The power of two tests
Introduction to the study
A landmark study recently published in the British Journal of Surgery found that colorectal cancer detection accuracy approaches 100% when a standard test is performed twice instead of once.
The test in question, known as a fecal immunochemical test (FIT), helps detect blood in stool that isn’t visible to the naked eye. This hidden blood could indicate the presence of colon cancer.
The importance of early detection
Colorectal cancer, a major health problem in the UK, is the fourth most common cancer in the country and the second leading cause of cancer-related death. Over 16,500 people die from this disease every year.
Early detection of colorectal cancer can significantly improve treatment outcomes. It is a curable disease if recognized in its early stages.
However, the symptoms of colorectal cancer are not specific and often resemble those of less serious bowel diseases. This overlap can lead to unnecessary invasive investigations.
A single FIT test is currently performed to decide whether a patient should be referred to a specialist.
At referral, the test results are used to decide whether further testing is needed based on the patient’s apparent risk of colon cancer.
A two test approach
Scientists from the University of Edinburgh decided to investigate the potential benefits of doing the FIT test twice.
They used two groups of NHS Lothian patients urgently referred to the Edinburgh Colorectal Surgery Unit to compare the effectiveness of one FIT test versus two.
The results were impressive. The double FIT testing approach correctly identified 96.6% of colorectal cancer cases, while using only one test captured 84.1%. The average time between the two tests was 13 days.
In addition, the study showed that approximately 16.8% of patients who underwent two FIT tests had sufficient variability in their scores to warrant a change in their treatment plan, regardless of the presence of serious bowel disease.
This data underscores the benefits of repeated testing.
Impact on patient safety and healthcare system
An important implication of the Double FIT testing strategy is its potential to reduce the need for invasive procedures in patients at low risk of colorectal cancer.
The study showed that patients with two negative FIT tests have a very low baseline risk of colorectal cancer (0.17%) and may not need further tests that could cause harm.
While this strategy could slightly increase the number of positive test results (by 7.3%), researchers believe it will not pose a significant burden on the healthcare system.
Instead, it opens the possibility for alternative treatment plans for patients with two negative tests.
Impact on patient care
Farhat Din, one of the researchers, remarked: “Our study shows how the use of FIT can be maximized in symptomatic patients. By using two FIT tests, fewer colorectal cancers are missed, which has a positive impact on patient care.
On-site, implementation of the Double-FIT strategy has resulted in a reduction in endoscopy procedures without negatively impacting cancer detection rates.”
This study has the potential to impact clinical practice by prioritizing patient safety and healthcare system efficiency.
As the use of FIT testing as the primary tool for suspected colorectal cancer grows across the UK, this approach offers a promising opportunity to streamline their use and improve patient outcomes.
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The study was published in the British Journal of Surgery.
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