NICE Diagnostic Guidance DG30 advises FIT to guide referral for colorectal cancer in primary care.
Symptoms associated with bowel disease include rectal bleeding and/or blood in the faeces, a change in bowel habit lasting three weeks or more, unexplained weight loss, anaemia or extreme tiredness for no obvious reason, a pain or lump in the abdomen and bloating.
Although most people with these symptoms do not have a serious disease, they are very common problems in primary care and often physicians refer patients directly to secondary care for invasive investigation. With current colonoscopy resources in many countries being inadequate, an effective rule-out test prior to secondary care can be a solution.
The FIT that are used to detect bowel cancers in screening populations have shown to be equally effective in ruling out this cancer in symptomatic patients, thereby helping to avoid unnecessary colonoscopies. On the other hand, these tests can also detect CRC after persons with symptoms have been seeking medical advice.
Some helpful facts
The early-detection cancer directives differ slightly from country to county around Europe. Some countries organise CRC screening programmes on a national or regional level, and the eligible population is invited to participate formally. In other European countries, screening is still opportunistic and offered by accredited GPs and paid for by statutory health insurance schemes.
There are three main tests in the majority of European countries, although this may differ slightly from country to country:
Please check with your local governmental authorities (guidelines and/or directives) regarding the status of preventive programmes in your region/country.
Immunochemical tests for haemoglobin in stool (FIT) are used to detect small amounts of blood in stool. They are detected using antibodies that bind specifically to human haemoglobin.
Compared to the guaiac test, immunological tests have better specificity and sensitivity. Furthermore, they can be evaluated quantitatively in the laboratory.