Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG)

Kevin J Monahan, Michael M Davies, Muti Abulafi, Ayan Banerjea, Brian D Nicholson, Ramesh Arasaradnam, Neil Barker, Sally Benton, Richard Booth, David Burling, Rachel Victoria Carten, Nigel D'Souza, James Edward East, Jos Kleijnen, Michael Machesney, Maria Pettman, Jenny Pipe, Lance Saker, Linda Sharp, James Stephenson, Robert Jc Steele, Kevin J Monahan, Michael M Davies, Muti Abulafi, Ayan Banerjea, Brian D Nicholson, Ramesh Arasaradnam, Neil Barker, Sally Benton, Richard Booth, David Burling, Rachel Victoria Carten, Nigel D'Souza, James Edward East, Jos Kleijnen, Michael Machesney, Maria Pettman, Jenny Pipe, Lance Saker, Linda Sharp, James Stephenson, Robert Jc Steele

Abstract

Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.

Keywords: ANEMIA; COLONOSCOPY; COLORECTAL CANCER; COLORECTAL SURGERY; STOOL MARKERS.

Conflict of interest statement

Competing interests: JEE has served on the clinical advisory boards for Lumendi, Boston Scientific and Paion; has served on the clinical advisory board and has share options in Satisfai Health; and reports speaker fees from Falk, Jannsen and Medtronic. KJM, SB and MM are medical advisors to the charity Bowel Cancer UK. MM is a director of Machesney & Easty Management, a private limited company. JEE is funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Pathway for FIT in patients with signs or symptoms of a suspected diagnosis of colorectal cancer (CRC), including symptoms such as those with per rectal bleeding, and signs including iron deficiency anaemia. Those with an abdominal mass should be referred urgently, but a FIT should be sent simultaneously in primary care in order to inform subsequent management. FIT, faecal immunochemical testing, fHb, faecal haemoglobin.

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