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- Title
Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England.
- Authors
Bailey, Sarah E. R.; Abel, Gary A.; Atkins, Alex; Byford, Rachel; Davies, Sarah-Jane; Mays, Joe; McDonald, Timothy J.; Miller, Jon; Neck, Catherine; Renninson, John; Thomas, Paul; Walter, Fiona M.; Warren, Sarah; Hamilton, Willie
- Abstract
<bold>Background: </bold>The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence.<bold>Methods: </bold>All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 μg Hb/g faeces defined a positive test.<bold>Results: </bold>Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1-9.3%). Negative predictive value was 99.8% (CI 99.5-99.9%). Sensitivity was 84.3% (CI 71.4-93.0%), specificity 85.0% (CI 83.8-86.1%). The area under the ROC curve was 0.92 (CI 0.86-0.96). A threshold of 37 μg Hb/g faeces would identify patients with an individual 3% risk of cancer.<bold>Conclusions: </bold>FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.
- Subjects
ENGLAND; RESEARCH; HEMOGLOBINS; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; FECES; PRIMARY health care; COLORECTAL cancer; COMPARATIVE studies; WEIGHT loss; RESEARCH funding; FECAL occult blood tests; IRON deficiency anemia; DISEASE complications
- Publication
British Journal of Cancer, 2021, Vol 124, Issue 7, p1231
- ISSN
0007-0920
- Publication type
journal article
- DOI
10.1038/s41416-020-01221-9