Faecal occult blood tests--eliminate, enhance or update?

Area of Science:

• Clinical Chemistry
• Gastroenterology
• Oncology

Background:

• Guaiac-based faecal occult blood tests (FOBT) are widely used in clinical practice.
• Evidence supports FOBT's role in reducing mortality for asymptomatic colorectal cancer screening.
• Limited evidence supports FOBT utility in symptomatic individuals; guidelines recommend bowel visualization and full blood count.

Purpose of the Study:

• To evaluate the clinical utility of guaiac-based faecal occult blood tests (FOBT).
• To assess the challenges associated with FOBT in clinical settings.
• To propose recommendations for the use or replacement of FOBT.

Main Methods:

• Review of existing evidence on FOBT efficacy in symptomatic and asymptomatic populations.
• Analysis of reported issues in FOBT sample collection and laboratory analysis.
• Consideration of alternative diagnostic approaches, including faecal immunochemical tests (FIT).

Main Results:

• Significant challenges exist in FOBT sample collection and analysis.
• FOBT demonstrates limited value in symptomatic individuals compared to bowel visualization.
• Faecal immunochemical tests (FIT) offer advantages in performance and interpretation over FOBT.

Conclusions:

• Discontinue FOBT in all clinical settings except for asymptomatic population screening programs.
• Consider replacing FOBT with faecal immunochemical tests due to their superior clinical and laboratory advantages.
• Laboratory-led improvements for FOBT require significant resources that may be better allocated elsewhere.