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Faecal Immunochemistry Test (FIT) for Early Detection of Bowel Cancer

Learn about the Faecal Immunochemistry Test (FIT) and its role in early detection of colorectal cancer, including guidelines for patient referral and interpretation of test results. Discover how FIT compares to traditional methods and its potential impact on cancer survival rates.

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Faecal Immunochemistry Test (FIT) for Early Detection of Bowel Cancer

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  1. Faecal Immunochemistry Test - qFIT Dr Rob Palmer GPwSI Gastro CCG Cancer and Gastro lead

  2. Colorectal Cancer (CRC)- Epidemiology • 4th most common malignancy in the UK • 2nd commonest cause of cancer death • >20% of new cases in London are in people under 60 years old (i.e. below the screening age)

  3. Bowel Cancer (C18-C20): 2002-2006 Five-Year Relative Survival (%) by Stage, Adults Aged 15-99, Former Anglia Cancer Network

  4. Bowel Cancer (C18-C20) Proportion of Cases Diagnosed at Each Stage, All Ages

  5. Over half of all cases in England and almost 60% of cases in London are diagnosed at Stages 3 and 4. • People under 60 years are less likely to be diagnosed with early stage CRC (37%) compared to those over 60 years (44%). • In London: • 28% diagnosed via an emergency route – 33% 5yr survival • 49.7% diagnosed via 2ww referral - 69% 5yr survival • In NEL, 6 out of 7 CCGs have a one year survival for • colorectal cancer below the England average • Colorectal cancer survival

  6. Local data

  7. HOW AND WHEN BOWEL CANCER PATIENTS ARE DIAGNOSED

  8. FIT (Faecal Immunochemical Test) - uses antibodies that specifically recognise human haemoglobin TO TEST FOR OCCULT BLOOD Comparison of FIT vs g-FOBT • What is FIT and how can it help?

  9. NICE Cancer Recognition and Referral guidelines – NG12

  10. Refer on 2WW if: • ≥40y with unexplained weight loss and abdominal pain • ≥50y with unexplained rectal bleeding • ≥60y with iron deficiency anaemia (IDA) or change in bowel habit • Positive faecal occult blood test • Consider referral on a 2WW if: • Rectal or abdominal mass • <50y and rectal bleeding + any of: abdominal pain, change in bowel habit, weight loss or IDA • Lower GI Suspected Cancer Pathway (2WW) - NICE NG12

  11. Offer FIT to assess for colorectal cancer in adults without rectal bleeding who: • Are aged 50 years and over with unexplained: • Abdominal pain or • Weight loss or • Are aged under 60 with: • Changes in their bowel habit or • Iron deficiency anaemia or • Are aged 60 and over and have anaemia even in the absence of iron deficiency. NICE DG30 Guidelines • Offer a FIT test if:

  12. New Pan London Suspected Lower GI Cancer Referral Form

  13. GP offers test to eligible patient and issue s FIT test kit • Broad Principles of how FIT will work locally Patient completes test and returns the kit to the lab for processing Safety-netting Result to GP – communication with patient Negative FIT Positive FIT ie [FHb] ≥10µg/g Safety-netting Symptoms persist Symptoms resolve Safety-netting 2WW pathway Safety-netting Further investigations or referral NFA

  14. Godber et al ClinChem Lab Med 2016; 54(4): 595-602 Scottish Study using FIT at 10mcg/g threshol Sensitivity for colorectal cancer 100%, Specificity 80.2% PPV 26.3% NPV 100% • How good is FIT? • Widlak et al Aliment PharmacolTher 2017: 45: 354-363 • English study • Sensitivity 84%, Specificity 93% • NPV 99%

  15. The risk of cancer would be very low… but not zero and it doesn’t rule out other non-cancer diagnoses • If ongoing clinical concerns  refer • If FIT result negative…

  16. FIT: measures human haemoglobin; i.e. bleeding • Calprotectin: released from neutrophils & macrophages at sites of inflammation • Recommend to use FIT when suspect cancer and F.calp when suspect IBD. In younger patients, it may be appropriate to request both. • What is the difference between FIT and calprotectin?

  17. Proportion of CRC diagnosed at Stage 1-2 to increase from 39.9% (2015) to 43.1% (NEL STPs) • Proportion of CRC diagnosed through emergency A&E visit to drop from 28.4% to 20% • Reduction in the need for colonoscopy in 75-80% of cases • Overall reduction of colonoscopy/CTC by 15% • Significant savings to NHS (middle projection figure £6.5million for London) • Cost of test = £15-20 (kit + testing) • Projected benefits of implementation of FIT

  18. Due to replace g-FOBT during 2019 • Improved sensitivity over FOBt • Higher thresholds for qFIT used in screening programme (120mcg/g vs 10mcg/g for symptomatic patients) • i.e. patients who have a negative screening result may still have bowel cancer and should be offered a symptomatic FIT test if appropriate • Projected improved uptake by patients (approx 7%) • FIT in Bowel Cancer Screening Programme (BCSP)

  19. Use in high-risk (2ww) patients • Surveillance (previous polyps, strong FH CRC) • The Future …

  20. What is FIT and how to deliver samples: • Leaflet • Video • https://gps.cityandhackneyccg.nhs.uk/topic/cancer • Patient resources

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