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Background <p>The incidence of early-onset colorectal cancer (EOCRC) is rising rapidly, with diagnoses typically occurring at a more advanced stage than late-onset CRC. In the absence of screening for younger patients, diagnosis relies on symptomatic presentation. The faecal immunochemical test (FIT) is a diagnostic triage tool for patients presenting with clinical features of CRC in primary care, though its performance in individuals under 50 years is not well established.</p> Methods <p>A cohort of 38,117 symptomatic patients aged 18–49 years in upper South West England underwent FIT in primary care between 01/01/2021 and 10/07/2023. A FIT result of ≥10 µg Hb/g faeces was considered positive. In the same region, 528 EOCRC diagnoses were recorded between 01/01/2021 and 10/10/2024.</p> Results <p>Of the 528 EOCRC patients, 105 (20%) underwent FIT in the year before diagnosis. The sensitivity of FIT was 92.4% (95% CI 85.5–96.7%), specificity was 88.5% (88.2–88.8%), positive predictive value (PPV) was 2.2% (1.8–2.6%), and negative predictive value was 100% (100–100%). PPVs decreased in younger age groups (18–29, 30–39, 40–49 years).</p> Conclusions <p>FIT performs excellently for patients aged 40–49; however, it may not be used optimally in patients &lt;40 years. A more targeted strategy is needed to guide investigation in younger patients.</p>

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The diagnostic accuracy of the faecal immunochemical test for the detection of early-onset colorectal cancer: an age-stratified analysis in South West England

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  • 发表日期：

    2025年8月22日

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  • Melissa Barlow,
  • David Messenger,
  • Ryan Preece,
  • Amy Prowse,
  • Gary Abel,
  • Willie Hamilton,
  • Samuel WD Merriel,
  • Adam Chambers,
  • Sarah ER Bailey

摘要

Background

The incidence of early-onset colorectal cancer (EOCRC) is rising rapidly, with diagnoses typically occurring at a more advanced stage than late-onset CRC. In the absence of screening for younger patients, diagnosis relies on symptomatic presentation. The faecal immunochemical test (FIT) is a diagnostic triage tool for patients presenting with clinical features of CRC in primary care, though its performance in individuals under 50 years is not well established.

Methods

A cohort of 38,117 symptomatic patients aged 18–49 years in upper South West England underwent FIT in primary care between 01/01/2021 and 10/07/2023. A FIT result of ≥10 µg Hb/g faeces was considered positive. In the same region, 528 EOCRC diagnoses were recorded between 01/01/2021 and 10/10/2024.

Results

Of the 528 EOCRC patients, 105 (20%) underwent FIT in the year before diagnosis. The sensitivity of FIT was 92.4% (95% CI 85.5–96.7%), specificity was 88.5% (88.2–88.8%), positive predictive value (PPV) was 2.2% (1.8–2.6%), and negative predictive value was 100% (100–100%). PPVs decreased in younger age groups (18–29, 30–39, 40–49 years).

Conclusions

FIT performs excellently for patients aged 40–49; however, it may not be used optimally in patients <40 years. A more targeted strategy is needed to guide investigation in younger patients.