Doctors advised to offer Faecal Immunochemical Tests before referring for colonoscopy

NICE is advising doctors to offer people with signs or symptoms of colorectal cancer a Faecal Immunochemical Test (FIT) to reduce colonoscopy waiting times.

The FIT test looks for small traces of blood in a faecal sample that may not be visible to the human eye. While blood in stools may not always be a sign of cancer, it can help doctors to determine whether further tests (such as a colonoscopy or CT colonography) are needed.

The tests cost between £4 and £5 per sample, and can correctly identify about nine in 10 people with colorectal cancer.

As well as being cost effective and accurate, the tests have a quick turnaround time with results normally available within a week. FIT tests can therefore help people at risk of colorectal cancer to quickly receive a diagnosis.

Thousands waiting six weeks or more for colonoscopy

There are 42,000 new cases of colorectal cancer each year, but colonoscopy capacity is limited, and there are sometimes long wait times.

The latest NHS figures from April 2023 reveal that at the month end, there were 75,715 people waiting for a colonoscopy.

In total, 41.7% of these people had been waiting for six weeks or more, an increase of 4% from the same time last year (37.7% in April 2022).

These long waits highlight the urgent need to 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.

The NICE Committee says this new guidance could therefore help to reduce referrals by up to 50%, freeing up more appointments.

However, for people where there is ongoing clinical concern, the guidance remains to refer them immediately to secondary care. This means that GPs can refer people for colonoscopy without a positive FIT result if they think it is necessary.

Colorectal cancer fourth most common cancer in the UK

Mark Chapman, interim director of medical technology and digital evaluation at NICE, said the new recommendations will ensure that the best care and value for money are balanced.

“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,” he said.