FIT for the future

Based on evidence from patients with both high-risk and low-risk symptoms of colorectal cancer (CRC), National Institute of Clinical Excellence (NICE) NG56 (quantitative faecal immunochemical testing (FIT) to guide CRC referral in primary care) places FIT at the heart of CRC diagnosis in primary care.1 When fully implemented, it should improve the diagnosis of CRC by identifying those at increased risk and reduce the demand for unnecessary (low value) endoscopy in those at low risk. However, greater use of FIT as a triage tool in primary care will lead to two challenges: first, how to manage any increased demand arising from widespread use of FIT in patients outside of NG56 recommendations, and second, how to manage patients with symptoms but who are ‘FIT negative’ (and not anaemic) and who represent the vast majority of patients referred for suspected cancer. In their publication, Bashir et al provide reassuring real-world evidence from the north-east of England which validates the use of FIT and propose cancer detection rate (CDR) as a new …