NICE’s diagnostic advisory committee has recommended the use of the HM-JACKarc or OC-Sensor quantitative faecal immunochemical tests (FIT) in draft guidance released for consultation.
A sample is sent in the post to a laboratory where the amount of blood in the faeces is measured. The results are usually available within a week and people with 10 or more micrograms of haemoglobin in their faeces should then be referred for further investigation.
Further assessment using colonoscopy, or CT colonography, is required to diagnose cancer. Under existing NICE guidance, FIT was already offered to some people presenting to primary care with symptoms suggestive of colorectal cancer, while others were immediately referred on the suspected cancer pathway. The new draft guidance will now see everyone receive a FIT.
Colonoscopy capacity is limited, and there are sometimes long wait times. Using FIT could reduce the number of people referred for colonoscopy, and so reduce the waiting times to allow people on non-urgent referral pathways to be seen more quickly.
For people where there is ongoing clinical concern, the guidance remains to refer them immediately to secondary care. The tests cost between £4 and £5 per sample, and can correctly identify about 9 out of 10 people with colorectal cancer.
The committee agreed it is important that GPs can refer people for colonoscopy without a positive FIT result if they think it is necessary and where symptoms persist.
The recommendation of the tests should reduce the number of unnecessary colonoscopies, thus freeing up appointments for more non-urgent referrals. This should lead to 50% fewer referrals for urgent colonoscopies being made by GPs in primary care settings each year. There are 42,000 new cases of colorectal cancer each year according to Cancer Research UK.
Mark Chapman, interim director of medical technology and digital evaluation at NICE, said: “Colorectal cancer is the fourth most common cancer in the UK and ensuring people receive a fast diagnosis must be a priority to allow treatment to get started as soon as possible.
“We know the demand for colonoscopies is high, so recommending the use of FIT in primary care could identify people who are most likely to have a condition that would be detected by colonoscopy.
“Introducing FIT to people as an initial test will also mean that those who are unlikely to have colorectal cancer may avoid having a colonoscopy, and those who are more likely to have it can be prioritised. We hope this will reduce waiting times because fewer people will be receiving a colonoscopy they don’t need.
“These recommendations ensure we are balancing the best care with value for money, while at the same time delivering both for individuals and society as a whole.”
A consultation has now begun on the committee’s recommendations via nice.org.uk until Wednesday 19 July 2023.
