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. 2023 Apr;25(4):787-793.
doi: 10.1111/codi.16451. Epub 2022 Dec 28.

Impact of faecal haemoglobin based triage of bowel symptoms presenting to primary care on colorectal cancer diagnosis

Dwi Delson  1 , Mark Ward  1 , Rosemary Haddock  2 , Jennifer Nobes  1   3 , Jayne Digby  1 , Judith A Strachan  1   3 , Craig Mowat  1   2
Affiliations

Impact of faecal haemoglobin based triage of bowel symptoms presenting to primary care on colorectal cancer diagnosis

Dwi Delson et al. Colorectal Dis. 2023 Apr.

Abstract

Aim: Faecal immunochemical testing (FIT) for faecal haemoglobin was introduced into primary care in National Health Service Tayside in 2015 as an adjunct to clinical assessment of new bowel symptoms. We aimed to assess the impact of FIT-based triage in primary care on colorectal cancer (CRC) diagnosis.

Method: Cancer audit data between January 2016 and December 2019 were reviewed to identify all patients diagnosed locally with CRC. The mode of presentation and stage at diagnosis were noted and patient records were interrogated to identify whether FIT and full blood count (FBC) had been performed prior to referral. Results were compared between the FIT and non-FIT groups.

Results: In all, 1245 patients were diagnosed with CRC of whom 581 (46.7%) presented through primary care. FIT was performed prior to referral in 440/581 (75.7%), with the proportion increasing from 62.3% in 2016 to 85.8% in 2019. At faecal haemoglobin ≥10 μg Hb/g faeces, sensitivity for CRC was 94.1%. Over the study period the annual proportion of non-emergency presentations increased significantly; presentations from primary care increased from 43.1% to 53.5% (P = 0.0096). After excluding non-FIT patients who had an overt CRC at referral, there was no difference in stage at diagnosis between FIT and non-FIT cancers. Safety-netting with FBC was widely used in our cohort with 97.3% of FIT patients having also had FBC.

Conclusion: FIT-based triage of new bowel symptoms in primary care is associated with increased non-emergency presentation of CRC but this did not influence stage at diagnosis.

Keywords: colorectal cancer; diagnosis; faecal haemoglobin; primary care.

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References

REFERENCES

    1. Cancer Research UK. Bowel cancer incidence statistics. 2021. Available from: https://www.cancerresearchuk.org/health-professional/cancer-statistics/s.... Accessed February 2022.
    1. Jellema P, Van der Windt DA, Bruinvels DJ, Mallen CD, van Weyenberg SJ, Mulder CJ, et al. Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis. BMJ. 2010;340:c1269.
    1. National Cancer Registration and Analysis Service (NCRAS). Publications. Most recent. Routes to diagnosis workbook 2006-2016. Available at: http://www.ncin.org.uk/publications/. Accessed February 2022.
    1. McDonald PJ, Digby J, Innes C, Strachan JA, Carey FA, Steele RJ, et al. Low faecal haemoglobin concentration potentially rules out significant colorectal disease. Colorectal Dis. 2013;15:e151-9.
    1. Godber IM, Todd LM, Fraser CG, MacDonald L, Younes HB. Use of a faecal immunochemical test for haemoglobin can aid in the investigation of patients with lower abdominal symptoms. Clin Chem Lab Med. 2016;54:595-602.

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