INTRODUCTION
The Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG) have published a new guideline around faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC).1 The guideline was written by a multidisciplinary team including GPs and patient representatives, and includes recommendations for both primary and secondary care. NHS England has subsequently written to all GP practices in England recommending they implement this guideline ‘in full’,2 but this has created concern among some GPs regarding a perceived shifting of risk and responsibility to primary care. This article reviews the recommendations made by the ACPGBI/BSG and considers what they mean for primary care clinicians.
THE NEED FOR IMPROVED PRIMARY CARE DIAGNOSTICS
In the UK, CRC is the fourth most common type of cancer.3 Close to 50% of patients are currently diagnosed with stage III or IV cancer.3 Symptoms alone have a poor sensitivity for CRC, meaning a high volume of secondary care investigations are required to detect cases if symptom-based criteria alone guide referrals.1 Endoscopy services in the UK have been struggling to keep up with referral demands, and waiting times for a colonoscopy lengthened during the COVID-19 pandemic.4 It is in this context that the role of FIT has been recently evaluated, to determine whether it can safely triage referrals and better identify high-risk patients than symptoms and non-specific blood tests alone.
FIT USE IN SYMPTOMATIC PATIENTS SEEN IN PRIMARY CARE
FIT has been shown to be a valuable test for clinicians working in primary care to help triage patients presenting with lower gastrointestinal (GI) symptoms into high-or low-risk CRC groups. For example, the National Institute for Health and Care Excellence (NICE) FIT study, a double-blinded study that included close to 10 000 patients referred for colonoscopy on a suspected CRC pathway, reported that 0.4% of those with …
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