Beating bowel cancer together

Improving use of the faecal immunochemical test

Lead researcher: Professor Robert Steele

Location: University of Dundee

Grant award: £110,151

Dates: November 2019 to October 2021

The faecal immunochemical test (FIT) is a test used to look for blood in poo, which could be a sign of bowel cancer or pre-cancerous growths (polyps). Professor Robert Steele and his team investigated ways to improve how FIT is used to improve early diagnosis of bowel cancer.

The challenge

FIT is used as part of the bowel cancer screening programme and also used for some patients who visit their GP with potential symptoms of bowel cancer.

FIT looks for hidden blood in poo. This can be an indication of bowel cancer or a pre-cancerous growth (polyp). The results of this test can help decide which patients need further tests such as a colonoscopy.

FIT isn’t always able to detect or rule out bowel cancer effectively. There’s an urgent need to improve this, so that more people can be diagnosed with bowel cancer at an early stage.

The science behind the project

FIT measures the amount of blood in a poo sample, not just whether or not it’s there, and this level is used to decide if a person needs further tests. Currently the same threshold for this is used for everyone.

This study used large, high-quality databases from NHS Scotland to link FIT results with other patient information, such as age, gender, blood test results like anaemia, and what symptoms had led them to doing a FIT.

The researchers used this detailed data to determine whether the decision to send someone for further investigations could be more accurate if these factors were calculated alongside the FIT result, leading to earlier diagnosis for some and less unnecessary investigations, such as colonoscopies, for others.


The team found that if the level of blood in poo that sends someone for further tests is adjusted based on their age, it might detect more early bowel cancers, particularly in women.

None of the other factors they looked at improved diagnosis above using FIT results alone.

If you like, you can find out more about this work by reading this key research article, published by the researchers.

Other impact

These results have been published in two papers in scientific journals, sharing them with the wider research community and with policy makers.

What difference will this project make?

We are always looking for ways to improve bowel cancer diagnosis and to detect as many cancers as possible at the earliest stages, while making best use of the colonoscopy services available.

This research has explored possible ways to enhance our use of FIT, considering age can might make a difference, but by showing that adding other risk factors doesn’t improve accuracy, it helps researchers to focus on other ways to diagnose more people earlier.

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