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 colonoscopy.
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 band to go over the toilet to help with collection
- a plastic pouch for the test tube with the sample
- a card envelope for the plastic pouch and the referral form.
The turnaround time for FIT is 48 hours.
FIT can be used for cancer screening or for symptomatic patients. 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.
For symptomatic patients falling into the defined higher-risk groups which need two week wait 2ww referral according to NICE guidelines, FIT is not currently nationally recommended.
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 general practitioners
- 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
- Open test pack and write the patients (N) name,(A) date of birth,
(D) date of sample, (S) gender and on the test tube
2. Refer to instructions and explain to patient how to collect the stool sample without it being contaminated with the water in the toilet bowl.
3. GP must complete the request form on Sunquest ICE or TQuest – search ‘Faecal Immunochemical Test’, print and insert request form in the test pack
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.
Ordering FIT testing kits
You can order more FIT testing kits on the SWLP website.
Below are links to the key documents for the FIT service.
Below are links to useful information about FIT.
Lunchtime mortality and morbidity lectures
9 May 2019More
South West London Pathology Histopathologist Dr Lorrette Ffolkes is introducing a series of lunchtime talks aimed at looking at specific cases, following a sample from receipt in the laboratory to examination by a pathologist, and looking at where things may have gone wrong and where improvements can be made.