Faecal immunochemical tests in the COVID-19 pandemic; safety-netting of patients with symptoms and low faecal haemoglobin concentration - can a repeat test be used?

Abstract

Quantitative faecal immunochemical tests for haemoglobin (FIT) are increasingly being used in the UK and elsewhere to assist in the assessment of patients presenting to primary care with lower bowel symptoms to guide referral for further investigation, often colonoscopy. A very low or undetectable faecal haemoglobin concentration (f-Hb) has been demonstrated in multiple studies to have a very high negative predictive value for colorectal cancer (CRC). In 2017, the National Institute for Health and Care Excellence (NICE) issued Diagnostics Guidance DG30, which encouraged the use of FIT in the assessment of patients at low risk of CRC. These guidelines were then incorporated into the NICE guidance NG12 on referral of patients considered at risk of CRC. DG30 advises that patients with symptoms considered low risk for CRC and with f-Hb <10 μg Hb/g do not need to be referred on the NHS England two-week wait pathway and can instead be monitored in primary care.

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DOI

https://doi.org/10.1177/0004563220967569

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https://discovery.dundee.ac.uk/en/publications/1bd455dc-5abe-4876-aac0-2b840298750b