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A stool test for hidden blood, done at home every year. Positive results are followed by colonoscopy.
The faecal immunochemical test is an antibody-based assay that detects human haemoglobin in a stool sample collected at home, and a positive result is followed by colonoscopy. Its sensitivity for cancer in a single round is moderate and it detects few adenomas, but when offered every year within an organised programme its modelled benefit approaches that of colonoscopy screening. It is the backbone of most European and Asian colorectal screening programmes and appears alongside the newer stool DNA tests Cologuard and Cologuard Plus and their BLUE-C and DeeP-C trials. Readers also meet it in the colorectal screening technology record, the NordICC and Minnesota trials, the record on Dame Deborah James, and the bottleneck on cancers found late.
Showing the technology this term belongs to: Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
A colonoscopy probably does reduce bowel cancer risk for the person who has it, but a programme that offers colonoscopy achieves much less if most people decline. Programmes based on stool tests with high uptake may deliver as much population benefit at lower cost and risk.
The first molecular stool test to reach approval, and the template for the blood tests that followed: more sensitive for cancer, much less specific, and still poor at the precancerous lesions that screening is supposed to remove.
The evidence that a cheap home test posted to a whole population saves lives, and the reason England, Scotland, Wales and Northern Ireland all run bowel screening programmes; the 40 percent who never did the test are the reason uptake is still the biggest lever.
The second randomised trial to show the same effect in a different health system; together with Nottingham and Minnesota it made biennial stool testing an accepted public health intervention across Europe.
A cheap home stool test, repeated yearly or every two years and followed by colonoscopy when positive, prevents bowel cancer deaths. This is what national bowel screening programmes do today, with FIT replacing the older guaiac test.
Shares BLUE-C, DeeP-C, Cologuard Plus, Cologuard.
Shares Screening uptake, Interval cancer, NHS bowel cancer screening programme, Surveillance intervals after polypectomy.
Shares UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set, NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
Shares UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is, Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model, Early-onset colorectal cancer (under 50), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood).
Shares Cologuard Plus, Cologuard, Multitarget stool RNA test (ColoSense), Early-onset colorectal cancer (under 50).
Shares Minnesota trial: a yearly stool blood test cuts bowel cancer deaths by a third, Multitarget stool RNA test (ColoSense), NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, The hardest cancers are found late.
Shares Minnesota Colon Cancer Control Study, NordICC (Nordic-European Initiative on Colorectal Cancer), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer.
Shares UK gap: shorten the route to diagnosis for patients below the screening age, where the rise in incidence is, Early-onset colorectal cancer (under 50), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation.