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Faecal Immunochemistry Test - qFIT

Faecal Immunochemistry Test - qFIT. Dr Rob Palmer GPwSI Gastro CCG Cancer and Gastro lead. Colorectal Cancer (CRC)- Epidemiology. 4 th most common malignancy in the UK 2 nd commonest cause of cancer death

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Faecal Immunochemistry Test - qFIT

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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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