Colorectal cancer is the fourth most common cancer in the UK with 54% of cases classified as preventable (Cancer Research UK, 2015). Public Health England and Public Health Wales have evidenced that the one-year net survival for colorectal cancer decreases from 98% when cancer is diagnosed at stage 1, to just over 40% when diagnosed at stage 4.
The British Society of Gastroenterology (BSG) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) have produced new joint guidance and a flowchart on use of FIT in symptomatic patients. NHS England have supported the adoption of this guidance and NICE are expected up to update NG12/ DG30 guidance this year.
Bowel Cancer UK have summarised this change online.
Start GatewayC’s 1 hour CPD accredited colorectal and FIT courses.
Key recommendation for the use of FIT with patients:
- FIT should be used by primary care clinicians to prioritise patients with suspected bowel cancer for referral for urgent investigation
- FIT should be used at a sensitivity level of 10ug/g in primary care to select patients with lower GI symptoms for an urgent referral pathway for further investigation
- Patients should not be excluded from referral from primary care for symptoms on the basis of FIT testing alone
Managing FIT negative patients:
- Consider referral on a non-site-specific pathway if concerning symptoms persist e.g. weight loss, abdominal pain, anaemia
- Consider referring patients with persistent gastro-intestinal symptoms on an urgent or routine pathway
For safety netting, clinical teams should consider:
- Providing clear information regarding who to contact if symptoms develop or worsen
- Ensure patients understand the reason for and importance of the test
- Consider coding FIT requests and searching for non-returned samples
For a short visual update on these guidelines, Dr Kevin Monahan, Consultant Gastroenterologist and Chair of the Colorectal Section of the BSG, has presented this in a webinar format.
