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FIT Testing for 2ww Lower GI Referrals

Publication date: June 2022

The LMC continues to be contacted by practices who are experiencing issues with 2ww referrals for lower GI cancers being rejected or delayed if a FIT test has not been carried out. A recent email from the HNY Cancer Alliance has caused further confusion and the LMC wish to clarify the situation.

The NICE 2ww guidance sets out how GPs should:

Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:

  • They are aged 40 years and over with unexplained weight loss and abdominal pain, or
  • They are aged 50 years and over with unexplained rectal bleeding, or
  • They are aged 60 years and over with: iron-deficiency anaemia, or changes in their bowel habit, or
  • Tests show occult blood in their faeces.

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in people with a rectal or abdominal mass.

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 years with rectal bleeding and any of the following unexplained symptoms or findings:

  • Abdominal pain.
  • Change in bowel habit.
  • Weight loss.
  • Iron-deficiency anaemia

Source: Scenario: Referral for suspected gastrointestinal tract (lower) cancer | Management | Gastrointestinal tract (lower) cancers - recognition and referral | CKS | NICE.

While there is a NICE diagnostics guideline on the use of faecal immunochemical testing (FIT) to guide referral for colorectal cancer in primary care (Overview | Quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care | Guidance | NICE), this is not part of the 2ww guidance. Many areas use FIT testing as a helpful adjunct to triage referrals, particularly during the pandemic.

The LMC has always taken the position that while primary care can be asked to request a FIT at the point of referral, or include a FIT result in a 2ww lower GI referral, it cannot be mandated. No cancer referral should be rejected or delayed due to lack of the test. This is the current agreement with all acute trusts in our region.

In the event that a FIT test has been requested but the result is not available at the time of booking an appointment, the clinical responsibility remains with secondary care.

If you or your colleagues have experienced any issues around FIT testing and access to care, please contact the LMC via our main inbox humberside.lmcgroup@nhs.net and we will escalate these immediately on your behalf.

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