Faecal immunochemical test outside colorectal cancer screening?

Abstract

Faecal immunochemical tests (FITs) are the most widely colorectal cancer (CRC) diagnostic biomarker available. Many population screening programmes are based on this biomarker, with the goal of reducing CRC mortality. Moreover, in recent years, a large amount of evidence has been produced on the use of FIT to detect CRC in patients with abdominal symptoms in primary healthcare as well as in surveillance after adenoma resection. The aim of this review is to highlight the available evidence on these two topics. We will summarize the evidence on diagnostic yield in symptomatic patients with CRC and significant colonic lesion and the different options to use this (thresholds, brands, number of determinations, prediction models and combinations). We will include recommendations on FIT strategies in primary healthcare proposed by regulatory bodies and scientific societies and their potential effects on healthcare resources and CRC prognosis. Finally, we will show information regarding FIT-based surveillance as an alternative to endoscopic surveillance after high-risk polyp resection. To conclude, due to the coronavirus disease 2019 pandemic, FIT-based strategies have become extremely relevant since they enable a reduction of colonoscopy demand and access to the healthcare system by selecting individuals with the highest risk of CRC.

Keywords: Adenoma; Colorectal cancer; Diagnostic performance; Faecal biomarkers; Faecal haemoglobin; Faecal immunochemical test; Primary healthcare.

Figure 1

Estimation of the number of patients who need to be referred for colonoscopy, and the diagnostic yield for colorectal cancer in the 10 and 20 µg Hb/g of faeces thresholds[8]. CRC: Colorectal cancer; FIT: Faecal immunochemical test.