Faecal immunochemical test-based prediction tools

Topic Status Complete

Faecal immunochemical test-based prediction tools for the assessment of people presenting to primary care with symptomatic bowel disease.

Outcome of the appraisal


The evidence supports the adoption of FIT to guide the referral of patients with lower gastrointestinal symptoms for colonoscopy. The use of the FIT-based prediction tools FAST and COLONPREDICT shows promise but the incremental benefits as compared with FIT alone are uncertain from the evidence currently available.


HTW therefore supports the adoption of FIT as recommended by NICE Diagnostic Guidance 30 but proposes that a prospective and structured evaluation of the clinical and cost benefits of combining FIT with the prediction tools FAST and COLONPREDICT be incorporated into the implementation strategy in NHS Wales.

Why was this topic appraised?


The majority of colorectal cancer cases are diagnosed through GP referral. NICE Diagnostics Guidance 30 recommends faecal immunochemical tests (FITs) to guide referral of symptomatic patients in primary care who do not meet the referral criteria for suspected cancer referral (NICE guideline 12). FIT-based prediction tools could help optimise referral for colorectal cancer investigations, reducing unnecessary colonoscopies.

Plain language summary


HTW has assessed tools that included faecal immunochemical tests and other characteristics, to help NHS Wales decide whether to use these tools.


Colorectal cancer covers cancers in both the colon (colon cancer or bowel cancer) and rectum (rectal cancer). It’s one of the most common cancers in Wales, with about 2,300 new cases in Wales each year.


Faecal immunochemical tests can detect small amounts of blood in stool samples. They can help GPs decide if people with unexplained CRC-associated symptoms, but no rectal bleeding, should be referred for more urgent tests. Other characteristics, such as age or gender, can also help GPs identify people who are at risk.


HTW found evidence for two different tools: FAST and COLONPREDICT. FAST uses the faecal immunochemical test with age and sex. COLONPREDICT uses the faecal immunochemical test with 11 other characteristics, including age, sex and other tests. There isn’t enough evidence to recommend the FAST tool or COLONPREDICT tool.

Topic Exploration Report

TER011 08.2018

Evidence Appraisal Review

EAR007 01.2019


GUI007 02.2019

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