Service evaluation of faecal immunochemical testing introduced for use in North East London for patients at low risk of colorectal cancer

Abstract

AimsColorectal 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.MethodsTesting 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.Results1203 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.ConclusionsThese 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.