Talk:Fecal occult blood

ICD10 code in infobox
This source discusses the decision whether in ICD10, faecal occult blood should be coded to "R19.5 – Other faecal abnormalities" or "K92.1 - Melaena", and concludes that because "ICD10 can’t measure the quantity of blood, a diagnosis of faecal occult blood should be coded to K92.1 -  Melaena". --Arcadian 14:19, 23 December 2005 (UTC)

Trademarks
I tried to trim some of the excessive marketing hype. The article has been infected by too many confusing trademark terms. It needs to get cleaned up and organized, by someone who actually understands the trademarks.-69.87.203.221 00:56, 28 June 2007 (UTC)

Evidence based screening
According to the National Guideline Clearinghouse™ (NGC), a public resource for evidence-based clinical practice guidelines.

at

http://www.guideline.gov/summary/summary.aspx?doc_id=14345

[All emphasis added.]

Colorectal cancer screening clinical practice guideline 

MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (evidence-based A-D, I and consensus-based) are provided at the end of the "Major Recommendations" field.

Recommendation 1*: Factors Associated with an Increased Risk of Colorectal Cancer in the General Population

...

Recommendation 2: Effectiveness of Colorectal Cancer Screening Tests

1. Colorectal cancer screening is strongly recommended for all asymptomatic, average-risk adults. (Evidence-based: A) 2. Any of the following tests are acceptable for colorectal cancer screening in asymptomatic, average-risk adults:* 3. The following additional screening tests are either less-preferred options or not recommended for screening. However, an adult who has had one of these tests is considered screened. Follow-up screening using a preferred option is recommended.
 * High-sensitivity' fecal occult blood test (FOBT) (Consensus-based)
 * Immunochemical fecal occult blood test (iFOBT/FIT)** (Consensus-based)
 * Flexible sigmoidoscopy (Evidence-based: B)
 * Colonoscopy** (Consensus-based)
 * A combination of high-sensitivity guaiac FOBT test and flexible sigmoidoscopy (Consensus-based)
 * An annual standard guaiac FOBT is a less-preferred option.*** (Consensus-based)
 * Air contrast barium enema is not recommended as a screening strategy for average-risk adults. (Evidence-based: I)
 * Virtual colonoscopy is not recommended as a screening strategy for average-risk adults.* (Consensus-based)
 * Fecal DNA is not recommended as a screening strategy for average-risk adults.****(Consensus-based)

Note: For fecal blood tests, inform patients of the potential risks associated with false-positive test and false-negative test results, as well as the need for prompt follow-up of a positive test result. For flexible sigmoidoscopy, inform patients that the test has a small risk of complications and is not a complete examination of the entire colon.

*There is insufficient evidence to choose one screening test over another.


 * If a patient has had a normal colonoscopy within the last 10 years, there is insufficient evidence that supplemental FOBT adds any incremental benefit.


 * Even though there is sufficient evidence in support of this screening modality, it is not a preferred option due to its low sensitivity and low compliance rates.


 * Please note that fecal DNA testing and virtual colonoscopy are not listed as "appropriate screening tests" in 2008 HEDIS (Health Plan Employer Data and Information Set) specifications for colorectal cancer screening, and therefore regions may choose to screen members with other appropriate tests.

Recommendation 3: Frequency of Colorectal Cancer Screening

1. The following intervals for colorectal cancer screening in asymptomatic, average-risk adults are recommended*: 2. The following additional screening tests are either less-preferred options or not recommended for screening. However, if these tests are performed, then the recommended intervals are as indicated below. Follow-up screening using a preferred option is recommended.
 * Flexible sigmoidoscopy: at least every 10 years (Consensus-based)
 * High-sensitivity guaiac or immunochemical FOBT (iFOBT/FIT): every 1-2 years (Consensus-based)
 * Colonoscopy: every 10 years (Consensus-based)
 * Combined FOBT and flexible sigmoidoscopy: every 1-2 years for FOBT, at least every 10 years for flexible sigmoidoscopy (Consensus-based)
 * Standard guaiac FOBT: every 1-2 years (Consensus-based)
 * Air contrast barium enema:** every 5 years (Consensus-based)
 * Virtual colonoscopy:** every 10 years (Consensus-based)
 * Fecal DNA:** every 5 years (Consensus-based)


 * The GDT recognizes that these screening intervals differ from current HEDIS measures. Some regions may choose to offer screening at more frequent intervals.  HEDIS intervals are as follows: FOBT (annual), flexible sigmoidoscopy (every 5 years), air contrast barium enema (every 5 years), colonoscopy (every 10 years).


 * These modalities are not recommended for screening average-risk adults (see Recommendation #2 above).

Recommendation 4: Age to Begin and End Colorectal Cancer Screening

In the absence of sufficient evidence, the following ages at which to begin and end colorectal cancer screening in asymptomatic average-risk adults are recommended:

1. Initiation of screening is recommended at age 50. (Consensus-based) 2. Discontinuation of screening is generally recommended at age 75, provided that there is a history of routine screening. For those with no history of routine screening, discontinuation is recommended at age 80. The decision to discontinue screening should be based on physician judgment, patient preference, the increased risk of complications in older adults, and existing comorbidities. (Consensus-based)  —Preceding unsigned comment added by Ocdcntx (talk • contribs) 15:22, 15 February 2010 (UTC)

Suggest replace photo of brand name guaiac FOBT, which is no longer preferred, with photo of a high-senstivity test, which is
See illustration:

"Cards and bottle used for the Hemoccult test, a type of stool guaiac test. —Preceding unsigned comment added by Ocdcntx (talk • contribs) 15:59, 15 February 2010 (UTC)

Major recommendations of best practices excluding most guaiac FOBT need to be laid into article.
Note that if a "guaic" FOBT is not recommended unless both (A) high-sensitivity and (B) even then, only when combined with a regular flex sig.

http://www.guideline.gov/summary/summary.aspx?doc_id=14345

...

MAJOR RECOMMENDATIONS

Definitions of the levels of evidence (evidence-based A-D, I and consensus-based) are provided at the end of the "Major Recommendations" field.

Recommendation 1*: Factors Associated with an Increased Risk of Colorectal Cancer in the General Population

...

Recommendation 2:

1. Colorectal cancer screening is strongly recommended for all asymptomatic, average-risk adults. (Evidence-based: A)

2. Any of the following tests are acceptable for colorectal cancer screening in asymptomatic, average-risk adults:*

Ocdcntx (talk) 19:23, 15 February 2010 (UTC)
 * High-sensitivity' fecal occult blood test (FOBT) (Consensus-based)
 * Immunochemical fecal occult blood test (iFOBT/FIT)** (Consensus-based)
 * Flexible sigmoidoscopy (Evidence-based: B)
 * Colonoscopy** (Consensus-based)
 * A combination of high-sensitivity guaiac FOBT test and flexible sigmoidoscopy (Consensus-based)

After recently reviewing the recommendations and editing the article in accordance with them, as a new and inexperienced Wiki person I then stumbled on this talk item, and I realise I should have been here first. That said, I agree that the guidelines need to be discussed and referenced, and I have initiated that, but I presently disagree that the guidelines generally mandate sigmoidoscopy, despite the outlier advocacy of ACG. My personal preference in favor of the ACG position, for a variety of reasons, is not rigorously supported on reviewing the literature, and is not appropriate for an encyclopedic text.--FeatherPluma (talk) 18:18, 29 October 2010 (UTC)

Canadian GI taskforce guidelines in favor of programmatic iFOBT vs high sensitivity gFOBT, 2010 Dec. Will edit article when I have time. — Preceding unsigned comment added by FeatherPluma (talk • contribs) 02:49, 4 January 2011 (UTC)

Graphic needs replacement
Graphic is traditional gFOBT, which is no longer recommended. Replace with graphic of currently-recommended test. — Preceding unsigned comment added by Ocdncntx (talk • contribs) 18:19, 20 September 2011 (UTC)

Signs and symptoms of possible GI bleeding?
It would be very useful to add a new section to the article about the signs and symptoms that warrant tests for fecal occult blood. (I was actually looking for that information when I checked this article.) 84.0.42.178 (talk) 09:51, 24 January 2013 (UTC)

Wrong focus in article
This article refers several times to "guidelines", "best practices recommendation" and the like, with no reference to what places use these guidelines. For example, the guaiac test is still the test sent out for routine screening in the UK. If the guidelines mentioned are the ones used in America, fair enough, but say so!

The Fecal DNA Test has little relevance to this page, as (according to its name, and the description here) it does not test for faecal occult blood. This page is about faecal occult blood testing, not colorectal cancer testing, which I'm sure is covered elsewhere. Browneyedgirl13 (talk) 10:14, 13 September 2013 (UTC)

FDA Approves Cologuard for Colorectal Cancer Screening
FDA Approves Cologuard for Colorectal Cancer Screening http://www.medscape.com/viewarticle/829757?src=wnl_edit_specol&uac=70451CR

Can Cologuard Improve Colon Cancer Screening Rates? http://www.medscape.com/viewarticle/830596?src=wnl_edit_specol&uac=70451CR

Wikipedia lacks an article on Colorectal cancer screening -- this article should be re-purposed as such
Wikipedia needs a separate article on

Colorectal cancer screening

The new article should replace and subsume this current article on no-longer-recommended fecal occult blood testing, which has not been updated to reflact current best practices for screening, as show in peer-reviewed studies indicating that fecal occult blood testing misses too many cancers.


 * FOBs are used for more than just colon cancer screening so no. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:08, 17 September 2014 (UTC)


 * Oh, right, e.g. anemia. However the use of Fobt for colon cancer screening should be expressly address that there are now better tests, and that in comparison fobt is second rate, both not sensitive enough (missed cancers) and not specific enough (alert on non-cancer, leading to unnecessary procedures).  A separate additional article should be added on Colorectal cancer screening while the Fobt article is appropriately confined in scope.
 * Yes iFOBT is preferred over gFOBT in some guidelines but their are other issues that will keep gFOBT in use for some time. Can you provide some refs and we can clarify? The 2012 ACP and 2008 USPSTF still recommends and they are the most recent by these two organizations. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 15:29, 17 September 2014 (UTC)


 * Definitely the section is bloating. Not sure another article is necessary.  Some of the information could fit better in the screening section of the colorectal cancer article.  ... PeterEasthope (talk) 17:28, 2 April 2017 (UTC)

FIT-iFOBT
Where is the FIT-iFOBT article to correspond to the gFOBT article?-71.174.175.150 (talk) 19:44, 14 November 2014 (UTC)

false neg / false pos
This is a tricky article to get right! It is ostensibly about Fecal Occult Blood tests, and yet in general the purpose of such tests, and the goals of most readers, has to do with colon cancer. On the one hand, the proper measure of an FOB test should be whether it reliably detects fecal blood, at various levels. And that should be the proper context for judging False Neg and False Pos rates, narrowly defined. But I think in the real world these tests are judged by colonoscopies and colon cancer correlations. Somehow the article should separate out these two different perspectives on the test accuracies?-71.174.175.150 (talk) 22:03, 14 November 2014 (UTC)

FIT test can better distinguish upper from lower GI bleeding, making it a more specific test
The FIT test looks at globulin instead of heme, and so the FIT test can better distinguish upper from lower GI bleeding, making it a more-specific test. Thus the FIT test might be a follow-up if an initial less-specific test revealed blood in the stool.
 * Refs would be useful to start with. Doc James  (talk · contribs · email) 09:24, 26 November 2014 (UTC)


 * ... InSure® FIT™ detects the globin portion of hHb, not the heme. Since globin does not survive passage through the upper gastrointestinal (g.i.) tract, the presence of globin in the stool indicates bleeding in the colon or rectum. ... http://www.insuretest.com/medical/performance.php


 * Please read WP:MEDRS regarding sources. Doc James  (talk · contribs · email) 18:39, 2 December 2014 (UTC)

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