|A number of Faecal Immunochemical Test (FIT) samples are being sent to SWLP in the wrong container. This means that the samples cannot be processed.
Please ensure that all FIT samples are sent in the containers supplied by SWLP. If you are running out of containers please contact us to request more. You can order more by emailing SWLPBusinessDevelopment@stgeorges.nhs.uk.
South West London Pathology provides the symptomatic FIT testing service for the following boroughs in south London/Surrey:
- Surrey Dows (Epsom and East Elmbridge localities)
Find out more about FIT testing in Croydon
If you are a primary care clinician in one of these boroughs and would like to report an issue or request further information please email: SWLPBusinessDevelopment@stgeorges.nhs.uk.
Ordering FIT testing kits
You can order FIT testing kits on the SWLP website.
For Merton and Sutton, FIT testing will need to be requested via DART. Practices will need to order testing kits using the order form called ‘St Helier Phlebotomy Stock Order Form incl FIT’ which can be found on the document section of the website. Completed templates should then be returned to firstname.lastname@example.org.
About the Faecal Immunochemical Test (FIT)
The Faecal Immunochemical Test (FIT) is a type of faecal occult blood test which uses antibodies that specifically recognise human haemoglobin (Hb). It is used to detect and quantify the amount of human blood in a single stool sample.
An abnormal result suggests that there may be bleeding within the gastrointestinal tract that needs to be investigated. Those with an abnormal result are then invited for further testing via a diagnostic procedure.
FIT is given to patients to carry out at home and return to their GP. Patients will receive:
- the specially-designed test tube
- a patient information leaflet
- a referral form which needs to be kept with the sample when it is sent to the lab
- a green plastic pouch for the test tube with the sample.
The turnaround time for FIT is 48 hours.
FIT is also used for the National Bowel Cancer Screening Programme.
The guidance below refers to tests offered to symptomatic patients.
Who should have the FIT test?
NICE DG30 sets out the current national guidance for FIT testing in low-risk symptomatic patients. It recommends using FIT in primary care to guide referral for suspected colorectal cancer in patients without rectal bleeding who have unexplained symptoms but do not meet the criteria for a suspected cancer referral pathway (amounting to a risk of cancer less than three percent).
The purpose of the FIT is to help identify patients who may have adverse bowel symptoms who needs colonoscopy or CT colonography. However, not all patients with colorectal cancer will have an abnormal FIT result and symptoms which indicate the use of FIT may also reflect other types of cancer, so persisting symptoms would still need further investigation.
Symptomatic patients who fall into the defined higher-risk groups will need to be referred via the 2WW pathway as per NICE guidelines.
For low-risk (DG30) symptomatic patients, FIT should be offered to patients without rectal bleeding who:
- are aged 50 and over with unexplained abdominal pain or weight loss
- are aged under 60 with changes in their bowel habit or iron deficiency anaemia
- are aged 60 and over and have anaemia without of iron deficiency.
Clinical benefit of FIT
Benefit for patients
- Avoid more invasive tests
- Reduce anxiety as it is most unlikely that the patient have cancer and would not benefit from an early referral for colonoscopy (for those whose qFIT test is negative)
- Earlier diagnosis of cancer (rather than waiting for up to six weeks as part of routine referral)
Benefit for primary care clinicians
- More patients with bowel cancer can be identified at an early stage
- Offers greater confidence in managing some patients with benign bowel conditions without the need for more invasive tests
Administering the test
- Patients from Sutton, Merton, Richmond, Kingston, Wandsworth and Surrey Downs (Epsom & East Elmbridge): their label will be provided on the request form. Remove the label and stick it on the test tube. Please ensure the patient checks their details are correct, then they must write the date they collected their sample where indicated on the request form. Once the patient has opened their test pack they need to write their first name and surname (N) ,
date of birth (A), date of birth (D) , gender (S) on the test tube label. Patients from Croydon: Ensure patient writes their name (N),
date of birth (A) and the date they collect their sample (D) where indicated on the test tube and adds the date of collection to the test form.
2. It is advised that the referring primary care clinician refer to the instructions and explain to the patient how to collect the stool sample without it being contaminated with the water in the toilet bowl.
3. Primary care clinicians must complete the request form on their local system eg Sunquest ICE , DART or TQuest – search ‘Faecal Immunochemical Test’, print and insert request form in the test pack (DART users to return their forms to email@example.com).
4. Give the test pack to the patient and advise them to read the instructions carefully before they complete the test and return the pack which will contain the test tube and request form to the practice within three working days.
Interpreting the results
FIT negative/normal: Negative patients have an extremely low risk both of colorectal cancer, and of high-risk adenoma. Your patient does not need a referral for suspected colorectal cancer, but as always you should consider seeking specialist advice if worrying symptoms persist.
FIT positive/abnormal: Refer using 2WW lower GI pathway. The form has been updated to reflect FIT results.
Croydon practices will be taking part in a FIT pilot study during 2019/2020. Guidance can be found locally on DXS.
Patient information leaflets
The patient information leaflet is available in 12 languages.
Below are links to the key documents for the FIT service.
Cancer Research UK Safety netting guidance endorsed by the Royal College of GPs downloadable summary in table or flowchart format to further support practices
Below are links to useful information about FIT.
For further information, please see the general introduction video of FIT from the Peninsula Cancer Alliance