More on Fecal Occult Blood Test Misuse

Abstract

The current issue of the Journal includes a study by Narula et al (1) (pages 421–426) that nicely demonstrates the numerous reasons why fecal occult blood test (FOBT) use outside of screening purposes should be considered inappropriate and how it may, in fact, negatively impact patient care. The authors performed a chart review of all FOBTs ordered in Hamilton Health Sciences’ (Hamilton, Ontario) acute care campuses over a three-month period in 2011, combined with a survey of health care providers on their practices regarding the use of FOBT. Use of point-of-care FOBT was not included. The clinical presentations were anemia, overt or suspected gastrointestinal (GI) bleeding, diarrhea, iron deficiency and dyspepsia. Thirty-four percent of patients underwent ≥2 FOBTs, and the majority of tested patients were either on medications or on a diet that could interfere with the test. Only 50% of the FOBT positives were ever referred for a GI consultation and, most importantly, 27% of patients presenting with overt GI bleeding in whom an FOBT was ordered experienced a delay in the GI referral because of the FOBT process. The survey included 67 health care professionals (mainly primary care physicians and nurses); the most common reasons for ordering an FOBT were: symptoms potentially consistent with GI bleeding (84%); anemia (53%); iron deficiency with or without anemia (31%); overt GI blood loss (26%); and nonbloody diarrhea (10%). Interestingly, screening for colorectal cancer was a cited reason in only 25% of the cases.