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FIT Testing for 2ww Lower GI Referrals - An Update

Publication date: July 2022

The LMC provided guidance to practices in June 2022 in response to experiences of practices having issues with 2ww referrals for lower GI cancers being rejected or delayed.  Following a constructive dialogue with secondary care colleagues at HUTHT we reiterate this advice and add additional comments below.

GPs should follow the NICE 2ww guidance which is outlined below.  Whilst not mandated, the LMC would encourage and support the practice of requesting a FIT at the point of referral with the aim of assisting with risk stratification.  We know that many practices already do this.  No cancer referral should be rejected or delayed due to lack of the test.

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.

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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