Tens of thousands of people could be spared the need for a
colonoscopy following new guidance from NICE.
People with signs or symptoms of colorectal cancer should be
offered a home test with quantitative faecal immunochemical tests
(FIT) from 1 of 2 technologies (HM-JACKarc or OC-Sensor). This
could lead to faster diagnosis, with fewer people referred to
secondary care for an unnecessary colonoscopy. People who require
follow up investigation can then be prioritised for referral
leading to colonoscopy services focusing on those people who need
them most.
Analysis carried out by NICE shows if there is a 25% reduction in
the number of people referred, 94,291 fewer colonoscopies would
take place.
North Tees and Hartlepool NHS Foundation Trust is already using
the approach recommended by NICE and found they detected more
cancers using fewer colonoscopies, which is better for patients
and more efficient for the NHS.
NICE’s diagnostic advisory committee has recommended a sample is
sent in the post to a laboratory where the amount of blood in the
faeces is measured. The results are usually available within a
week and people with 10 or more micrograms of haemoglobin in
their faeces should then be referred for further investigation.
Under previous NICE guidance, FIT was already offered to some
people presenting to primary care with symptoms suggestive of
colorectal cancer, while others were immediately referred on the
suspected cancer pathway.
Further assessment using colonoscopy, or CT colonography, is
required to diagnose cancer.
Colonoscopy capacity is limited, and there are sometimes long
wait times. Using FIT could reduce the number of people referred
for urgent colonoscopy, and so reduce the waiting times to allow
people on non-urgent referral pathways to be seen more quickly.
For people where there is strong clinical concern of cancer
because of ongoing unexplained symptoms, the guidance remains to
refer them immediately to secondary care.
, interim director of medical
technology and digital evaluation at NICE, said: “Our
recommendations can help around 100,000 people avoid having a
colonoscopy when an at home test could rule out the need for one
and at the same time free up waiting lists to diagnose those more
likely to have colorectal cancer.
“Colorectal cancer is the fourth most common cancer in the UK.
These recommendations ensure we are balancing the best care with
value for money, while at the same time delivering both for
individuals and society as a whole.”
Genevieve Edwards, chief executive at 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.
“This guidance will help GPs to better identify and refer the
right patients for further testing quickly and could help detect
bowel cancer at an earlier stage when it is more treatable and
curable.”
The tests cost the NHS between £4 and £5 per sample and can
correctly identify about 9 out of 10 people with colorectal
cancer.
The committee agreed it is important that GPs can refer people
for colonoscopy without a positive FIT result if they think it is
necessary and where symptoms persist.
There are 42,000 new cases of colorectal cancer each year
according to Cancer Research UK.
ENDS
About the tests
-
HM-JACKarc (Minaris Medical/Alpha
Laboratories)
HM JACKarc is an automated quantitative immunoturbidimetric FIT
system. It comprises a sample collection device, designed to
measure 2 milligrams of faeces in 2 ml of buffer, latex
agglutination reagent, and buffer solution. The assay is
compatible with the HM JACKarc analyser, which can process up to
200 samples per hour, with a maximum capacity of 80 samples per
run.
-
OC-Sensor (Eiken Chemical/MAST Diagnostics)
OC‑Sensor is a quantitative immunoturbidimetric FIT system. It
comprises faecal sample collection tubes, latex agglutination
reagent and buffer. The OC-Auto sampling bottles can hold
10 milligrams of faeces. The test can be run on either the
OC‑Sensor PLEDIA or OC‑Sensor iO analysers, which differ in the
number of samples they are able to process. Two other historical
OC‑Sensor devices (DIANA and MICRO) were also included in this
assessment and assumed to be equivalent to the other OC‑Sensor
devices. The OC‑Sensor PLEDIA can process up to 320 samples
per hour with a maximum capacity of 200 samples per run. The
OC‑Sensor iO can process up to 88 samples per hour with a
maximum capacity of 20 samples per run. MAST Diagnostics
state that the OC-Sensor iO will be replaced by the OC‑Sensor
CERES, which processes 90 samples per hour and has technical
specifications equivalent to the OC‑Sensor PLEDIA.
References
- Implementation at North Tees and Hartlepool NHS Foundation
Trust has contributed to a 9% increase in colorectal cancer
detection, alongside a 24% fall in demand for symptomatic
colonoscopies.
About the guidance
- The guidance will be available at www.nice.org.uk from
00.01 BST on Thursday 24 August 2023.
- An embargoed copy of the guidance can be downloaded from this
message.
- NICE diagnostic guidance applies to England and Wales.
- How to complete your FIT – patient leaflet from Cancer
Research UK
