Dear All,
Many thanks for all the information regarding FOB testing. I've summarised a response from Stephen Halloran and other mailbase users re. my query:
Would FIT be OK for use by GPs?
· The question from GP: I have a patient, bit too frail to send directly for colonoscopy, can I use FIT?
For older patients (over 75): The Bowel Cancer screening programme currently runs from 60-69 with age extension being introduced to 74 across the country. Patients older than this can phone up and ask to be included 0800 7076060. For this they will then be sent their test kit as before every two years.
If the GP thinks that this time period is too far apart, the patient should be referred to a gastroenterologist.
· If patient has symptoms, neither the FIT or FOB test are good enough and the patient needs to be referred to gastroenterology
· For GPs who want to investigate iron deficiency anaemia: British Society for Gastroenterology Guidelines for the management of Iron Deficiency Anaemia state that FOB testing is of no benefit in investigation, being both insensitive and non-specific.
· If there is a strong family history of Bowel Cancer there are guidelines produced by the British Society of Gastroenterology and NICE which guide GPs through the process and when they should be referred to gastroenterologist and what symptoms the patients should be aware of. http://www.bsg.org.uk/images/stories/docs/clinical/guidelines/endoscopy/ccs_10.pdf
· Paediatrics and younger patients: beware of the different FIT devices and test that are available, some are quantitative, some qualitative. And as yet there is no clear evidence that either guaiac based FOBT or FIT are good enough as a test to detect bowel cancer in a non-screening situation.
· Scotland start screening at 50, as do most of the rest of Europe
· UK have started a flexible sigmoidoscopy screening programme being rolled out to everyone aged 55 years, as part of the Bowel Cancer Screening Programme these patients will then go onto the normal gFOBT (or FIT by then) screening programme at aged 60.
· Dr Maggie Carroll who works at the Bowel cancer screening lab has recently completed a full evaluation of the FIT assay for use in screening; this is awaiting publication. The use of the FIT test in cancer screening is hoping to be rolled out late 2015.
Best wishes,
Emma
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From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Mainwaring-Burton Richard (SOUTH LONDON HEALTHCARE NHS TRUST) [[log in to unmask]]
Sent: 21 August 2013 14:52
To: [log in to unmask]
Subject: Re: Alternative to FOB testing
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Michael
Kit is “hema-screen” from immunostics.inc which is indeed guiac based
I have one I could show you mine if you have not yet been invited. (too young ?)
If you look in [cid:image001.jpg@01CE9E7B.6A79DB60] page 51-52 there are some useful recommendations.
See also Ruth M Ayling review article : Ann Clin Biochem 2012; 49: 44–54. DOI: 10.1258/acb.2011.011150
I collected some paperwork in relation to earlier postings on mailbase which may be of interest, of which I hope the authors will not mind circulation.
with best wishes
Richard
Richard Mainwaring-Burton
Consultant Biochemist
South London Healthcare Trust
Queen Elizabeth Hospital, Woolwich
Princess Royal Hospital, Farnborough
Queen Mary's Hospital, Sidcup
020-8836-5724
mob: 07831-739876
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Colley, Michael
Sent: 21 August 2013 14:26
To: [log in to unmask]
Subject: Re: Alternative to FOB testing
Richard
Isn’t the programme you’re part of using guaiac? The pics on the website would seem to suggest so.
Some of us have actually participated more than once!
And Steve Halloran sends you a nice, personalised message, saying (hopefully) something to the effect of :-
“Your test shows no indication of cancer – however this does not mean that you do not have cancer or that you will not get cancer”
Comforting, isn’t it?
Michael
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mainwaring-Burton Richard (SOUTH LONDON HEALTHCARE NHS TRUST)
Sent: 21 August 2013 14:21
To: [log in to unmask]
Subject: Re: Alternative to FOB testing
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Programme is already going
http://www.cancerscreening.nhs.uk/bowel/
When you get to the grand old age of 60, you might be invited to participate.
with best wishes
Richard
Richard Mainwaring-Burton
Consultant Biochemist
South London Healthcare Trust
Queen Elizabeth Hospital, Woolwich
Princess Royal Hospital, Farnborough
Queen Mary's Hospital, Sidcup
020-8836-5724
mob: 07831-739876
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ashley Emma (KINGSTON HOSPITAL NHS FOUNDATION TRUST)
Sent: 20 August 2013 17:27
To: [log in to unmask]
Subject: Alternative to FOB testing
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Dear all,
We've had an enquiry from one of our GP's regarding an alternative to FOB testing, as we no longer offer this service. Do any labs offer faecal immunochemical testing (FIT) routinely to service users? I understand that FIT is to be rolled out for the Nation Bowel Cancer screening program in the near future.
Many thanks,
Emma
Emma Ashley
Clinical Biochemist
Kingston Hospital NHS Trust
Galsworthy Road
Kingston upon Thames
Surrey KT2 7QB
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