Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Oct;25(10):1151-1154.
doi: 10.1007/s10151-021-02466-z. Epub 2021 Jul 14.

Quantitative FIT stratification is superior to NICE referral criteria NG12 in a high-risk colorectal cancer population

J A Bailey  1   2 , H Ibrahim  3 , J Bunce  3 , C J Chapman  4 , J R Morling  5   6 , J A Simpson  3 , D J Humes  3   5   6 , A Banerjea  3
Affiliations
Review

Quantitative FIT stratification is superior to NICE referral criteria NG12 in a high-risk colorectal cancer population

J A Bailey et al. Tech Coloproctol. 2021 Oct.

Abstract

Background: Guidelines for urgent investigation of colorectal cancer (CRC) are based on age and symptom-based criteria. This study aims to compare the diagnostic value of clinical features and faecal immunochemical test (FIT) results to identify those at a higher risk of CRC, thereby facilitating effective triage of patients.

Methods: We undertook a review of all patients referred for investigation of CRC at our centre between September 2016 and June 2018. Patients were identified using a prospectively recorded local database. We performed a logistic regression analysis of factors associated with a diagnosis of CRC.

Results: One-thousand-and-seven-hundred-eighty-four patients with FIT results were included in the study. Change in bowel habit (CIBH) was the most common referring clinical feature (38.3%). Patients diagnosed with CRC were significantly older than those without malignancy (74.0 years vs 68.9 years, p = 0.0007). Male patients were more likely to be diagnosed with CRC than females (6.5% vs 2.5%, Chi-squared 16.93, p < 0.0001). CRC was diagnosed in 3.5% (24/684) with CIBH compared to 8.1% (6/74) with both CIBH and iron deficiency anaemia. No individual or combination of referring clinical features was associated with an increased diagnosis of CRC (Chi-squared, 8.03, p = 0.155). Three patients with negative FIT results (< 4 µg Hb/g faeces) were diagnosed with CRC (3/1027, 0.3%). The highest proportion of cancers detected was in the ≥ 100 µg Hb/g faeces group (55/181, 30.4%).

Conclusion: In a multivariate model, FIT outperforms age, sex and all symptoms prompting referral. FIT has greater stratification value than any referral symptoms. FIT does have value in patients with iron deficiency anaemia.

Keywords: Colorectal cancer; Colorectal cancer risk; Faecal immunochemical test; NG12; Symptomatic.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

References

    1. Vega P, Valentin F, Cubiella J (2015) Colorectal Cancer diagnosis: pitfalls and opportunities. World J Gastrointest Oncol 7(12):422–433 - PMC - PubMed
    1. Cancer Research UK (2020) Bowel Cancer Statistics. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/s.... Accessed 5 Jan 2020
    1. Thompson MR, et al. Predictive value of common symptom combinations in diagnosing colorectal cancer. Br J Surg. 2007;94(10):1260–1265. doi: 10.1002/bjs.5826. - DOI - PubMed
    1. NICE Guidelines (2017) Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care (DG30). Available from: https://www.nice.org.uk/guidance/dg30. Accessed 3 Jan 2020
    1. Chapman C et al (2019) Early clinical outcomes of a rapid colorectal cancer diagnosis pathway using faecal immunochemical testing in Nottingham. Colorectal Dis 22(6):679–688 - PubMed