Risk-stratified faecal immunochemical testing (FIT) for urgent colonoscopy in Lynch syndrome during the COVID-19 pandemic

Anne G Lincoln, Sally C Benton, Carolyn Piggott, Shama Riaz Sheikh, Andrew D Beggs, Leah Buckley, Bianca DeSouza, James E East, Pete Sanders, Michael Lim, Donal Sheehan, Katie Snape, Helen Hanson, John R Greenaway, John Burn, David Nylander, Menna Hawkins, Fiona Lalloo, Kate Green, Thomas J LeeJulie Walker, Gillian Matthews, Terry Rutherford, Peter Sasieni, Kevin J Monahan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

BACKGROUND: Lynch syndrome is a hereditary cancer disease resulting in an increased risk of colorectal cancer. Herein, findings are reported from an emergency clinical service implemented during the COVID-19 pandemic utilizing faecal immunochemical testing ('FIT') in Lynch syndrome patients to prioritize colonoscopy while endoscopy services were limited.

METHODS: An emergency service protocol was designed to improve colonoscopic surveillance access throughout the COVID-19 pandemic in England for people with Lynch syndrome when services were extremely restricted (1 March 2020 to 31 March 2021) and promoted by the English National Health Service. Requests for faecal immunochemical testing from participating centres were sent to the National Health Service Bowel Cancer Screening South of England Hub and a faecal immunochemical testing kit, faecal immunochemical testing instructions, paper-based survey, and pre-paid return envelope were sent to patients. Reports with faecal haemoglobin results were returned electronically for clinical action. Risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg of haemoglobin/g of faeces (µg/g)-scheduled within 6-12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g-triaged via an urgent suspected cancer clinical pathway. Primary outcomes of interest included the identification of highest-risk Lynch syndrome patients and determining the impact of faecal immunochemical testing in risk-stratified colonoscopic surveillance.

RESULTS: Fifteen centres participated from June 2020 to March 2021. Uptake was 68.8 per cent amongst 558 patients invited. For 339 eligible participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (17.7 per cent) had faecal haemoglobin greater than or equal to 10 µg/g. In the latter group, the diagnostic accuracy of faecal immunochemical testing was 65.9 per cent and escalation to colonoscopy was facilitated (median 49 versus 122 days, χ2 = 0.0003, P < 0.001).

CONCLUSION: Faecal immunochemical testing demonstrated clinical value for Lynch syndrome patients requiring colorectal cancer surveillance during the pandemic in this descriptive report of an emergency COVID-19 response service. Further longitudinal investigation on faecal immunochemical testing efficacy in Lynch syndrome is warranted and will be examined under the 'FIT for Lynch' study (ISRCTN15740250).

Original languageEnglish
Article numberzrad079
Number of pages8
JournalBJS Open
Volume7
Issue number5
Early online date5 Sept 2023
DOIs
Publication statusPublished - Oct 2023

Bibliographical note

Funding:
This emergency clinical service was supported by funding from the 40tude Curing Colon Cancer Charity. Additional support was provided by Mast Group Ltd, through their generous donation of FIT kits (OC-SENSOR™, Eiken Chemical Co., Ltd, Tokyo, Japan). J.E.E. is funded by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. A.G.L. is supported by a King’s College London Centre for Doctoral Studies Postgraduate Research (PGR) International Scholarship and S.R.S. is supported by Peter Sasieni grant, Cancer Research UK (grant number C8162/A16892); neither funder had a role in the preparation of the manuscript or the decision to submit for publication.

Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

Keywords

  • Humans
  • Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis
  • COVID-19/diagnosis
  • Pandemics
  • State Medicine
  • Colonoscopy

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