The faecal immunochemical test in low risk patients with suspected bowel cancer

The National Institute for Health and Care Excellence produced guidance recommending use of the faecal immunochemical test in patients with low risk symptoms for colorectal cancer. At a cut off of 10 μg haemoglobin per gram of faeces, the National Institute for Health and Care Excellence estimated that the sensitivity of the faecal immunochemical test to detect colorectal cancer ranged from 89% to 100%. The authors evaluated the evidence and noted that the data for the use of the faecal immunochemical test were extrapolated from all comers including high risk patients. Data on low risk patients were scarce and weak. Furthermore, faecal immunochemical test results vary by age, sex, deprivation, ethnicity and symptoms. Large national cohort studies are currently underway investigating the role of the faecal immunochemical test in the English population. Clear clinical pathways and rigorous safety netting are essential and should be part of implementing these guidelines to avoid missed cancers.