Faecal occult blood tests – eliminate, enhance or update?

Ann Clin Biochem 2008;45:117-121
© 2008 Association for Clinical Biochemistry


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Callum G Fraser 

Scottish Bowel Screening Centre Laboratory, Kings Cross, Dundee DD3 8EA, UK

Email: callum.fraser{at}nhs.net

Traditional guaiac-based faecal occult blood tests (FOBT) arecommonly performed investigations in laboratories, wards, clinicsand general practices. Although there is much evidence thatuse of FOBT in asymptomatic population screening programmesfor colorectal (bowel) cancer does reduce mortality, there islittle, if any, evidence of the value of FOBT in symptomaticindividuals. In contrast, recent evidence-based guidelines areunequivocal that most of those presenting with symptoms shouldhave bowel visualization and that the only laboratory test requiredis the full blood count. Moreover, recent literature shows thatthere are significant problems in sample collection for FOBTand in analysis of FOBT. In view of these facts, it is suggestedthat FOBT be ceased in all clinical settings except in asymptomaticpopulation screening programmes. An alternative to eliminationof FOBT would be laboratory-led improvement of knowledge onthe appropriateness of requests, the FOBT used, the qualityof FOBT sample collection and the standard of analysis, butthis would require significant efforts and resources, whichprobably could be better spent elsewhere. A favoured optionis that FOBT be replaced by faecal immunochemical tests sincethese undoubtedly have many clinical and laboratory advantagesand fewer problems in both performance and interpretation.

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L. F Brown and C. G Fraser
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