title: FIT for the future: a case for risk-based colorectal cancer screening using the faecal immunochemical test.
abstract: Worldwide, the guaiac faecal occult blood test (gFOBT) is being replaced with the more accurate faecal immunochemical test (FIT) for colorectal cancer (CRC) screening. From January 2016, the National Screening Committee in the UK has recommended a change from the gFOBT to the FIT following a successful Bowel Cancer Screening Programme pilot study with over 40 000 participants. Although the test has shown improved uptake and the ability to detect significantly more colorectal cancers and advanced adenomas, the higher uptake and test positivity will challenge the capacity of colonoscopy services. One of the main advantages of the FIT is that it provides a quantitative haemoglobin concentration which has been shown to relate to the risk of CRC. Risk scoring systems which combine the FIT concentration with risk factor assessment have been shown to improve the sensitivity of the test. This individualized approach to screening could enable those at greatest risk to be referred for colonoscopy, optimizing resource use and ultimately patient outcomes.
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK. jennifer.cooper@warwick.ac.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Cooper
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Moss
authors.affiliation: Midlands and North West Bowel Cancer Screening Hub, Hospital of St Cross, University Hospitals Coventry and Warwickshire NHS Trust, Rugby, UK.
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.affiliation: Surrey Research Park, NHS Bowel Cancer Screening Southern Programme Hub, Guildford, Surrey, UK.
authors.forename: H E
authors.initials: HE
authors.lastname: Seaman
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: S
authors.initials: S
authors.lastname: Taylor-Phillips
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: N
authors.initials: N
authors.lastname: Parsons
authors.affiliation: Department of Biochemistry and Physiology, University of Surrey, Guildford, Surrey, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Halloran
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods / Q000639:trends*; D005243:Feces / Q000737:chemistry*; D005544:Forecasting; D006138:Guaiac; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000639:trends*; D009780:Occult Blood; D011237:Predictive Value of Tests
chemical_list: D006138:Guaiac