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FIT performs ‘exceptionally well’ in primary care, study finds

When faecal immunochemical test (FIT) was introduced in 2017, there was little evidence on the clinical implications of using FIT to triage patients with low-risk symptoms of possible colorectal cancer in primary care.

In a new study, published in the British Journal of Cancer, data from all health care providers in the South West of England was used to identify 3890 patients aged ≥50 years presenting to primary care with low-risk symptoms of colorectal cancer who had a FIT between 1 June 2018 and 31 December 2018. A threshold of 10 μg Hb/g faeces defined a positive test.

A total of 618 (15.9%) patients tested positive. Of these, 458 (74.1%) had an urgent referral to specialist lower gastrointestinal services within three months and 43 were diagnosed with colorectal cancer within 12 months.

Of the 3272 who tested negative, 324 (9.9%) had an urgent referral within three months and eight were diagnosed with colorectal cancer within 12 months.

The positive predictive value for FIT was 7.0 per cent (95% CI, 5.1%-9.3%). The negative predictive value was 99.8 per cent (CI, 99.5%-99.9%). Sensitivity was 84.3 per cent (CI, 71.4%-93.0%), whereas specificity was 85.0 per cent (CI, 83.8%-86.1%).

The results showed that a threshold of 37 μg Hb/g faeces would identify patients with an individual 3 per cent risk of cancer.

Other cancers were also diagnosed, including 16 cases of oesophago-gastric or pancreatic cancer, of whom only four had a FIT result over the threshold. The authors say this suggests that GPs should consider other intra-abdominal cancers in patients with f-Hb <10 μg Hb/g faeces and continuing symptoms.


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