Introducing faecal immunochemical testing (FIT) in urgent secondary care to expedite colorectal cancer diagnosis: BHRUT pilot project

Abstract

Background: FIT in Urgent Secondary Care represents one of the Early Diagnosis Initiatives and Transformation projects designed by the national cancer team and NHSE. This new pilot aims to improve the uptake of FIT and mitigate the impact of endoscopy backlog across the region therefore facilitating early colorectal cancer (CRC) detection. Method(s): A retrospective analysis of a prospectively kept database was conducted for this study. Individuals arriving at the urgent care centers of two hospitals were offered FIT testing if they were over 40 years old and presented with red flag CRC symptoms. The pilot timeline started on 19/10/2023 and is still ongoing. The FIT level is monitored and escalated to the 2 week wait pathway if found to be positive. Result(s): A total of 235 patients were offered FIT within the pilot (128 male, 108 female). Of these, 49 (20.8%) had a positive FIT result. Among the FIT-positive patients, the most common red flag symptom was rectal bleeding (33 out of 49). This was followed by change in bowel habit (23/49), abdominal pain (22/49), and weight loss (7/49). One case of CRC was diagnosed. Conclusion(s): Introducing FIT testing in urgent care provides an alternative pathway for identifying high-risk patients and expediting CRC diagnosis. With 20.8% of tested patients yielding a positive result, this approach highlights the potential to improve early detection rates. Further evaluation is needed to assess its impact on cancer outcomes, but availability of FIT in urgent care could represent a significant advancement in CRC screening.