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BSG guidelines on faecal immunochemical testing: are they ‘FIT’ for purpose?
  1. Colin J Rees1,
  2. Willie Hamilton2
  1. 1 Gastroenterology, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
  2. 2 Primary Care Diagnostics, University of Exeter, Exeter, UK
  1. Correspondence to Professor Colin J Rees, Gastroenterology, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, Newcastle upon Tyne, UK; Colin.Rees{at}

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The use of faecal immunochemical testing (FIT) for patients with features of possible colorectal cancer (CRC) has increased significantly over recent years. The UK has been slower to adopt FIT than several other countries, especially in Scandinavia.1 Colonoscopy remains the ‘gold-standard’ test with high sensitivity and specificity, and allows biopsy of lesions and removal of polyps. However, endoscopy services in the UK (and internationally) are under huge pressure, with demand outstripping capacity, a situation exacerbated by the COVID-19 pandemic. Therefore, it is imperative to develop tools to stratify individuals at greatest risk of CRC, allowing those people to undergo definitive investigation. The patient’s symptoms can do this to a limited extent, for example, rectal bleeding is a higher risk for CRC than diarrhoea. This principle underpinned the National Institute for Healthcare and Clinical Excellence (NICE) guidance, ‘Suspected cancer: recognition and referral (NG12).2 This defined features of cancer equating to a cancer risk of 3% or below as low risk, and to be offered initial testing in primary care, with patients having a risk of cancer of greater than 3% defined as high risk, warranting specialist referral and definitive investigation. Further NICE guidance, ‘Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care’3 recommended FIT in primary care for the low-risk population, and for those testing positive to be offered definitive investigation.

The body of evidence supporting FIT in symptomatic patients has …

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  • Contributors CJR and WH cowrote, edited and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CJR and WH voted in the 92 member Delphi process linked to the BSG guidance but had no role in writing or forming the guidance. CJR has received grant funding from ARC medical, Norgine, Medtronic, 3D Matrix solutions and Olympus medical. He was an expert witness for ARC and Olympus medical. WH was clinical lead for NICE’s Suspected cancer: recognition and referral (NG12).

  • Provenance and peer review Commissioned; internally peer reviewed.

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