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Experience of adopting faecal immunochemical testing to meet the NICE colorectal cancer referral criteria for low-risk symptomatic primary care patients in Oxfordshire, UK
  1. Brian D Nicholson1,
  2. Tim James2,
  3. James E East3,
  4. David Grimshaw4,
  5. Maria Paddon2,
  6. Steve Justice2,
  7. Jason L Oke1,
  8. Brian Shine2
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
  3. 3 Translational Gastroenterology Unit, Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
  4. 4 Planned Care, Oxfordshire Clinical Commissioning Group, Oxford, UK
  1. Correspondence to Dr Brian D Nicholson, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX26GG, UK; brian.nicholson{at}


Objective To compare the diagnostic performance of guaiac faecal occult blood (gFOB) testing with faecal immunochemical test (FIT) in a low-risk symptomatic primary care population to provide objective data on which to base local referral guidelines.

Design Stool samples from routine primary care practice sent for faecal occult blood testing were analysed by a standard gFOB method and the HM-JACKarc FIT between January and March 2016. Symptoms described on the test request were recorded. Patients were followed up over 21 months for evidence of serious gastrointestinal pathology including colorectal adenocarcinoma.

Results In 238 patients, the sensitivity and specificity for colorectal adenocarcinoma detection using gFOB were 85.7% and 65.8%, respectively, compared with 85.7% and 89.2% for FIT. The positive predictive value (PPV) for gFOB was 7.1% and negative predictive value (NPV) was 99.3%. Comparatively, the PPV for FIT was 19.4% and NPV 99.5%. The improved performance of FIT over gFOB was due to a lower false positive rate (10.8 vs 34.2, p≤0.01) with no increase in the false negatives rate. For any significant colorectal disease, the PPV for FIT increased to 35.5% with a reduction in NPV to 95.7%.

Conclusion In this low-risk symptomatic patient group, the proportion of samples considered positive by FIT was considerably lower than gFOB with the same rate of colorectal adenocarcinoma detection. One in three of those with positive FIT had a significant colorectal disease. This supports National Institute of Health and Care Excellence recommendation that FIT can be reliably used as a triage test in primary care without overburdening endoscopy resources.

  • colorectal cancer
  • primary care
  • stool markers
  • guaiac test

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  • Contributors BDN, TJ, DG, JEE and BS conceived the study. TJ, BS, MP and SJ collected the data. BDN, JLO, BS and TJ analysed the data. TJ and BDN prepared the first draft of the manuscript. All authors provided critical revisions to the manuscript.

  • Funding BDN receives funding from Macmillan Cancer Support and the NIHR. JEE was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.