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OC-042 Sensitivity Of Annual Faecal Immunochemical Tests For Haemoglobin (fit) For Detecting Advanced Neoplasia In Patients Undergoing Three-yearly Surveillance Colonoscopy – The Fit For Follow-up Study
  1. E MacRae1,
  2. A Brenner1,
  3. J Martin1,
  4. S Pearson2,
  5. C Piggott2,
  6. H Bowyer3,
  7. G Vart3,
  8. C von Wagner3,
  9. J Wardle3,
  10. S Halloran2,4,
  11. W Atkin1
  1. 1Imperial College, London, UK
  2. 2NHS BCSP, Guildford, UK
  3. 3UCL, London, UK
  4. 4University of Surrey, Guildford, UK

Abstract

Introduction With increasing demand for colonoscopy in the NHS Bowel Cancer Screening Programme (BCSP) in England, there is a need for effective non-colonoscopic approaches to surveillance. We have undertaken a study to compare the sensitivity and specificity of a faecal immunochemical test for haemoglobin (FIT) annually for three years with colonoscopy surveillance, in patients diagnosed with intermediate-risk adenomas following a positive faecal occult blood test in the BCSP.

Methods Participants are invited to complete a FIT (OC-SENSOR, Eiken Chemical Co. Ltd.) annually while awaiting their first surveillance colonoscopy. Those testing positive (>40 µg Hb/g faeces) are invited to have their three-year colonoscopy brought forward, while those testing negative are sent another FIT a year later until they have completed three rounds of testing. We aim to determine the sensitivity of FIT in detecting colorectal cancer or advanced adenomas (≥10 mm, or with tubulovillous or villous histology, or with high-grade dysplasia), using colonoscopy as the reference standard.

Results We invited 8009 people to participate in the study, of whom 5840 (72.9%) consented. The positivity rate in Round 1 was 5.8% (336/5840). To date, 265/303 (87.5%) have had an early colonoscopy: 62/265 (23.4%) had advanced adenomas and five (1.9%) had cancer. 33/336 (9.8%) declined an early colonoscopy.

To date, in Round 2 we have invited 2800 patients who tested FIT negative in Round 1: 2560 (91.4%) completed a second FIT and 115/2560 (4.5%) tested positive. 85/106 (80.2%) have received an early colonoscopy: 13/85 (15.3%) had advanced adenomas and two (2.4%) had cancer. 9/115 (7.8%) declined an early colonoscopy.

A total of 2445 participants had negative FIT tests in Rounds 1 and 2 and will be invited to complete a final FIT, prior to their surveillance colonoscopy.

Satisfaction with the study was high among those who completed a questionnaire, with 95.4% (4177/4378) of FIT-negative and 91% (203/223) of FIT-positive participants in Round 1 stating that they would complete another kit in future.

Conclusion Compliance with the study was high, and the majority of participants reported that they would use FIT again. Almost a quarter (23.4%) of patients in Round 1 who had an early colonoscopy had advanced adenomas, falling to 15.3% in Round 2. Round 2 is ongoing, with Round 3 starting in January 2014.

Disclosure of Interest None Declared.

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