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The extent to which screening procedures reduce the incidence of gastrointestinal cancer or mortality depends on the rate of precancerous and cancerous disease in that population.
Two other recent guidelines, from the US Multisociety Task Force (MSTF) and the US Preventive Services Task Force (USPSTF) while permitting immediate colonoscopy as an option, did not categorize it as preferred.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).A related concept to colon cancer screening by FOBT, based on most neoplasms affecting the surface epithelium and losing small amounts of blood but no visible blood loss, is screening in populations at high risk for esophageal or gastric cancers by testing for blood by swallowing a small capsule that is recovered after 3 to 5 minutes by gentle retrieval by means of an attached nylon thread.Strenuous exercise, particularly in elite athlete runners and less frequently in other exercise activities, can cause acute incapacitating gastrointestinal symptoms including heartburn, nausea, vomiting, abdominal pain, diarrhea and gastrointestinal bleeding.Gradually government fund disbursement meant that some people are not yet eligible for the national program and should pay for a FOBT by themselves.
An extensive literature has examined the clinical value of FOBT in iron deficiency anemia.
MSTF looked at six studies that compared high sensitivity g FOBT (Hemoccult SENSA) to FIT, and concluded that there were no clear difference in overall performance between these methods.
The American College of Gastroenterology has recommended the abandoning of g FOBT testing as a colorectal cancer screening tool, in favor of the fecal immunochemical test.
These look at different properties, such as antibodies, heme, globin, or porphyrins in blood, or at DNA from cellular material such as from lesions of the intestinal mucosa.
The number of fecal samples submitted for FIT may affect the clinical sensitivity and specificity of the methodology. High sensitivity g FOBT tests such as Hemoccult SENSA remains an accepted option; and may retain a role in monitoring gastrointestinal conditions such as ulcerative colitis; 100 ml in the duodenum, and lesser amounts in the lower intestine. Fecal Immunochemical Testing (FIT) picks up as little as 0.3 ml of blood in the stool; yet this test threshold doesn't cause undue false positives from normal upper intestinal blood leakage because it does not detect occult blood from the stomach and upper small intestine.
If colon cancer is suspected in an individual (such as in someone with an unexplained anemia) fecal occult blood tests may not be clinically helpful.