Evaluating the impact of faecal immunochemical testing (FIT) on suspected colorectal cancer referrals and outcomes in the South West

Objective Patients with colorectal cancer (CRC) often face diagnostic delays. Faecal immunochemical testing (FIT) was introduced across the South West (SW) of England in October 2022 to support referral triage. This study evaluates the impact of FIT on referral patterns, investigations, outcomes and service adaptation across the region. Design/methods We performed a retrospective service evaluation using secondary care data from nine National Health Service (NHS) Trusts in the SW. Data were collected for July 2019, 2022 and 2023, representing prepandemic, pre-FIT and post-FIT periods. Outcomes included referral characteristics, investigation pathways, waiting times and cancer detection rates (CDRs), stratified by the National Institute for Health and Care Excellence guideline (NG12 (2023)) compliance. Results 10 140 records were analysed. In 2023, 87.0% of referrals included FIT. Compared to 2019, a greater proportion of patients were referred with an asymptomatic FIT ≥10 μg Hb/g (p<0.001) and fewer with traditional symptoms (p<0.001). Colonoscopy and clinic attendance fell (p=0.023 and p<0.001), with increased use of direct-to-test pathways (p<0.001). Total investigation volume was unchanged. The CDR rose from 4.1% (2019) to 4.7% (2023) but not significantly (p=0.266). Waiting times returned to prepandemic levels. Among non-NG12 compliant referrals, 48.6% still underwent colonoscopy, with modest CDRs (2.3%)—the clinical appropriateness of this was unclear. Asymptomatic FIT-positive patients aged >50 with FIT >100 μg Hb/g had a CDR of 7.1%. Conclusion FIT has been widely adopted in primary care, facilitating more efficient secondary care triage and helping restore diagnostic capacity. While NG12 (2023) non-compliant referrals yield fewer cancers, some high-risk groups (particularly asymptomatic FIT-positive patients) should not be excluded from investigation.