Evaluation of the FAST score in patients with suspected colorectal cancer in the Herts Valley CCG

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Abstract Objective The UK has seen a doubling in “urgent cancer ” referrals for patients with suspected colorectal cancer (CRC) over the last decade.1,2 The FAST score (faecal haemoglobin, age and sex test score) was proposed to improve the utility of the quantitative faecal immunochemical test (FIT) in the diagnosis of CRC. We aimed to investigate the utility of the FAST score for detection of CRC in our population. Methods Medical records of patients undertaking a FIT sample in primary care within the Herts Valley between June 2019 to November 2020 were referenced with the cancer database. Other significant colonic pathology (SCP) recorded included inflammatory bowel disease and high-risk adenomas. FIT analysis was performed using OC-Sensor analyser.3 FAST scores (≥ 2.12 versus < 2.12) were assessed.4 Results 5340 patients returned a FIT sample. 2150 patients were referred to secondary care and 924 patients were investigated with a colonoscopy (group A). 3190 patients were not referred to secondary care immediately (group B). Using a FAST score with ≥2.12, which gives high clinical sensitivity for CRC, 841 of 924 in group A would have been referred for colonoscopy, a 9.0% reduction in colonoscopy demand. 147 of 153 (96.0%) with SCP had a positive FAST score. Only 80 of 771 (10.4%) without SCP had a negative FAST score. In group B, 2226 (69.8%) had a FAST score ≥2.12 but only 149 (4.7%) were referred to secondary care; with no cases of CRC or SCP. Conclusion Our data does not support use of the FAST score in patient triage for colonoscopy.

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