based recommendations were developed, along with 17 recommendations for research to help further inform clinical management.