Focus on FIT Issue 2

Find out more at 3 Additionally, there is also the request for further research into whether faecal haemoglobin levels are influenced by age, gender and medicines that increase the risk of gastrointestinal bleeding, and whether a risk score could be used to refine the use of FIT in primary care. Despite DG30 addressing the clinical advantages and need for implementing FIT, it does not deal with the practicalities of how commissioning groups may implement it. The core benefit of FIT is the ability to detect low levels of faecal haemoglobin (f-Hb). The test is very specific for the intact Hb molecule, (unlike the original Guaiac test, which detected the haem moiety). Originally requests for FOBT required a stool sample to be provided by the patient in the blue topped tubes, with the faeces being processed by laboratory staff to generate the result. However, haemoglobin is an unstable molecule, more so in faeces, an environment where digestive enzymes and variable gut flora can accelerate molecular destruction. Additionally the transport time can be variable and the sample can be subject to differing ambient temperatures providing further uncertainty over the rate of f-Hb degradation. The new FIT technologies have specific collection devices which overcome such sample integrity challenges, by buffering and stabilising any haemoglobin present in the fresh stool sample. In particular, the HM-JACKarc (Alpha Laboratories, UK) device can protect the f-Hb for up to 120 days, if the sample can be refrigerated or 14 days at ambient temperature. To find out more about faecal immunochemical testing in the patient pathway, including case studies from hospitals already implementing the service or for information on the HM-JACKarc FIT system please visit Alpha Laboratories’ experience can support you in establishing a FIT service by providing education, product demonstrations and logistics solutions. Please contact us at However, this benefit is only possible from fresh faeces. Thus the ideal solution is to get the patient to collect their sample directly into the specific collection device, to retain as much of the f-Hb from the fresh sample. Having concluded that the best sample is obtained by getting the patient to collect it directly into the sample device, the next challenge is to provide the best logistics for both the delivery and return of the sample device. This is especially important for patients n rural areas with transportation limitations. Some sites in Scotland have been running FIT in primary care for over a year now. Due to the geography of the areas covered, different laboratories use various methods for distribution and return of the sample. One site uses postal services for delivery to the patient and return of the collection device to the lab. Another produces a patient pack which is provided in the GP practice. The patient then returns to the practice with the sample which is collected for onward transportation to the laboratory. For those looking to implement FIT as a new test service, it is important therefore to communicate effectively with all stakeholders, so that considerations can be made on sample pathway and its ultimate impact on the patient referral process. In the NICE DG30 evidence review, HM-JACKarc was reported with 100% sensitivity, 76.6% specificity, 6.1% positive predictive value and 100% negative predictive value for colorectal cancer. [FIT] assays were also cost effective when compared with no triage, with the HM-JACKarc dominating (that is, it was more effective and less expensive).