Delivering better value colonoscopy: bridging the gap with FIT

Colorectal cancer (CRC) survival is slowly improving in the Western world. To a considerable extent, this reflects earlier detection, either by a screening programme, or by earlier diagnosis in patients with symptoms. However, symptoms on their own are poor predictors of CRC, so this improvement comes at a cost – a considerable increase in the demand for colonoscopy – putting many endoscopy facilities under strain. So how can we deliver even better outcomes for patients at risk of CRC during, and after the COVID-19 pandemic? The important paper from D’Souza et al in Gut adds to a growing body of research examining if Faecal Immunochemical Test (FIT)can be used to target colonoscopy to those patients most likely to harbour CRC and possibly obviate the need for colonoscopy in others.1 D’Souza et al report on the use of the HM-JACKarc assay, one of the most used assays in the UK. For this assay, the limit of quantitation (the lowest value for reliable clinical use) is 7 µg Hb/g, though the assay can detect values as low as 2 µg Hb/g, although with decreasing reliability.2 One strength of D’Souza et al’ s paper is its large size, allowing examination of three possible definitions of a ‘positive’ test, as well as other demographic features, such as age, gender, deprivation and ethnicity. Unlike in previous studies, these four features transpired to have little predictive value, as other studies have also reported, though with small numbers in some of the ethnicity …