Variations in the Use of Faecal Immunochemical Testing (FIT) in Primary Care in England: A Population-Based Cohort of 531,735 FITs from 495,121 Patients Between 2019 and 2023
Alastair James Morton,1,2 Colin J Crooks,1– 3 Joe West,2,4,5 Brian D Nicholson,6 David J Humes1– 3 1School of Medicine, University of Nottingham, Nottingham, UK; 2National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2025-06-01
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| Series: | Clinical Epidemiology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/variations-in-the-use-of-faecal-immunochemical-testing-fit-in-primary--peer-reviewed-fulltext-article-CLEP |
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| Summary: | Alastair James Morton,1,2 Colin J Crooks,1– 3 Joe West,2,4,5 Brian D Nicholson,6 David J Humes1– 3 1School of Medicine, University of Nottingham, Nottingham, UK; 2National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; 3Nottingham Digestive Diseases Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK; 4Lifespan and Population Health - School of Medicine, University of Nottingham, Nottingham, UK; 5Department of Clinical Medicine - Hepatology and Gastroenterology, Aarhus University, Aarhus, Denmark; 6Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKCorrespondence: Alastair James Morton, Email alastair.morton1@nottingham.ac.ukBackground/Objectives: Faecal Immunochemical Testing (FIT) is recommended for patients presenting to primary care with symptoms suggestive of colorectal cancer. This study quantified variations in use across England.Methods: Retrospective cohort of English patients (≥ 18 years) with a FIT result reported in routinely collected primary care records, 2019– 2023. Rates of FIT testing by age, sex, year and region were adjusted using Poisson regression. Multivariate logistic regression compared the effect of factors on the proportion of results exceeding the recommended referral threshold (10μgHb/g).Results: Between 01/01/2019 and 05/06/2023 there were 531,735 FIT results among 495,121 patients. Rates of testing increased from 0.69 per thousand person-years in 2019 (95% CI 0.68– 0.71) to 27.70 in 2023 (95% CI 27.56– 27.85). There were large variations in testing between regions, with rates > 3-fold higher in the Northeast than the West Midlands: 17.05 (95% CI 16.87– 17.23) versus 4.72 (95% CI 4.67– 4.76) per thousand person-years. About 20.4% of FIT results were ≥ 10μgHb/g. Despite increased testing, this did not change over time. The proportion of FIT ≥ 10μgHb/g was lower in regions with higher rates of testing, from 16.7% (Southwest) to 25.3% (Southeast; rates of testing 14.62 and 8.00 per thousand person-years respectively). This difference in proportion of FIT ≥ 10μgHb/g persisted after adjusting for year, sex and age (OR 0.57, 95% CI 0.55– 0.58).Conclusion: Rapid increases in FIT testing in primary care show large, persistent variations between English regions, which correlate with the proportion of results meeting the criteria for onward referral. Differences in the population tested and FIT’s implementation between regions are likely to explain these variations.Plain Language Summary: 1) Why was this study done?A simple test for blood in the poo, called FIT, can help decide whether a person with bowel symptoms seeing their primary care doctor should be referred to a hospital for further bowel investigations.Currently, a FIT result of 10 μgHb/g faeces or more is recommended to guide referral for bowel tests.No study has reported how FIT use, or results, differs across England. 2) What did the researchers find?This is the first study on national patterns of FIT testing, showing a rapid but unequal increase across England.There is large variation in the proportion of FIT results exceeding the referral criteria of 10 μgHb/g faeces between English regions that is associated with the rate of testing in each region. 3) What do these results mean?Using a single FIT value as a threshold for onwards referral may work differently in different regions of England. As FIT is adopted more widely and rates of testing increase, primary care services may see a decrease in the proportion of patients with a FIT result reported over the referral threshold.Keywords: colorectal cancer, faecal immunochemical testing, health inequalities |
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| ISSN: | 1179-1349 |