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- Page navigation anchor for Faecal immunochemical (rule-in) testing in general practiceFaecal immunochemical (rule-in) testing in general practiceD’Souza and colleagues1 underestimate GPs clinical judgement in selecting patients for a faecal immunochemical test (FIT). . NICE may recommend FIT for “low-risk” symptomatic patients ‘without rectal bleeding who have unexplained (abdominal) symptoms but do not meet the criteria for a suspected cancer’2 but this has not led to the “deluge” of referrals or worsening of the “endoscopy capacity crisis” in the centres where FIT has been adopted.3The majority of the estimated 10%1 of consulting patients with abdominal complaints will not be referred for colonoscopy. GPs conduct a careful triage using history and examination, an understanding of their patients consulting patterns and comorbidity, preferences for testing, and by deciding when to respond to a positive result. Only a highly selected group of those tested and with a positive FIT are referred.The NICE positive predictive value (PPV) threshold to rule-in patients for urgent referral is 3%: the PPV for a low-risk symptom such as abdominal pain is 2% (increasing with age) compared to 5% for rectal bleeding.4 The PPV of a positive FIT in the low-risk symptomatic population is estimated at 13%.5 If FIT is positive, referral is uncontroversial; if negative, the PPV falls to <1% making colonoscopy non-referral re...Show MoreCompeting Interests: None declared.