Quality statement 3: Testing for blood in faeces

Quality statement

Adults presenting in primary care with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, have a test for blood in their faeces.

Rationale

Many colorectal cancers leak blood into the bowel intermittently. Tests for the presence of blood in faeces are relatively easy, inexpensive and safe, and help to identify people at higher risk of having colorectal cancer. People at higher risk can then receive definitive investigation sooner, resulting in earlier treatment for those diagnosed with cancer.

Quality measures

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults presenting in primary care with symptoms that suggest colorectal cancer who do not meet the referral pathway criteria, have a test for blood in faeces.

Data source: Local data collection.

Process

Proportion of presentations of adults with symptoms that suggest colorectal cancer, without visible rectal bleeding, in which the person has a test for blood in faeces.

Numerator – the number in the denominator resulting in a test for blood in faeces.

Denominator – the number of presentations of adults with symptoms that suggest colorectal cancer who do not meet the referral pathway criteria.

Data source: Local data collection.

Outcome

a) Stage of colorectal cancer at diagnosis.

Data source: Local data collection.

b) Colorectal cancer-related mortality.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary care services) ensure that systems are in place for adults with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, to have a test for blood in their faeces.

Healthcare professionals (GPs, specialists and practice nurses) ensure they offer a test for blood in their faeces to adults presenting in primary care with symptoms that suggest colorectal cancer who do not meet the referral pathway criteria.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which people presenting in primary care with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, have a test for blood in their faeces.

What the quality statement means for patients and carers

Adults who have certain symptoms that might be caused by cancer of the colon or rectum, should be offered a test to check for traces of blood in their faeces. This will check if the person is at risk of cancer, and may help to diagnose it early.

Source guidance

Definitions of terms used in this quality statement

Symptoms that suggest colorectal cancer

Adults should be offered testing for blood in faeces to assess for colorectal cancer if they do not have rectal bleeding but are:

  • aged 50 and over with unexplained:

    • abdominal pain or

    • weight loss, or

  • aged under 60 with:

    • changes in their bowel habit or

    • iron-deficiency anaemia, or

  • aged 60 and over and have anaemia even in the absence of iron deficiency.

[Adapted from Suspected cancer: recognition and referral (NICE guideline NG12) recommendation 1.3.4]

Criteria for suspected colorectal cancer pathway referral

Adults should be referred using a suspected cancer pathway (for an appointment within 2 weeks) for colorectal cancer if they fulfil the following criteria:

  • they are aged 40 and over with unexplained weight loss and abdominal pain or

  • they are aged 50 and over with unexplained rectal bleeding or

  • they are aged 60 and over with:

    • iron‑deficiency anaemia or

    • changes in their bowel habit, or

  • tests show occult blood in their faeces.

[Adapted from Suspected cancer: recognition and referral (NICE guideline NG12) recommendation 1.3.1]

Test for blood in faeces

A chemical test that can pick up the presence of tiny traces of blood in faeces. Current practice in the UK is to use the faecal occult blood test. However, the faecal immunochemical test is an alternative option.

[Adapted from Suspected cancer: recognition and referral (NICE guideline NG12)]