National Institute for Health and Clinical Excellence (NICE)
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Around 100,000 fewer colonoscopies expected to take place each year following updated NICE guidance

Tens of thousands of people a year could be spared the need for a colonoscopy following new guidance from NICE.

People with signs or symptoms of colorectal cancer should be offered a home test with quantitative faecal immunochemical tests (FIT) from 1 of 2 technologies (HM-JACKarc or OC-Sensor). This could lead to faster diagnosis, with fewer people referred to secondary care for an unnecessary colonoscopy. People who require follow up investigation can then be prioritised for referral leading to colonoscopy services focusing on those people who need them most.

Analysis carried out by NICE shows if there is a 25% reduction in the number of people referred, 94,291 fewer colonoscopies would take place.

North Tees and Hartlepool NHS Foundation Trust is already using the approach recommended by NICE and found they detected more cancers using fewer colonoscopies, which is better for patients and more efficient for the NHS.

NICE’s diagnostic advisory committee has recommended a sample is sent in the post to a laboratory where the amount of blood in the faeces is measured. The results are usually available within a week and people with 10 or more micrograms of haemoglobin in their faeces should then be referred for further investigation.

Under previous NICE guidance, FIT was already offered to some people presenting to primary care with symptoms suggestive of colorectal cancer, while others were immediately referred on the suspected cancer pathway.

Further assessment using colonoscopy, or CT colonography, is required to diagnose cancer.

Colonoscopy capacity is limited, and there are sometimes long wait times. Using FIT could reduce the number of people referred for urgent colonoscopy, and so reduce the waiting times to allow people on non-urgent referral pathways to be seen more quickly. For people where there is strong clinical concern of cancer because of ongoing unexplained symptoms, the guidance remains to refer them immediately to secondary care.

Mark Chapman, interim director of medical technology and digital evaluation at NICE, said: “Our recommendations can help around 100,000 people avoid having a colonoscopy when an at home test could rule out the need for one and at the same time free up waiting lists to diagnose those more likely to have colorectal cancer.

“Colorectal cancer is the fourth most common cancer in the UK. These recommendations ensure we are balancing the best care with value for money, while at the same time delivering both for individuals and society as a whole.”

Genevieve Edwards, chief executive at Bowel Cancer UK, said:“Those with low risk symptoms, especially younger people, often face a delayed diagnosis or have to see their GP a number of times before being referred for further tests.

“This guidance will help GPs to better identify and refer the right patients for further testing quickly and could help detect bowel cancer at an earlier stage when it is more treatable and curable.”

The tests cost the NHS between £4 and £5 per sample and can correctly identify about 9 out of 10 people with colorectal cancer.

The committee agreed it is important that GPs can refer people for colonoscopy without a positive FIT result if they think it is necessary and where symptoms persist.

There are 42,000 new cases of colorectal cancer each year according to Cancer Research UK.

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