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What is FIT
  • The Faecal Immunochemical Test (FIT) is the current test for checking for human haemoglobin in stool samples
  • FIT is more sensitive than the previously used guaiac faecal occult blood test (gFOBT) and as a result more reliable as an indicator of abnormal pathology, like colorectal cancer
  • It is also easier to collect that gFOBT as only one faecal sample is required, and no dietary or medical restrictions are needed prior to the test
  • As there are no borderline results, FIT will reduce the number of repeat tests needed for a conclusive result
  • FIT is inexpensive and helps find out who would benefit from further investigations for bowel cancer and other serious bowel conditions in patients with a range of bowel symptoms
  • FIT is an effective tool can be used for asymptomatic population-based bowel screening and also for the assessment of patients presenting with lower abdominal symptoms, particularly in primary care.


Key differences between screening and symptomatic FIT


Grade Screening Symptomatic
Use of FIT As the primary test in the NHS Bowel Cancer Screening Programme (BCSP) As a test to guide the management of patients
Who is it offered to? In England: People aged 60-74 years (every 2 years).
In Wales: People aged 55-74 years (every 2 years).
People who present symptomatically
How is the kit sent? The kit is sent to eligible individuals in the post The kit is given out by the GP, or sent to the patient by the lab once the GP has requested the kit
How is the kit returned? The completed kit is returned by post to the screening hub The completed kit is returned to the GP or directly to the lab
How are the results received? Results are sent to the patient by post. GPs are informed of all results electronically GPs will be given a result (normal/abnormal) which may include a numerical value and communicate this to the patient
Sensitivity threshold 120µg/g in England
150µg/g in Wales
80µg/g in Scotland


FIT for symptomatic patients
  • FIT test has high sensitivity and specificity, but it is not 100% accurate. It is important to remain alert for bowel and other cancers with similar symptoms and to follow-up with patients with concerning symptoms
  • Patients with a negative FIT test result who continue to experience symptoms should be reassessed
  • It is recommended that primary care professionals provide FIT kits to all patients with NICE NG12 symptoms that could be indicative of colorectal cancer. Then either:
    • Wait for the FIT test result before making a referral decision
      • For those with a FIT test result >10µg/g, the FIT test result should be recorded on the suspected cancer referral form and must be sent to secondary care to inform onward investigation
      • Patients with a FIT result <10µg/g, a normal full blood count and no ongoing clinical concern can be safety netted in primary care
      • Patients with a FIT result<10µg/g and ongoing symptoms of concern such as abdominal mass, abdominal pain, weight loss may need referring on a non-site specific pathway


Safety netting

Clinical teams should consider:

  1. Providing the patient with clear information about who to contact if they develop new symptoms or if their existing symptoms persist or worsen
  2. Referral to a non-specific symptoms (vague) pathway, if appropriate and there are ongoing concerns about possible cancer
  3. Management of FIT negative patients in an outpatient setting via non-urgent referral pathways, where available


Faecal Immunochemical Test (FIT) – Course summary

Click here to download a copy of the course summary.

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