Triage Optimisation in Patients with Symptoms Suspicious of Colorectal Cancer

Despite the advent of screening programmes, diagnosis for the majority of colorectal cancers (CRC) still follows a symptomatic presentation. Current approaches to assessment of patients with symptoms suspicious of CRC rely on subjective symptoms which are poor predictors of CRC diagnosis. Multiple practical challenges have also arisen as a result of excessive reliance on symptoms for diagnosis and triage. Current approaches have also overwhelmed health care resources without producing the expected benefits. Better ways of triaging patients with symptoms suspicious of CRC are needed. The principles of triaging are explored followed by an overview of the advantages and limitations of a number of current triaging approaches. The faecal immunochemical test (FIT) is a prime candidate to bring major practice change in how these patients are triaged. FIT offers practical solutions that address many of the challenges faced by current triaging methods. The role and evidence supporting the use of FIT in symptomatic patients is explored in detail, with further discussion about unresolved considerations such as safety netting for patients with low FIT results, equity concerns, and future directions for improving FIT implementation.