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CA: A Cancer Journal for Clinicians, Vol 34, 148-157, Copyright © 1984 by American Cancer Society

Diagnostic Approach to Evaluating the Cause of a Positive Fecal Occult Blood Test

¹ Associate Professor of Clinical Medicine at Baylor College of Medicine in Houston, Texas.
² Director of the Gastroenterology Unit of Concord General Hospital in Australia.
³ Professor and Head of the Division of Gastroenterology of McMaster University in Hamilton, Ontario, Canada.

The factors considered most significant in the development of these guidelines and the algorithm illustrated in the figure include:

The greater than 90 percent probability that an abnormal concentration of blood is present when analysis of a fecal specimen is positive when tested with a defined sensitivity peroxidase method under prescribed conditions.

The relative specificity of guaiac slide tests of limited sensitivity for lower GI bleeding.

The clinical importance of diagnosing colorectal neoplasia while it is asymptomatic.

The limited clinical importance of diagnosing many other conditions that do not appear to be clinically affected by early diagnosis while asymptomatic.

A 40 percent to 45 percent predictive value for neoplasia when diagnostic procedures are used to examine the large bowel following a positive FOBT.

The difficulties in examining the rectosigmoid.

The high incidence of multiple synchronous lesions involving the large bowel.

The superior diagnostic capability of colonoscopy.

The therapeutic potential of colonoscopy.

It is only relatively recently that colonoscopy and air-contrast barium studies have been introduced into clinical practice. Physicians and other providers of health care are eager to identify definitive approaches to clinical problems that, ironically, could be examined with a high degree of accuracy only in the past 10 to 15 years. Ongoing clinical studies of FOBT results, a national cooperative polyp study, and related investigations should provide important information that will help refine clinical strategies in our quest to control colorectal cancer.

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