ArticleAnnals of clinical biochemistry2021
Faecal haemoglobin concentration thresholds for reassurance and urgent investigation for colorectal cancer based on a faecal immunochemical test in symptomatic patients in primary care.
Article in Annals of clinical biochemistry, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- Quantitative faecal immunochemical tests to guide colorectal cancer pathway referral in primary care. A systematic review, meta-analysis and cost-effectiveness analysis.Health technology assessment (Winchester, England) · 2025Pooled it
- Faecal immunochemical test to triage patients with possible colorectal cancer symptoms: meta-analysis.The British journal of surgery · 2022Pooled it
- Development and external validation of a machine-learning risk model for colorectal cancer triage in Sweden's fast-track pathway.BMC medical informatics and decision making · 2026Article
- Article
- Observational
- Triaging colorectal urgent referrals in the COVID-19 era using faecal immunochemical testing: a prospective UK real-world multicentre cohort study.BMJ open gastroenterology · 2025Observational
- Variations in the Use of Faecal Immunochemical Testing (FIT) in Primary Care in England: A Population-Based Cohort of 531,735 FITs from 495,121 Patients Between 2019 and 2023.Clinical epidemiology · 2025Article
- Faecal immunochemical tests for patients with symptoms suggestive of colorectal cancer: An updated systematic review and multiple-threshold meta-analysis of diagnostic test accuracy studies.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2024Review
- Article
- Faecal Immunochemical Test (FIT) Sensitivity; A Five Year Audit.British journal of biomedical science · 2024Article
- Role of the faecal immunochemical test in patients with risk-stratified suspected colorectal cancer symptoms: A systematic review and meta-analysis to inform the ACPGBI/BSG guidelines.The Lancet regional health. Europe · 2022Article
- Prevalence of repeat faecal immunochemical testing in symptomatic patients attending primary care.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2022Observational
- Article
- Alternative diagnoses and demographics associated with a raised quantitative faecal immunochemical test in symptomatic patients.Annals of clinical biochemistry · 2022Observational
- Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway.International journal of colorectal disease · 2022Observational
- A Review of Colorectal Cancer in Terms of Epidemiology, Risk Factors, Development, Symptoms and Diagnosis.Cancers · 2021Review
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFaecal haemoglobin concentration (f-Hb), estimated using a faecal immunochemical test, can be safely implemented in primary care to assess risk of colorectal cancer (CRC). Clinical outcomes of patients presenting with symptoms of lower gastrointestinal disease were examined using an extensive range of f-Hb thresholds to decide on reassurance or referral for further investigation.
methodsAll patients who attended primary care and submitted a single faecal specimen faecal immunochemical test in the first year of the routine service had f-Hb estimated using HM-JACKarc: f-Hb thresholds from <2 to ≥ 400 µg Hb/g faeces (µg/g) were examined.
resultsLow f-Hb thresholds of <2, <7, <10 and <20 µg/g gave respective CRC risks of 0.1, 0.3, 0.3 and 0.4%, numbers needed to scope for one CRC of 871, 335, 300 and 249, and 'false negative' rates of 2.9, 11.4, 13.3 and 17.1%. With thresholds of <2, <7, <10 and <20 µg/g, 48.6, 74.6, 78.1 and 83.2% respectively of symptomatic patients could be managed without further investigation. With reassurance thresholds of <2 µg/g, <7 µg/g and <10 µg/g, the thresholds for referral for urgent investigation would be >400 µg/g, ≥200 µg/g and ≥100 µg/g. However, patients with a f-Hb concentration of <10 or <20 µg/g with iron deficiency anaemia, or with severe or persistent symptoms, should not be denied further investigation.
conclusionsIn primary care, f-Hb, in conjunction with clinical assessment, can safely and objectively determine individual risk of CRC and decide on simple reassurance or urgent, or routine referral.
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