James A. Bailey
Faecal immunochemical testing and blood tests for prioritization of urgent colorectal cancer referrals in symptomatic patients: a 2-year evaluation
Bailey, James A.; Weller, Jill; Chapman, Caroline; Ford, Abby; Hardy, Katie; Oliver, Simon; Morling, Joanne R.; Simpson, J. Alastair; Humes, David J.; Banerjea, Ayan
Authors
Jill Weller
Caroline Chapman
Abby Ford
Katie Hardy
Simon Oliver
JOANNE MORLING JOANNE.MORLING@NOTTINGHAM.AC.UK
Clinical Associate Professor
J. Alastair Simpson
DAVID HUMES david.humes@nottingham.ac.uk
Clinical Associate Professor
Ayan Banerjea
Abstract
Background
A novel pathway incorporating faecal immunochemical testing (FIT) for rapid colorectal cancer diagnosis (RCCD) was introduced in 2017. This paper reports on the service evaluation after 2 years of pathway implementation.
Methods
The RCCD protocol was based on FIT, blood results and symptoms to stratify adult patients in primary care. Two-week-wait (2WW) investigation was indicated for patients with rectal bleeding, rectal mass and faecal haemoglobin (fHb) level of 10 µg Hb/g faeces or above or 4 µg Hb/g faeces or more in the presence of anaemia, low ferritin or thrombocytosis, in all other symptom groups. Patients with 100 µg Hb/g faeces or above had expedited investigation . A retrospective audit of colorectal cancer detected between 2017 and 2019 was conducted, fHb thresholds were reviewed and critically assessed for cancer diagnoses.
Results
In 2 years, 14788 FIT tests were dispatched with 13361 (90.4 per cent) completed returns. Overall, fHb was less than 4 µg Hb/g faeces in 9208 results (68.9 per cent), 4–9.9 µg Hb/g in 1583 (11.8 per cent), 10–99.9 µg Hb/g in 1850 (13.8 per cent) and 100 µg Hb/g faeces or above in 720 (5.4 per cent). During follow-up (median 10.4 months), 227 colorectal cancers were diagnosed. The cancer detection rate was 0.1 per cent in patients with fHb below 4 µg Hb/g faeces, 0.6 per cent in those with fHb 4–9.9 µg Hb/g faeces, 3.3 per cent for fHb 10–99.9 µg Hb/g faeces and 20.7 per cent for fHb 100 µg Hb/g faeces or above. The detection rate in the cohort with 10–19.9 µg Hb/g faeces was 1.4 per cent, below the National Institute for Health and Care Excellence threshold for urgent referral. The colorectal cancer rate in patients with fHb below 20 µg Hb/g faeces was less than 0.3 per cent.
Conclusion
Use of FIT to "rule out" urgent referral from primary care misses a small number of cases. The threshold for referral may be adjusted with blood results to improve stratification .
Citation
Bailey, J. A., Weller, J., Chapman, C., Ford, A., Hardy, K., Oliver, S., …Banerjea, A. (2021). Faecal immunochemical testing and blood tests for prioritization of urgent colorectal cancer referrals in symptomatic patients: a 2-year evaluation. BJS Open, 5(2), Article zraa056. https://doi.org/10.1093/bjsopen/zraa056
Journal Article Type | Article |
---|---|
Acceptance Date | Nov 15, 2020 |
Online Publication Date | Mar 9, 2021 |
Publication Date | Mar 9, 2021 |
Deposit Date | Nov 24, 2020 |
Publicly Available Date | Mar 10, 2022 |
Journal | BJS Open |
Electronic ISSN | 2474-9842 |
Publisher | Wiley |
Peer Reviewed | Peer Reviewed |
Volume | 5 |
Issue | 2 |
Article Number | zraa056 |
DOI | https://doi.org/10.1093/bjsopen/zraa056 |
Public URL | https://nottingham-repository.worktribe.com/output/5067962 |
Publisher URL | https://academic.oup.com/bjsopen/article/5/2/zraa056/6162967 |
Files
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Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/
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