Article | Published:

Molecular Diagnostics

The value of using the faecal immunochemical test in general practice on patients presenting with non-alarm symptoms of colorectal cancer

British Journal of Cancer (2018) | Download Citation

Abstract

Background

Around 50% of individuals with colorectal cancer (CRC) initially present with non-alarm symptoms.

Methods

We investigated the value of using the faecal immunochemical test (FIT) in the diagnostic process of CRC and other serious bowel disease in individuals presenting with non-alarm symptoms in general practice. The study was conducted in the Central Denmark Region from 1 September 2015 to 30 August 2016. The FIT was used as a rule-in test on patients aged ≥30 years with non-alarm symptoms of CRC. The cut-off value was set to 10 µg Hb/g faeces.

Results

A total of 3462 valid FITs were performed. Of these, 540 (15.6%) were positive. Three months after FIT performance, 51 (PPV: 9.4% (95% CI: 7.0;11.9)) individuals with a positive FIT were diagnosed with CRC and 73 (PPV: 13.5% (95%CI: 10.6;16.4)) with other serious bowel disease. Of CRCs, 66.7% were diagnosed in UICC stage I & II and 19.6% in stage IV. The false negative rate for CRC was <0.1% for the initial 3 months after FIT performance.

Conclusion

The FIT may be used as a supplementary diagnostic test in the diagnostic process of CRC and other serious bowel disease in individuals with non-alarm symptoms of CRC in general practice.

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Note: This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License.)

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Acknowledgements

The authors would like to thank biomedical laboratory technician Erik Sloth Jørgensen, who assisted in setting up the requisition of the FIT in the Central Denmark Region. The authors would also like to thank Gry Stie (academic coordinator), Rikke Pilegaard Hansen (MD PhD) and Flemming Bro (professor and GP), who helped rolling out the study and assisted at the training courses.

Author contributions

J.S.J. has contributed to designing the study, developing the intervention, performing the training course, coordinating the data collection, and analysing the data. N.H. was in charge of analysing the FITs. B.S.A., S.L., and F.O. assisted in developing the study design and the intervention and in analysing the data. P.V. assisted in developing the study design, developing the intervention, performing the training course, and analysing the data. All authors have contributed to and approved the final manuscript.

Author information

Affiliations

  1. Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark

    • Jakob Søgaard Juul
    • , Frede Olesen
    •  & Peter Vedsted
  2. Department of Public Health, Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark

    • Jakob Søgaard Juul
    •  & Peter Vedsted
  3. Department of Clinical Biochemistry, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NE, Denmark

    • Nete Hornung
  4. Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 1, 8930, Randers, NE, Denmark

    • Berit Andersen
  5. Department of Surgery, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark

    • Søren Laurberg
  6. Department of Clinical Medicine, Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Aarhus University, Aarhus C, Denmark

    • Peter Vedsted

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Competing interests

The authors declare no competing interests.

Ethical approval

The study obtained ethical clearance from the Committee on Health Research Ethics in the Central Denmark Region (j.no. 142/2014).

Availability of data and material

The datasets supporting the conclusions of this article are stored in a secured research database and may be available upon presentation of formal approval.

Funding

This study was funded by the Central Denmark Region, the Committee for Quality Improvement and Continuing Medical Education (KEU) for general practice of the Central Denmark Region and the Danish Cancer Society. None of the funding bodies has been involved in designing the study or writing the article, nor in the collection, analyses and interpretation of data.

Note

This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).

Corresponding author

Correspondence to Jakob Søgaard Juul.

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DOI

https://doi.org/10.1038/s41416-018-0178-7