Triaging colorectal urgent referrals in the COVID-19 era using faecal immunochemical testing: a prospective UK real-world multicentre cohort study

Triaging colorectal urgent referrals in the COVID-19 era using faecal immunochemical testing: a prospective UK real-world multicentre cohort study

Objective During the early COVID-19 pandemic, UK guidelines advocated faecal immunochemical tests (FIT) with a threshold of 10 µg/g to help secondary care clinicians triage urgent suspected colorectal cancer (CRC) referrals. We aimed to evaluate the real-world performance and impact of FIT in a high...

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Main Authors: Nicholas A Kennedy, Willie Hamilton, Gareth Walker, Mark Feeney, Mark Cartmell, Timothy McDonald, Sarah ER Bailey, Timothy J McDonald, Gareth J Walker, Iain Bain, Sebastian Smolarek, Suzie Marriott, Melanie Feldman, Robert Bethune, Angela Cooper, David Mabin, Pauline Sibley, Supriya Balasubramanya, Joel Bowen, Nedal Debab, William Faux, Naomi Spencer, Venla Kantola, Sarah E R Bailey, Sally Ward-Booth, John Renninson, Bowen Joel, Nedal Dabab, Adam Kimble, Andrew Sloper, Joe Mays, Allen Barker, Sarah-Jane Davies, Beverly Parker, Susan Cose, Alex Atkins, Stuart Weymouth, Katie Caley
Format: Article
Language:English
Published: BMJ Publishing Group 2025-07-01
Series:BMJ Open Gastroenterology
Online Access:https://bmjopengastro.bmj.com/content/12/1/e001749.full
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Summary:Objective During the early COVID-19 pandemic, UK guidelines advocated faecal immunochemical tests (FIT) with a threshold of 10 µg/g to help secondary care clinicians triage urgent suspected colorectal cancer (CRC) referrals. We aimed to evaluate the real-world performance and impact of FIT in a high-risk cohort referred against National Institute for Health and Clinical Excellence NG12 (2015) criteria.Methods Multicentre prospective observational cohort study of FIT at all four secondary care hospitals in Devon (UK) between 1 April 2020 and 31 December 2020. FIT use was at the discretion of primary and secondary care clinicians. Incident CRC cases were identified ≥12 months after general practitioner (GP) referral using regional National Bowel Cancer Audit data linkage. We assessed diagnostic accuracy and healthcare utilisation in patients with and without FIT.Results Overall, 6698 patients were included: 55% female, median age 72 years (IQR 65–82). Just over half (53%, 3552) of patients underwent FIT with a positivity rate of 34% (n=1237). CRC prevalence in patients with no FIT, positive FIT and negative FIT was 6% (189), 11% (137) and 0.5% (11), respectively. The prevalence of all cancers, including non-CRCs, was similar among FIT and no-FIT cohorts (p=0.74). Sensitivity and specificity of FIT for CRC were 0.93 (95% CI 0.87 to 0.96) and 0.68 (95% CI 0.66 to 0.69), respectively. Patients with negative FIT underwent fewer lower gastrointestinal endoscopies (no FIT 62% (1964) vs positive FIT 69% (857) vs negative FIT 36% (835)), p=0.0005).Conclusions FIT is a useful triage tool for patients with suspected CRC which safely reduces endoscopy demand and prioritises those at greatest cancer risk. Standardised regional referral pathways, greater use of ‘straight-to-test’ investigations and GP support are needed to maximise its impact.
ISSN:2054-4774

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