The South West Cancer Alliances have been awarded transformation funding to provide access to quantitative Faecal Immunochemical Testing (qFIT) for General Practice from June of this year.

qFIT is a new type of faecal occult blood test used to detect traces of human haemoglobin in stool samples. It is more sensitive and specific than the old FOB, and is not affected by diet. The introduction of qFIT is intended to identify a new cohort of 'low risk but not no risk' patients, some of whom may be suitable for urgent investigation. These patients do not fit existing guidelines for 2WW referral.

qFIT is not a substitute for a referral for suspected cancer. If your patient fits the criteria for a suspected cancer referral (look at the NICE guideline, the local formulary, or your local 2WW forms for more detail), you should refer via the appropriate 2WW pathway and not use this test.

**ADDENDUM MAY 2021**

Special measures to support endoscopy service during Covid 19 Pandemic.

Unless there is ongoing rectal bleeding, ALL patients referred for suspected lower GI cancer should have a qFIT test prior to referral, and the result should be included on the referral form.

If it is not possible to defer the referral for long enough to enter the result, please indicate that the FIT test has been sent and that the result is awaited.

In our area, qFIT can be requested in a subgroup of patients from the criteria described in the 2015 NICE guidelines on the recognition and referral of patients with suspected cancer (NG12) and referred to in more recent diagnostic guidance (DG30). These are people without rectal bleeding who are:

• Aged over 50 with unexplained abdominal pain or weight loss
• Aged 50 to 60 with changes in their bowel habit or iron deficiency anaemia
• Aged 60 or over with anaemia without iron deficiency

This set of criteria differs very slightly from those recommended in DG30 or NG12. This is because our provision of this service is part of a project to evaluate the impact of the test. Pending the evaluation of the project we may expand the criteria. For the moment though, samples for patients under the age of 50 will be rejected. If your patient has symptoms you are concerned about and is not eligible for qFIT, please seek specialist advice via the usual channels.

Patients with a positive test for the relevant groups should be referred to the 2WW service in the usual way via the referral form. The new version including these new referral groups is attached.

Patients with a negative test are highly unlikely to have colorectal cancer or even high risk adenoma.

In June you will receive a stock of qFIT packs as well as instructions for use and details of how the test result will be communicated to you. You can start using the packs as soon as they arrive.

In addition to this introductory letter you should also receive the following communications:

• Appendix 1: A more detailed document describing the use of the test and advice on interpreting the results
• Appendix 2: A quick reference guide for your consulting room
• Appendix 3: A sheet of FAQs regarding qFIT
• Appendix 4: Updated 2WW referral form which include the option for you to mark a positive qFIT as the main reason for referral

If you wish, you can also view a short video interview on the use of qFIT via this link.

Dr J Mays
Clinical Executive GP
Lead GP Clinical Commissioner for Cancer
Northern, Eastern and Western Devon Clinical Commissioning Group
Peninsula Cancer Alliance Lead for Prevention and Early Diagnosis / CRUK Alliance GP

Published: June 2018

Date Updated: May 2021