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GPs to take part in new colorectal cancer diagnostics trial

GP practices in London are taking part in a pilot of the new qFIT stool test to see if it could be used to rule out bowel cancer and avoid referring people for unnecessary colonoscopies.

Experts claimed that if the study is successful, the test could reduce the number of patients undergoing colonoscopy needlessly by 40%.

Under the pilot scheme, the Quantitative Faecal Immunochemical Test, or qFIT, will be rolled out to patients at 30 GP practices in North London and West Essex as part of the two-week wait referral pathway for colorectal cancer.

Patients with symptoms of suspected colorectal cancer who have been referred for a colonoscopy will also be asked to do a qFIT test at home, to test for hidden amounts of blood in their stool before they are seen by a specialist, to see if the test can correctly predict the result of the colonoscopy.

If the trial, which hopes to gather results from at least 2000 patients, shows that qFITs can accurately rule out colorectal cancer in patients with suspicious symptoms, wide scale use of the tests could dramatically reduce the number of patients having unnecessary colonoscopies and ease the burden on overstretched hospital endoscopy departments, researchers said.

Dr Ed Seward, consultant gastroenterologist at University College London Hospitals, said: ‘Whilst colonoscopy is an excellent tool for diagnosing potentially curable bowel cancer, too many patients are currently coming into hospital to have what turns out to be an unnecessary procedure as the pick-up rate for bowel cancer is tiny - only 4%.

‘The burden on endoscopy departments is predicted to get even higher over coming years and so, if this pilot is successful, we may be able to reduce the number of unnecessary colonoscopies by perhaps 40%. This is good news for hospitals and good news for patients.’

Dr Imogen Staveley, GP and Primary Care Cancer Lead in Camden, said: ‘I’m really excited to be one of the GP practices taking part in the qFIT pilot study. Currently when patients come to see their GP, with symptoms that could indicate colorectal cancer, many will end up being referred for a colonoscopy to investigate further,’ said Dr Imogen Staveley, GP and Primary Care Cancer Lead in Camden.

‘We are hoping that the qFIT test will prove to be a simple, inexpensive alternative to a colonoscopy for lots of patients to rule our colorectal cancer. This would be excellent news for patients as many of them would avoid having to go through a potentially unnecessary invasive procedure.’

The pilot is the largest of a series of studies carried out under the auspices of NHS England’s qFIT working group, in line with the call from NICE for evidence on whether the qFIT could be used to rule out potential cancer in people with symptoms, either in primary or secondary care, or in both settings.

Currently NICE recommends use of the faecal occult blood test (FOBT) to rule out potential bowel cancer in people at low risk who would not be eligible for colonoscopy, although it is anticipated this test will be replaced with the qFIT in an update to the guidance in the summer.

The FOBT test is not widely available for GPs to order from labs and experts have suggested CCGs were waiting for qFIT to come on stream as part of the UK national bowel screening programme.


Readers' comments (2)

  • Cobblers

    Confused. NICE had lowered the threshold for the positive predictive value of symptoms that should trigger a cancer assessment from 5% to 3% in 2014.

    Here we have a pick up rate on colonscopy of 4%. Kudos then to Primary Care for referring.

    FOBT should never be used in ruling things out or in. It is a blunt screening tool.

    qFIT might be something that secondary care might care to use? Let's see the figures when available. Only then might GPs take it on and only after the workload in GP has eased.

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  • Agree with "cobblers" Can think of 2 of my patients recently with -ve FOB via screening and admitted by me as large bowel obstruction secondary to bowel cancer.

    Evidence locally is NICE Guidance change didn't result in increased number of FOB tests.

    Also didn't some labs actually stop doing FOB prior to NICE guidance citing it is a poor test?

    qFIT is better but more expensive currently

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