The fecal occult blood test has an unimpeachable role in population-wide colorectal
cancer screening. More than 5 decades ago, soon after commercial availability of the
test, its use was extended for workup of altered stool color (example, melena) or
anemia. Although this practice was debatable even then, current imaging and endoscopic
tools have revolutionized our approach, rendering the fecal occult blood test irrelevant
to modern hospital practice.
1
,
2
,
- US Preventive Services Task Force
Final Recommendations Statement Colorectal Cancer: Screening.
https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2
Date accessed: October 21, 2017
3
Yet the routine use of fecal occult blood tests in hospitalized patients has persisted,
sometimes reflexively with rectal examinations. Fecal occult blood tests are of 2
types: guaiac-based tests measuring heme, and immunochemical tests measuring globin.
3
They are used to detect the microscopic presence of hemoglobin in stool but are plagued
by poor accuracy. False-positive results can occur with nongastrointestinal bleeding
sources (epistaxis, swallowed hemoptysis), mucosal inflammation without bleeding (inflammatory
bowel disease), certain foods (vegetables containing peroxidase, and meats), toxins
(such as alcohol), or clinically insignificant bleeding caused by anti-inflammatory
drugs.
3
False-negative results, such as those caused by slow or intermittent bleeding, ingestion
of antioxidants such as vitamin C, or upper gastrointestinal bleeding in which globin
is denatured, preclude their ability to convincingly rule out important pathology.
3
Multiple samples need to be sent for increased sensitivity, and visual misinterpretation
of results can occur.
3
Inappropriate testing and interpretation not only leads to increased costs of testing
but can lead to patient harm through incorrect downstream management decisions and
unnecessary interventions. Studies have questioned the utility of having fecal occult
blood tests available as an orderable test in the inpatient setting.
4
,
5
,
6
,
7
,
8
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References
- Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.CA Cancer J Clin. 2008; 58: 130-160https://doi.org/10.3322/CA.2007.0018
- Final Recommendations Statement Colorectal Cancer: Screening.(Available at:)https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2Date accessed: October 21, 2017
- Fecal occult blood testing in hospitalized patients with upper gastrointestinal bleeding.J Hosp Med. 2017; 12: 567-569
- An audit of the utility of in-patient fecal occult blood testing.Am J Gastroenterol. 2001; 96: 1256-1260https://doi.org/10.1111/j.1572-0241.2001.03709.x
- Use and abuse of faecal occult blood tests in an acute hospital inpatient setting.Intern Med J. 2010; 40: 107-111https://doi.org/10.1111/j.1445-5994.2009.02149.x
- When inexpensive tests have expensive outcomes: faecal occult blood tests as an example.Intern Med J. 2010; 40: 91-93https://doi.org/10.1111/j.1445-5994.2010.02170.x
- Inappropriate use of the faecal occult blood test outside of the National Health Service colorectal cancer screening programme.Eur J Gastroenterol Hepatol. 2012; 24: 1270-1275https://doi.org/10.1097/MEG.0b013e328357cd9e
- Use of fecal occult blood testing in hospitalized patients: results of an audit.Can J Gastroenterol Hepatol. 2014; 28: 489-494
- Drug shortage leading to serendipitous adoption of high-value care practice.BMJ Qual Saf. 2017; 26: 852-854
- Early trends among seven recommendations from the choosing wisely campaign.JAMA Intern Med. 2015; 175: 1913-1920
- Small decline in low-value back imaging associated with the “choosing wisely” campaign, 2012-14.Health Aff (Millwood). 2017; 36: 671-679
- Choosing wisely: how to fulfill the promise in the next 5 years.Health Aff (Millwood). 2017; 36: 2012-2018
- Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices.Aust New Zealand Health Policy. 2007; 4: 23
- Disinvestment from low value clinical interventions: NICEly done?.BMJ. 2011; 343: d4519
- Setting a research agenda for medical overuse.BMJ. 2015; 351: h4534
- The behaviour change wheel: a new method for characterising and designing behaviour change interventions.Implement Sci. 2011; 6: 42
- The routine guaiac stool test.N Engl J Med. 1952; 246: 864-866https://doi.org/10.1056/NEJM195205292462205
Article info
Publication history
Published online: March 27, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
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© 2018 Elsevier Inc. All rights reserved.
