Find out more about FIT at www.faecal-immunochemical-test.co.uk 13 The evidence that supports this proposal was then used to model what impact this would have on colonoscopy resources if a 2 µg Hb/g faeces cut-off was applied [Figure 4]. Mr Abulafi suggested that for every 1000 patients tested, 300 would be positive, of which 25 would have cancer (PPV 8%), 28 HRA and 35 IBD (PPV 28%) Of the 700 negative FIT results two will be missed cancers (NPV 99.8%). Safety Netting would result in additional secondary care referrals from this group. However it is estimated that the overall referrals for colonoscopy would result in a reduction between 30-50 % of the original 1,000. Of course there is still another 7,500 patient FIT and colonoscopy results yet to be reviewed. This would add to the statistical significance of the findings as in total it would double the data reviewed by NICE in 2017. However, the conclusion of the presentation suggested that there was definitely a revolution in progress with FIT. The early results have proved promising especially in view of the optimised cut-off of 2 µg Hb/g faeces proposed by Mr Abulafi for the symptomatic population, but that additional work on evidence base and safety netting pilots should be implemented to complete the proposed patient pathway. References 1. NICE DG30 (2017), Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care. Section 4 – Evidence. www.nice.org.uk/guidance/dg30/ chapter/4-Evidence 2. NICE NG12 (2015), Suspected cancer: recognition and referral. www.nice.org.uk/guidance/ng12 “FIT should be used as a rule in rather than the original NICE proposal of a rule out test. Using the test in this way would reduce missing cancer by two thirds.” Figure 3. Using the Limit of Detection as a cut-off threshold would reduce missing cancer by two thirds Figure 4. Using FIT to triage symptomatic patients could reduce colonoscopy requirements by 30-50% Alpha Laboratories is proud to be supporting the NICE FIT study by providing the FIT analyser (HM_JACKarc), the FIT kits, the raw materials and patient instruction leaflets. Expertise and experience in both the logistics and analysis of FIT specimens is provided by the team at the Bowel Cancer Screening Hub- South of England, led by Sally Benton [Figure 5]. The study team has created a website where full details can be found at www.nicefitstudy.com Figure 5. Sally Benton (left) with staff at the Bowel Cancer Screening Hub - South of England
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