What are fecal occult blood tests?

Fecal occult blood tests are special chemical tests performed on the stool samples to detect the presence of "occult blood." These tests are usually begun at age 40 and then performed annually, accompanied by a digital rectal examination by a doctor. Fecal occult blood tests are based on the observation that slow bleeding from colon polyps or cancers can cause chronic blood loss from the colon (sometimes causing iron deficiency anemia ). Such bleeding are often not visible (occult) to the naked eye. Therefore, sensitive chemical tests are developed to detect blood traces in stool.

How are fecal occult blood tests performed?

The testing consists of checking for chemical traces of blood in 3 stool specimens, collected on special cards by the individuals at home. To properly prepare for this examination, individuals are asked to abstain (for 3-5 days before stool collection) from certain foods, medications and vitamins that can interfere with the accuracy of occult blood testing. They include certain meats, vitamins (especially vitamin C), iron, aspirin, and other antiinflammatory medicines or NSAIDs (medications, such as ibuprofen , used in treating arthritis and other painful inflammatory conditions).

An individual whose stool specimen tests positive for blood then undergoes a colonoscopy examination of the entire colon to exclude colon polyps, cancers, or other bleeding abnormalities (such as abnormal blood vessels and colitis). The majority (greater than 90%) of the polyps detected can be removed painlessly and safely during the Colonoscopy examination. Polyps so removed are later examined by a pathologist under the microscope. Individuals with pre-cancerous polyps have higher than average risk of colon cancer, and are advised to return for periodic surveillance colonoscopies (see below). Colon cancers so detected are usually removed surgically, especially if the cancer has not already spread to other parts of the body. Pre-cancerous polyps that are too large or technically not possible to remove during colonoscopy are usually also removed surgically. Several studies have shown that fecal occult blood testing can reduce death rates (mortality) from colorectal cancer by 30-40%.

If no colon abnormalities are found in an individual whose stool is positive for occult blood, considerations are then given to examining the stomach and the small intestines for sources of blood loss.

For additional information, please visit MedicineNet.com's Colon Cancer Screening area.

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