‘FIT is superior to symptoms in predicting pathology in patients with suspected colorectal cancer symptoms’ - De'Souza et al., 2021

FIT stands for (Quantitative) Faecal Immunochemical Test. FIT detects hidden or ‘occult’ blood in stool samples, using antibodies that specifically recognise human haemoglobin. FIT is used in many screening programmes worldwide because it can detect more cancers, particularly advanced adenomas (premalignant adenomas). There are fewer false positives and it is a sensitive enough test to assess patients who are at low risk of developing colorectal cancer.

This revised pathway includes expanded use of FIT, aligning to guidance from the British Society of Gastroenterology
Ash Bassi photo.jpgG) and Association of Coloproctology of Great Britain & Ireland (ACPGBI), which is supported by NHSE and accredited by NICE.  It is also underpinned by compelling evidence to support the use of FIT in conjunction with relevant blood tests, history and clinical examination to determine the appropriate referral or management pathway, improving the detection of cancers and improve patient experience.

"FIT tests has high sensitivity and specificity and may be an effective triage tool when considering whether to perform investigations in patients presenting with lower GI symptoms. IT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for colorectal cancer."

- Dr Ash Bassi, Cheshire and Merseyside FIT Clinical Lead; NHS England Endoscopy Advisor, North West

Debbie Harvey photo.jpg

"We know that FIT is superior to symptoms in detecting people with colorectal cancer. We believe that this revised pathway which includes all of those 18yrs and above, incorporates FIT results and unexplained IDA will help improve cancer outcomes for our population in Cheshire and Merseyside."

- Dr Debbie Harvey, CMCA GP Lead and Cheshire and Merseyside FIT Primary Care Lead

New guidance and supporting materials

Please go to The Cancer Academy website for the up-to-date guidance and other useful resources like the new Urgent Suspected Lower GI Cancer Referral Form:


Our video, below, for clinicians explains how the use of FIT and referral practice for suspected Lower GI cancers is changing in Cheshire and Merseyside.

Watch the video presented by Dr Debbie Harvey, CMCA GP Cancer Lead, below, or via this YouTube link: https://www.youtube.com/watch?v=4vt6ZuCGcGI

The video above is also available with subtitles in the following languages:

For videos about the FIT test in various languages, see: FIT Testing - YouTube


Patient information

Patient letter

This can be given to patients by primary care clinicians to explain why they are being asked for the test and the importance of getting their blood tests done as well. It is important to note that there may be slight local variations.

Patient information letter

An Easy Read version is available here. The letter is also available in a Braille version, which can be requested by emailing: ccf-tr.admin.cmca@nhs.net

This leaflet is also available in the following translations:

Patient information leaflets for completion of FIT

The instruction leaflet has been produced to assist patients in completing their FIT test.  It will be included when a patient receives their kit, but you can also download it from this site to be used, shared and distributed around Cheshire and Merseyside. Primary care may wish to share the links with their patients via text messages to support them in completing the FIT.

Patient instruction leaflet

Patient instruction leaflet (for patients referred to Liverpool University Hospitals Foundation Trust)

An Easy Read version is available here. The leaflet is also available in a Braille version, which can be requested by emailing: ccf-tr.admin.cmca@nhs.net

The Cheshire and Merseyside information leaflet is also available in the following translations:

Piloting distribution of FIT kits in primary care

Following the C&M FIT Pathology Review completion in September 2022, a recommendation was made to pilot distribution of FIT kits by primary care.  This would mean that a patient can be given the kit there and then so they can take it home to complete.  This has been done in other areas and it has shown that there are advantages and disadvantages to this, which is why it was decided that pilots in local areas were the best course of action. One is already underway across Liverpool and Sefton, with another one to take place in Warrington and Halton.  CMCA and its stakeholders will then work together to improve the processes put in place and, importantly, confirm how the Cancer Alliance rolls out this approach safely across Cheshire and Merseyside.

Liverpool and Sefton primary care colleagues can find supportive information on the Cancer Academy site.

If you would like more information, please do not hesitate to contact ccf-tr.admin.cmca@nhs.net.