Project #5

The aim of this work is to assess NHS England guidance issued at the peak of the COVID pandemic recommending FIT (stool) testing for all patients suspected of colo-rectal cancer which could be undertaken in primary or secondary care. The extent to which this advice has been implemented across the system, particularly in primary care, is unknown, since routine operational reporting from pathology systems is not a mandatory requirement.

In addition FIT testing in patients aged <50 (who are at very low risk of colo-rectal cancer) may be adding to the demand for the cancer two week waits, Lower GI referrals and subsequent colonoscopy.

Analysis of the data will allow us to determine if particular variables (e.g. age, gender, ethnicity, locality, FIT level, etc.) are related to an increased risk of colo-rectal cancer diagnosis, and importantly, if patients can be categorised into a very low risk of colo-rectal cancer. NHS England would then ensure that these outputs were included in further guidance to support more appropriate and targeted referral for colonoscopy when investigating suspected colo-rectal cancer.