FITTER: A standard for Faecal Immunochemical TesTs for haemoglobin Evaluation Reporting.

Colorectal cancer is a major health concern in many countries and measurement of faecal haemoglobin concentration using faecal immunochemical tests for haemoglobin (FIT) is widely recognised as the best non-invasive test currently available for asymptomatic population screening(1).

There are many publications of different types concerning FIT. These publications have appeared in many journals and other media. Most document the major clinical findings and outcomes in detail, but adequate descriptions of the pre-analytical aspects (specimen collection, handling and storage prior to analysis), and the analytical performance characteristics attained, are very often deficient or missing. This deficiency of information is not unique to FIT. In order to evaluate published data, compare and contrast the results of published studies and translate published results into practice, pre-analytical and analytical aspects do need to be adequately described and documented.

An Expert Working Group (EWG) on FIT for Screening was formed by the Colorectal Cancer Screening Committee (CRCSC) of the World Endoscopy Organization (WEO). The EWG has a broad remit to improve all aspects of FIT and has produced and promulgated a number of informative discussion documents and publications ( The EWG recognised the importance of improving published papers on FIT and has now produced a standard for adequate reporting of FIT studies. The new standard includes a check-list that lists items to be documented in any publication describing the use of FIT: data on specimen collection and handling (10 items), analysis (5 items), quality management (4 items) and result handling (4 items).  The standard and check-list are available at:

 The EWG on FIT for Screening recommends that:

  • investigators and authors adhere to the FITTER standards and use the check-list provided and
  • reviewers of submitted manuscripts on FIT request adherence to the standards and look for inclusion of a completed check-list.

It is also hoped that the editors of medical journals and editorial staff will appreciate the value of good documentation of studies on FIT and request authors make the check-list available to all readers.

 This entry was posted by the Members of the EWG:

Callum G Fraser, Centre for Research into Cancer Prevention and Screening,
University of Dundee, Scotland.
James E Allison, Division of Gastroenterology, University of California San Francisco, San Francisco, California, USA.
Graeme P Young, Flinders Centre for Cancer Prevention and Control, Bedford Park (Adelaide), South Australia.
Stephen P Halloran, NHS Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Trust and University of Surrey, Guildford, UK.
Helen E Seaman, NHS Bowel Cancer Screening Southern Programme Hub, Royal Surrey County Hospital NHS Trust and University of Surrey, Guildford, UK.

For more information, email


1.  Halloran S, Launoy G, Zappa M. Fecal occult blood testing. In: Segnan N, Patnick J, von Karsa L, editors. European guidelines for quality assurance in colorectal cancer screening. First ed. Luxembourg: Publications Office of the European Union; 2010. p. 165-206. [Read full article:]

2.  Fraser CG, Allison JE, Young GP, Halloran SP, Seaman HE. A Standard for Faecal Immunochemical TesTs for Haemoglobin Evaluation Reporting (FITTER) (Letter). Annals of Clinical Biochemistry (in press).

3.  Fraser CG, Allison JE, Young GP, Halloran SP. Quantitation of hemoglobin improves fecal immunochemical tests for noninvasive screening. Clinical Gastroenterology and Hepatology 2013;11(7):839-40. Epub 2013 Apr 13. [Read full article:]

4.  Fraser C, Halloran S, Allison J, Young G. Making colorectal cancer screening FITTER for purpose with quantitative faecal immunochemical tests for haemoglobin (FIT). Clinical Chemistry and Laboratory Medicine 2013;51(11):2065-7. [Read full article:]

5.  Young GP, Fraser CG, Halloran SP, Cole S. Guaiac based faecal occult blood testing for colorectal cancer screening: an obsolete strategy? Gut 2012;61(7):959-60. [Read full article:]

6.  Fraser CG, Allison JE, Halloran SP, Young GP. A proposal to standardize reporting units for fecal immunochemical tests for hemoglobin. Journal of the National Cancer Institute 2012;104(11):810-4. Epub 2012/04/05. [Read full article:]

7.  Fraser C, Allison JE, Young GP, Halloran S. Newer fecal tests: opportunities for professionals in laboratory medicine. Clinical Chemistry 2012;58(6). Epub 27 March 2012. [Read full article:]

8.  Allison JE, Fraser CG, Halloran SP, Young GP. Comparing Fecal Immunochemical Testing: Improved Standardization Is Needed. Gastroenterology 2012. Epub 2012/01/28. [Read full article:]



Leave a Reply