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Introduction Patients referred on the urgent suspected cancer iron deficiency anaemia (USCIDA) pathway undergo upper/lower GI investigations to exclude significant pathology and colorectal cancer (CRC). FIT in USCIDA remain unclear although recent guidance recommends its use. 1 We retrospectively analysed FIT-positive patients on the USCIDA pathway who underwent investigations and compared them with a FIT-negative cohort of 214 patients.Methods Data were extracted via SQL query from the backend of electronically graded referrals labelled 2WWIDA i.e. USCIDA, FIT tests, and from investigations in the electronic health record (EHR). A retrospective analysis of 214 consecutive USCIDA referrals with positive FIT was compared to 214 USCIDA referrals with negative FIT. All patients underwent lower GI investigations. Data on demographics, investigations, and clinical outcomes of lower GI investigations were analysed. Statistical analysis was performed with Graphpad Prism.Results FIT negative patients had a mean age of 65.3 years (SD 12.8), 59.3% were female. FIT-positive cohort were significantly older (mean age 71.6 years, SD 12.2), with 57% being female. 73.8% underwent colonoscopy in the FIT negative group, compared to 67.3% in the FIT positive group. 9 FIT-negative and 19 FIT-positive patients had flexible sigmoidoscopy. CT colon/colonography rates were lower in the FIT-negative cohort compared to FIT-positive (n=70, n=92). Significantly more CT scans were performed in the FIT-positive group (FIT-negative n=1, FIT-positive n=39). There were significantly more negative lower GI investigations in FIT-negative patients (FIT-positive 102 (47.7%), FIT-negative 59 (27.6%)). CRC was diagnosed in 1.4% (n=3) of FIT-negative patients. FIT-positive patients had significantly higher CRC, 15.9% (n=34, p <0.05). Colonic polyps >1cm were significantly less common in FIT-negative patients (1.9%, n=4), compared to the FIT-positive group (9.8%, n=21, p <0.05). For distribution of other findings, see table 1.Conclusion FIT-positive patients on the USCIDA pathway have an 11-fold increased risk of CRC, compared to FIT-negative patients in our audit. The significant age difference between cohorts (65.3y vs 71.6y) may be a compounding factor. Regardless, positive FIT significantly increases CRC diagnosis. Consideration should be given to include FIT in USCIDA referrals.Reference Goddard, et al. Frontline Gastro. 2025. doi: 10.1136/flgastro-2025-103329Abstract P270 Table 1DiagnosisFIT negative IDA n (%)FIT positive IDA n (%)P valueCRC3 (1.4%)34 (15.9%)<0.05Polyps >1cm4 (1.9%)21 (9.8%)<0.05Polyps <1cm36 (16.8%)31 (14.5%)nsDiverticular disease52 (24.3%)48 (22.4%)nsAngiodysplasia3 (1.4%)5 (2.3%)nsHaemorrhoids13 (6.1%)14 (6.5%)nsCrohn’s disease1 (0.5%)2 (0.9%)nsRadiation Proctitis0 (0.0%)4 (1.9%)nsNormal102 (47.7%)59 (27.6%)<0.05