12 PERSPECTIVE 2019 The FIT Revolution Coming to Your Practice Soon The initial aim was to test a minimum of 5500 patients in London, and further patients across the UK to create a robust evidence base that patients, GPs and hospital doctors can use with confidence. NHS England is funding the work through RM Partners and all hospitals that manage referrals for suspected colorectal cancer are eligible to join the study. When Alpha Laboratories previously reported on progress of the NICE FIT study (Focus on FIT 2018), 1000 patients had been recruited. Earlier this year Mr Muti Abulafi, consultant colorectal surgeon and chief investigator at Croydon University Hospital [Figure1], presented an update at the Royal College of Physicians with some of the interim results from the study. He reported that 12 months on, over 11,000 patients had now been recruited in sites right across England [Figure 2]. Although recruitment has now finished for the main study, there are still some sub-studies ongoing; a review of the patient and GP experience, a multi sampling study as well as an additional biomarker study. The presentation reviewed data from 4,069 patients with both FIT and colonoscopy results and where the clinical data had been thoroughly checked for correct coding of data entry. The number of cancers in this data set was 105 (2.5%) [Figure 3]. This interim data was similar in number to the 10 studies across two technologies that were reviewed by the NICE DG301 committee and used to generate their recommendation on the applications of FIT. Optimised Cut-Off of 2 µg Hb/g faeces Mr Abulafi presented a case that compared the NICE DG30 guideline cut-off of 10 µg Hb/g faeces where 94 out of the 105 cancers were positive, to an optimised cut-off of 2 µg Hb/g faeces where 101 out of 105 cancers were positive. Mr Abulafi suggested that identification of patients with cancer was a priority and hence FIT should be used as a rule in rather than the original NICE proposal of a rule out test. He suggested that using the test in this way would reduce missing cancer by two thirds. The NICE FIT Study is a research project in Bowel Cancer Care that has been initiated by the department of Colorectal Surgery at Croydon University Hospital together with RM Partners Accountable Cancer Network in South and West London. Evidence from studies conducted around the world indicate that faecal immunochemical testing (FIT) could rule out bowel cancer in symptomatic patients, thus avoiding the need for invasive and costly colonoscopy. Following a review of these studies, NICE1 in 2017 recommended using FIT in primary care for patients presenting to their GPs with low risk symptoms (cancer risk <3%) before referral to secondary care. However, there has never been a large research study on FIT published in England, that looks at faecal haemoglobin level variation by age, sex, ethnicity and deprivation. Large scale diagnostic studies are required to create reference values for the English population with the defined symptom spectrum recommended for referral under the NICE suspected cancer referral guidelines (NICE NG12 20152). The NICE FIT study is the largest study in England investigating whether FIT can be used as a triage tool in primary care to guide referrals for colonoscopy. Figure 2. As of February 2019, 11523 patients across England had been recruited to the NICE FIT Study Figure 1. Mr Muti Abulafi, (5th from the left) and his team at Croydon University Hospital.
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