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Fecal occult blood testing (FOBT), as its name implies, aims to detect subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon.Positive tests ("positive stool") may result from either upper gastrointestinal bleeding or lower gastrointestinal bleeding and warrant further investigation for peptic ulcers or a malignancy (such as colorectal cancer or gastric cancer).
The fecal immunochemical test (FIT) is a diagnostic technique that examines stool samples for traces of non-visible blood, which could potentially indicate conditions including bowel cancer. [1] Symptoms which could be caused by bowel cancer and suggest a FIT include a change in bowel habit, anaemia, unexplained weight loss, and abdominal pain.
The consequences of overdiagnosis and overtreatment resulting from cancer screening can lead to a decline in quality of life, due to the adverse effects of unnecessary medication and hospitalization. [10] [12] [13] The accuracy of a cancer screening test relies on its sensitivity, and low sensitivity screening tests can overlook cancers. [10]
Since January 2007, the US Medicare program reimburses for colorectal cancer screening with gFOBT only when this code is used. [ 36 ] The stool guaiac test method may be preferable to fecal immunochemical testing (FIT) if there is a clinical concern about possible gastric or proximal upper intestinal bleeding. [ 37 ]
Routine use of colonoscopy screening varies globally. In the US, colonoscopy is a commonly recommended and widely utilized screening method for colorectal cancer, often beginning at age 45 or 50, depending on risk factors and guidelines from organizations like the American Cancer Society. [9] However, screening practices differ worldwide.
The recommendation to begin screening at an older age received significant attention, including proposed congressional intervention. [13] The 2016 recommendations maintained 50 as the age when routine screening should begin. [14] In April 2024, The USPSTF lowered the recommended age to begin breast cancer screening.
The signs and symptoms of colorectal cancer depend on the location of the tumor in the bowel, and whether it has spread elsewhere in the body ().The classic warning signs include: worsening constipation, blood in the stool, decrease in stool caliber (thickness), loss of appetite, loss of weight, and nausea or vomiting in someone over 50 years old. [15]
The American College of Gastroenterology has recommended the abandoning of gFOBT testing as a colorectal cancer screening tool, in favor of the fecal immunochemical test (FIT). [3] The newer and recommended tests look for globin, DNA, or other blood factors including transferrin, while conventional stool guaiac tests look for heme.
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