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Guidelines Might Spare Thousands from Needing Colonoscopies

People in England with signs or symptoms of colorectal cancer should be offered a home test with quantitative faecal immunochemical tests (FIT) from one of two named technologies, the National Institute for Health and Care Excellence (NICE) said. It estimated that the new guidance could mean almost 100,000 fewer colonoscopies would need to be carried out, permitting faster investigation for patients needing one the most.

FIT detect small amounts of blood in faeces, and evidence had shown that offering the test in primary care could identify people who were most likely to have colorectal cancer. 

Previous NICE guidance recommended that FIT was offered to some people presenting to primary care with symptoms suggestive of colorectal cancer, while others were immediately referred on the suspected cancer pathway.

Diagnostic Accuracy of Two Technologies

In its updated guidance, NICE stipulated that people with signs or symptoms of colorectal cancer should be offered a home test with FIT from one of two technologies — HM-JACKarc or OC-Sensor — as there was "clear evidence on the diagnostic accuracy" of these tests. People who required follow up investigation could then be prioritised for referral to secondary care, while those less likely to have colorectal cancer could "avoid unnecessary investigations", NICE counselled. 

Its own analysis revealed that if there was a 25% reduction in the number of people referred, 94,291 fewer colonoscopies would take place. This meant that tens of thousands of people a year could avoid having a colonoscopy.

Mark Chapman, interim director of medical technology and digital evaluation at NICE, said home testing could also "free up waiting lists to diagnose those more likely to have colorectal cancer".

Limited Colonoscopy Capacity

Each test costs the NHS between £4 and £5 per sample and could correctly identify about 9 out of 10 people with colorectal cancer, explained NICE. Results from FIT were usually available within a week and people with 10 or more micrograms of haemoglobin in their faeces should then be referred for further investigation, which might involve colonoscopy or CT colonography, the regulator explained.

North Tees and Hartlepool NHS Foundation Trust Already is already using the NICE recommended approach and had found that it detected "more cancers using fewer colonoscopies", which NICE emphasised was "better for patients and more efficient for the NHS".

NICE alerted that colonoscopy capacity was "limited", and a backlog of patients meant there are sometimes long wait times. 

Helping GPs Refer the Right Patients

Genevieve Edwards, chief executive of Bowel Cancer UK, said: "Those with low-risk symptoms, especially younger people, often face a delayed diagnosis or have to see their GP a number of times before being referred for further tests."

The guidance would help GPs to "better identify and refer the right patients" for further testing quickly, she reassured, adding that it could help detect bowel cancer at an earlier stage when it was more treatable and curable.

The NICE committee agreed it was important that GPs could still refer people for colonoscopy without a positive FIT result if they thought it was necessary and where symptoms persisted. For patients where there was a strong clinical concern of cancer because of ongoing unexplained symptoms, the NICE guidance remained to refer them immediately to secondary care.

Figures obtained from Cancer Research UK show there were just under 43,000 new cases of colorectal cancer each year, making it the fourth most common cancer in the UK.

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