Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines

Faecal immunochemical tests (FITs) have recently been introduced for investigation of primary care patients with low-risk symptoms of colorectal cancer (CRC). However, recommendations vary across the world, thus, a systematic review of clinical practice guidelines was conducted to determine how FITs are used globally. The search yielded 25 documents developed across five continents; Asia, Europe, Oceania, North America and South America. FIT was found to be recommended in primary care for symptomatic patients in only three countries; Australia, Spain and the UK (excluding Scotland). Australian guidelines written by authors including, Professor Jon Emery and Professor Finlay Macrae of the University of Melbourne, were informed by the UK National Institute for Health and Care Excellence (NICE) guidelines and its most recent systematic review. Early studies have suggested FIT is effective in selecting patients for further investigations and also for identifying patients at very low risk of CRC, who can avoid a colonoscopy. Despite the emerging evidence, the limited use of FIT in primary care may be due to the length of time it takes for evidence to be integrated into practice. However, FIT testing is gaining momentum, if this review is repeated in 5 or 10 years, other countries may have joined Australia, Spain and the UK in the use of FIT in primary care patients with low-risk symptoms of colorectal cancer. 

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Australian clinical practice guidelines for the prevention, early detection and management of colorectal cancer