The information on this page is to support staff working in primary care. If you are a patient or member of public and are looking for information about FIT, please see here: Completing a FIT – how to give a poo sample :: South Yorkshire, Bassetlaw & North Derbyshire Cancer Alliance (canceralliancesyb.co.uk).

What is the Faecal Immunochemical Test and how does it work?

The FIT test should not be regarded as a diagnostic tool but an effective and reliable means of stratification.

The FIT (Faecal Immunochemical Test) is a stool test which can help to inform the clinical management of patients presenting with ‘suspicious of cancer’ lower GI symptoms, by enabling risk stratification of the likelihood of serious underlying colonic pathology.

It uses specific antibodies to detect minute amounts of human blood in the faeces and is a more definitive indicator of colorectal cancer than any other type of stool test. Since significant colorectal pathology is often associated with bleeding, blood in the stool can be an indication of colorectal abnormalities – warranting referral and further investigation

FIT in the lower GI pathway

Comprehensive use of FIT in NG12 patients is critical to improving bowel cancer survival in England, ensuring patients on the lower GI pathway can be diagnosed promptly and using our available colonoscopy capacity in the most effective way.

By fully implementing the use of FIT in the symptomatic lower GI pathway, before referral, we will be able to spare patients unnecessary colonoscopies, releasing the capacity to decompress the symptomatic lower GI pathway and ensure the most urgent symptomatic patients are seen more quickly. Additionally, we will spare patients the emotional anxiety associated with hospital referrals, especially when on a ‘suspicious of cancer’ pathway.

• Except for patients presenting with rectal or anal mass/ulceration - ALL patients with suspicioions of bowel cancer symptoms (NG12 compatible) must have a FIT prior to instigation of referral.  
• Patients presenting with a palpable Abdominal Mass should undergo FIT and, if locally available, an urgent, direct access Abdo/pelvis CT* requested simultaneously to a LGI ‘suspicious of cancer’ referral being generated (*if CT not locally available, request urgent Abdo/pelvic USS).
• Patients with a FIT result above threshold (≥ 10) should be referred via the LGI ‘suspicious of cancer’ route in accordance with the SYB Optimum LGI Rapid Diagnostic Pathway.
• Patients with a FIT result below threshold (< 10) but where specific clinical concerns remain, pursue Advice and Guidance routes.  Alternatively, the patient can be referred via a routine or urgent, non-colorectal cancer pathway.

The links below offer more information and resources.