From FOBt to FIT: making it work for patients and populations

For patients presenting to primary care symptom-based referral criteria have been broadened in an attempt to detect early stage disease, while National Institute for Health and Care Excellence (NICE) NG12 guidance introduced testing for the presence (or absence) of occult blood using guaiac based te...

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Bibliographic Details
Published inClinical medicine (London, England) Vol. 19; no. 3; pp. 196 - 199
Main Authors Mole, Guy, Withington, John, Logan, Robert
Format Journal Article
LanguageEnglish
Published London Elsevier Ltd 01.05.2019
Royal College of Physicians
Subjects
Anemia
Colonoscopy
Colorectal cancer
Conference Report
Hemoglobin
Medical imaging
Medical research
Medical screening
Population
Primary care
Studies
United Kingdom > UK
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Summary:For patients presenting to primary care symptom-based referral criteria have been broadened in an attempt to detect early stage disease, while National Institute for Health and Care Excellence (NICE) NG12 guidance introduced testing for the presence (or absence) of occult blood using guaiac based tests.3 These changes have led to more urgent 2-week-wait (2WW) cancer referrals however colonoscopies in this group do not detect CRC or other serious bowel pathology.4 In 2017, NICE recommended replacing the guaiac based test with the newer faecal immunochemical test (FIT) which is more specific for blood,5 however the demand for colonoscopy from 2WW referral remains a challenge. Within his presentation, Dr Logan explained how for most (low prevalent) conditions seen in primary care (and certainly for CRC) small changes to the prevalence can have a significant impact on the PPV. [...]by also lowering the referral threshold for suspected CRC within DG30, the PPV of FIT may be much lower than previously estimated (see Fig 2). [...]results were reported from Eastbourne where they looked at 1,000 2WW referrals with NG12 symptoms. Prof Halloran explained that the quantitative value of FIT hints at the pathology and reiterated that the PPV provides an opportunity to create a predictive score, based on simple measures, such as age, gender or deprivation which is also known to be an important risk factor for CRC.13 While other groups have combined the quantitative properties of FIT with enhanced computer learning of serial full blood count to improve the PPV for non-symptom based risk scores for CRC.
ISSN:1470-2118
1473-4893
DOI:10.7861/clinmedicine.19-3-196