What is it about?
Unfortunately, symptoms alone are poor at predicting underlying bowel disease which makes it hard for a GP to decide when to refer for colonoscopy. However, levels of blood in faeces increase as disease develops and can be measured by a poo test Faecal Immunochemical Test (FIT). We provided FIT as a routine service to GPs in our health board and encouraged them to use this in all patients with new bowel symptoms. In the first year 5372 patients took the FIT test, and only 22% had traces of blood. GPs decided not to refer 47% of all patients (almost all had no blood detectable). We followed all patients to see who was found to have bowel cancer by checking the Scottish Cancer Registry. In those patients with undetectable blood only 0.2 % subsequently were diagnosed with bowel cancer. These results suggest that FIT should become integral to the assessment of all patients presenting to primary care with new bowel symptoms to objectively determine the risk of underlying bowel disease.
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Why is it important?
Unfortunately bowel symptoms alone cannot predict the presence of underlying cancer which means that if a person consults their GP describing new symptoms a colonoscopy is frequently the next test. Only around 5% of patients are found to have a cancer. Recent research has suggested a FIT test ( a poo test which detects traces of blood) could identify those patients who do NOT have blood in the poo, and in whom the chances of bowel cancer are extremely low and in whom colonoscopy could safely be avoided. This new study confirms that this is a safe strategy and should influence the way all GPs approach the assessment of new bowel symptoms.
Perspectives
This research challenges the convention that a colonoscopy is required to reassure patients with new bowel symptoms that there is nothing serious going on. This promotes the idea of getting the right patient to the right test at the right time and will avoid exposing patients to an unnecessary colonoscopy.
craig mowat
University of Dundee
Read the Original
This page is a summary of: Impact of introducing a faecal immunochemical test (FIT) for haemoglobin into primary care on the outcome of patients with new bowel symptoms: a prospective cohort study, BMJ Open Gastroenterology, May 2019, BMJ,
DOI: 10.1136/bmjgast-2019-000293.
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