Document resource
Introduction NICE recommend faecal immunochemical testing (FIT) in the pathway for suspected colorectal cancer (CRC) in patients over the age of 40 (HTG690). Locally FIT requests are not restricted by age, due to the increase in CRCs currently seen in in younger adults.Recently, we have explored the option of testing faecal calprotectin (fCal) on FIT requests (from the same sampling device) in younger adults to potentially improve investigation of bowel diseases, thereby bridging the pathways for patient referral.Methods For 2 months (Nov-Dec 2025) FIT samples received from the Nottingham areas for patients under 40 years old were also tested for fCal, following local clinical agreement. FIT results were reported back to the requesting clinician and any elevated fCal results reported to the colorectal team at NUH for clinical review. Both FIT and fCal were performed from the same collection device using the OC-Sensor Pledia assays (Eiken Chemical Co./MAST Diagnostics, Tokyo, Japan). Locally agreed ranges using the OC-FCa assay were based on previous studies comparing results of the OC-FCa to currently used CALPRO2 EliA enzyme immunoassay (Phadia250), note cut-offs are still under clinical review.Results 699 FIT samples from patients <40 years were analysed (14% of all FITs received). Of these, 259 patients (37%) had a separate request for fCal. In total 496 (71.6%) had OC-FCa results <100 ug/g with 40 (5.8%) having a result ≥500 ug/g.The table below summarises the proportion of results obtained in relation to the assay cut-offs for 251patients that had a routine fCal result using the CALPRO2 assay and a OC-FCa result obtained from the FIT sample.Conclusions While the incidence of bowel cancer in young adults is increasing, the overall risk in people under 40yrs remains low with symptoms more commonly associated with other pathology. However, increases in FIT requests in this younger age group suggests that primary care are cautiously following suspected cancer pathways, which, if negative, may inadvertently cause delays in diagnosis of other conditions such as IBD. This pilot has shown that there is already significant overlap in requests for these tests and that a combined approach, made possible from a single sample using the OC-Sensor, may offer significant benefits especially in younger patients when investigating persistent bowel symptoms. Furthermore, the clinical outcome from the different fCal assays is comparable providing assay specific cut-offs are applied.Abstract O47 Table 1fCal result indicating No inflammationfCal result indicating Active inflammationCut-off ug/gTotalFIT <10 ug/gFIT >10 ug/gCut-off ug/gTotalFIT <10 ug/gFIT >10 ug/gOC-FCa<100189 (75.3%)170 (89.9%)19 (10.1%)≥50016 (6.4%)7 (43.8%)9 (26.3%)CALPRO2<50214 (85.3%)193 (90.2%)21 (9.8%)≥10020 (8.0%)7 (35.0%)13 (65.0%)