{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:28:52Z","timestamp":1792265332424,"version":"4.4.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C8640\/A23385"],"award-info":[{"award-number":["C8640\/A23385"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Br J Cancer"],"published-print":{"date-parts":[[2021,3,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged \u226550 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01\/06\/2018 to 31\/12\/2018. A threshold of 10\u2009\u03bcg Hb\/g faeces defined a positive test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1\u20139.3%). Negative predictive value was 99.8% (CI 99.5\u201399.9%). Sensitivity was 84.3% (CI 71.4\u201393.0%), specificity 85.0% (CI 83.8\u201386.1%). The area under the ROC curve was 0.92 (CI 0.86\u20130.96). A threshold of 37\u2009\u03bcg Hb\/g faeces would identify patients with an individual 3% risk of cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41416-020-01221-9","type":"journal-article","created":{"date-parts":[[2021,1,18]],"date-time":"2021-01-18T20:02:24Z","timestamp":1611000144000},"page":"1231-1236","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England"],"prefix":"10.1038","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0020-4778","authenticated-orcid":false,"given":"Sarah E. 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As this project was not changing routine clinical practice, but evaluating existing provision, ethical approval was not required. Data sharing agreements were drawn up between all parties, and Caldicott guardian approvals were in place to allow data sharing. The requirement for individual NHS numbers for use within this evaluation meets the criteria set out in section 6 of the General Data Protection Regulation: Guidance on Lawful Processing. The processing of data is based upon GDPR Article 6(1)(e)\u2014\u2018exercise of official authority\u2019 and article 9(2)(h) \u2018management of health and care services\u2019. The enabling legislation is the NHS Act 2006 section 13E, including the duty on NHS England to \u2018secure continuous improvement in the quality of services\u2019. The same basis supported the secondary care providers supplying data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"As the raw data analysed in this study include patient identifiable information, we cannot share them currently. We are happy to discuss requests for data with the Caldicott guardian (J.R.).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This research arises from the CanTest Collaborative, which is funded by Cancer Research UK [C8640\/A23385], of which W.H. and F.M.W. are Directors, G.A.A. is Co-investigator and S.B. is Senior Postdoctoral Researcher. It was also supported by the Peninsula Cancer Alliance, the Somerset, Wiltshire, Avon, and Gloucestershire (SWAG) Cancer Alliance, and NHS England.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding information"}}]}}