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
|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
||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
Clinical teams should consider:
- Providing the patient with clear information about who to contact if they develop new symptoms or if their existing symptoms persist or worsen
- Referral to a non-specific symptoms (vague) pathway, if appropriate and there are ongoing concerns about possible cancer
- 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.