Division of Surgery, School of Graduate Entry Medicine & Health, Royal Derby Hospital, University of Nottingham, Derby, UK.
Eur J Gastroenterol Hepatol. 2012 Nov;24(11):1270-5. doi: 10.1097/MEG.0b013e328357cd9e.
The faecal occult blood test (FOBT) is the screening test validated for use in the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP) after trials demonstrated a 16% reduction in colorectal cancer-specific mortality. FOBT is not validated for use outside the BCSP. The aim was to investigate the number of FOBTs performed outside of the NHS BCSP at a single centre.
All FOBTs performed over 1 year were identified. Basic patient demographics, requesting physician and FOBT results were obtained. Referrals and outcomes of the investigation following the FOBT were collected.
A total of 758 FOBTs were requested in 701 patients (352 female; median age 69; range 16-99). The majority (91%) were requested by general practitioners. A total of 515 out of 758 tests (68%) were performed in patients outside the NHS BCSP age range. Thirty-seven out of 86 positive FOBTs were investigated, diagnosing four rectal cancers and two polyps. Forty-nine out of 87 patients with a positive FOBT were not investigated further by the requesting physician or the test repeated. Of the remaining 672 FOBTs, 615 were negative and 57 were either incomplete or unsuitable for analysis. A total of 111 patients (18%) were referred to hospital and 105 of these had FOBT performed as part of the referral process.
Our study demonstrates significant misuse of the FOBT outside the NHS BCSP. Inappropriate use leads to false positives and exposes patients to unnecessary risk. False negatives provide reassurance to patients who may have symptoms that should be investigated. The FOBT should not be available to physicians in either primary or secondary care and be restricted to NHS BCSP.
粪便潜血试验（FOBT）是在临床试验证明可降低 16%结直肠癌特异性死亡率后，经验证可用于国民保健服务（NHS）结直肠癌筛查计划（BCSP）的筛查试验。FOBT 未经验证可用于 BCSP 之外的用途。目的是调查在单一中心进行的 NHS BCSP 之外的 FOBT 数量。
确定在一年内进行的所有 FOBT。获取基本的患者人口统计学资料、请求医生和 FOBT 结果。收集 FOBT 后的转诊和调查结果。
在 701 名患者（352 名女性；中位年龄 69 岁；范围 16-99 岁）中，共请求了 758 次 FOBT。大多数（91%）是由全科医生请求的。在 NHS BCSP 年龄范围之外，共进行了 758 次测试中的 515 次（68%）。86 次阳性 FOBT 中有 37 次进行了调查，诊断出 4 例直肠癌和 2 例息肉。87 例阳性 FOBT 患者中有 49 例未由请求医生进一步调查或重复测试。在其余的 672 次 FOBT 中，615 次为阴性，57 次为不完整或不适合分析。共有 111 名患者（18%）被转至医院，其中 105 名患者在转诊过程中进行了 FOBT。
我们的研究表明，FOBT 在 NHS BCSP 之外被大量滥用。不当使用会导致假阳性，并使患者面临不必要的风险。假阴性会使有症状的患者感到安心，而这些症状应该进行调查。FOBT 不应提供给初级或二级保健医生，并应限于 NHS BCSP。
