Continuing with our series of recommended reading Professor Callum G Fraser (University of Dundee) has a very clear recommendation with significant practical application

Title: Symptom or faecal immunochemical test based referral criteria for colorectal cancer detection in symptomatic patients: a diagnostic tests study.

Authors: Herrero JM, Vega P, Salve M, Bujanda L, Cubiella J

Link:  BMC Gastroenterol 2018;18:155. doi: 10.1186/s12876-018-0887-7.

Colonoscopy is a scarce resource. Demands continue to increase for a number of reasons, including the recent adoption of faecal immunochemical tests (FIT) in the Scottish Bowel Screening Programme. Demands for surveillance after detection of disease have also increased. Very importantly, much publicity has informed of the need to have lower bowel symptoms investigated quickly, leading to many referrals from primary care. This paper is important since it compares symptom based referral criteria for colorectal cancer with the use of FIT alone and with two published FIT-based prediction models The convincing take home message is that referral of patients based on FIT, either alone or within prediction models, does indeed have higher diagnostic accuracy than symptom-based strategies.

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