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The consultation responses are quite informative, yet NIHCE ignored them all (sigh!) So, a £4.86 test with 50% sensitivity (FOB guaiac) or a £9.42 test with a 74% sensitivity (FIT) is more cost effective in the NICE economic model than a £275 tests with 96% sensitivity. No surprises there. I wonder how cost effective flipping a coin would work out to be in the NICE economic modelling? martin From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Lamb Edmund (EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST) Sent: 23 June 2015 13:13 To: [log in to unmask] Subject: Re: Earlier diagnosis of cancer --- This message was sent from an email address external to NHSmail but gives the appearance of being from an NHSmail (@nhs.net) address. The recipient should verify the sender and content before acting upon information contained within. The identified sender is [log in to unmask]<mailto:[log in to unmask]> --- for those blood pressure can stand it, its also worth looking at the consultation responses at: http://www.nice.org.uk/guidance/ng12/documents/suspected-cancer-update-guideline-consultation-table-with-responses2 Dr Edmund Lamb PhD FRCPath Consultant Clinical Scientist (Biochemistry) and Head of Clinical Biochemistry, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, UK Tel: (44) 01227 864112 (direct) Tel: (44) 01227-766877 extn 7224112 Fax: (44) 01227-783077 E-mail: [log in to unmask]<mailto:[log in to unmask]> eGFR-C Study Chief Investigator: eGFR-C Study<http://www.birmingham.ac.uk/research/activity/mds/trials/bctu/trials/renal/egfr-c/index.aspx> Editor-in-Chief, Annals of Clinical Biochemistry, journal http://acb.sagepub.com/ submissions http://mc.manuscriptcentral.com/acb From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay Sent: 23 June 2015 12:52 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Earlier diagnosis of cancer Hello, Leifur. One of the great things about NIHCE guidance is that it’s fully referenced! Here’s the evidence.<http://www.nice.org.uk/guidance/NG12/evidence> Jonathan On 23 Jun 2015, at 12:37, Leifur Franzson <[log in to unmask]<mailto:[log in to unmask]>> wrote: Hi all. Interesting discussion. Does anybody know about the specificity and sensitivity of this test to detect colorectal cancer ? Best regards Leifur Franzson Department of Genetics and Molecular Medicine Landspitali, Hringbraut Iceland From: David James <[log in to unmask]<mailto:[log in to unmask]>> To: [log in to unmask]<mailto:[log in to unmask]> Date: 23.06.2015 11:31 Subject: Re: Earlier diagnosis of cancer Sent by: Clinical biochemistry discussion list <[log in to unmask]<mailto:[log in to unmask]>> ________________________________ Sorry - if I think I or a family member is at risk of bowel cancer I'll go for the telescope!! How many people would feel comfortable in sending patient away if FOB negative and pt has symptoms/signs?? dj -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Benton Sally (ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST) Sent: 23 June 2015 09:19 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Earlier diagnosis of cancer --- This message was sent from an email address external to NHSmail but gives the appearance of being from an NHSmail (@nhs.net<http://nhs.net>) address. The recipient should verify the sender and content before acting upon information contained within. The identified sender is [log in to unmask]<mailto:[log in to unmask]> --- Hi Jonathon, In the bowel cancer screening world we are very surprised that this test has still been included and are discussing how to respond. A number of professional bodies, groups and individuals involved in colorectal cancer responded to the draft guidelines highlighting the deficiencies of the FOB test for diagnosis, particularly due to the high risk of false negative results. The guiaic test is certainly unsuitable diagnostically and there is currently insufficient evidence to support faecal immunochemical testing in this situation. So I'm not sure that producing professional standards for performance of the assay is going to help things at this stage since no matter how well the test is performed it is still likely to generate a result that may lead to the incorrect diagnosis. Sally Sally C Benton FRCPath Consultant Biochemist, Surrey Pathology Services, Royal Surrey County Hospital, Guildford Director, Bowel Cancer Screening Hub - South of England Direct telephone: 01483 409850 PA: Kate Randall. Telephone: 01483 409854 Postal Address: Bowel Cancer Screening Southern Programme Hub Surrey Research Park, 20 Priestley Road Guildford, Surrey GU2 7YS -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay Sent: 23 June 2015 09:03 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Earlier diagnosis of cancer NICE guidance just published on earlier diagnosis of cancer. There's a big new emphasis on measurement of occult blood (and similar)*. Does the ACB have professional standards for performance of this assay? Jonathan * And so soon after we engineered it out of primary care... This message and any files transmitted with it are confidential and intended solely for the individual(s) addressed. If you have received this e-mail in error then please note that disclosing, copying, distributing or retaining this message or any part of it is strictly prohibited. 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