+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know

Faecal immunochemical tests versus guaiac faecal occult blood tests: what clinicians and colorectal cancer screening programme organisers need to know

Gut 64(8): 1327-1337

Although colorectal cancer (CRC) is a common cause of cancer-related death, it is fortunately amenable to screening with faecal tests for occult blood and endoscopic tests. Despite the evidence for the efficacy of guaiac-based faecal occult blood tests (gFOBT), they have not been popular with primary care providers in many jurisdictions, in part because of poor sensitivity for advanced colorectal neoplasms (advanced adenomas and CRC). In order to address this issue, high sensitivity gFOBT have been recommended, however, these tests are limited by a reduction in specificity compared with the traditional gFOBT. Where colonoscopy is available, some providers have opted to recommend screening colonoscopy to their patients instead of faecal testing, as they believe it to be a better test. Newer methods for detecting occult human blood in faeces have been developed. These tests, called faecal immunochemical tests (FIT), are immunoassays specific for human haemoglobin. FIT hold considerable promise over the traditional guaiac methods including improved analytical and clinical sensitivity for CRC, better detection of advanced adenomas, and greater screenee participation. In addition, the quantitative FIT are more flexible than gFOBT as a numerical result is reported, allowing customisation of the positivity threshold. When compared with endoscopy, FIT are less sensitive for the detection of advanced colorectal neoplasms when only one time testing is applied to a screening population; however, this is offset by improved participation in a programme of annual or biennial screens and a better safety profile. This review will describe how gFOBT and FIT work and will present the evidence that supports the use of FIT over gFOBT, including the cost-effectiveness of FIT relative to gFOBT. Finally, specific issues related to FIT implementation will be discussed, particularly with respect to organised CRC screening programmes.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 057861787

Download citation: RISBibTeXText

PMID: 26041750

DOI: 10.1136/gutjnl-2014-308074

Related references

M1013 a Cost-Effectiveness Analysis in Colorectal Cancer Screening Comparing Immunochemical Faecal Occult Blood Tests with Guaiac Faecal Occult Blood Tests and No Screening. Gastroenterology 136(5): A-331, 2009

Immunochemical vs guaiac faecal occult blood tests in a population-based screening programme for colorectal cancer. British Journal of Cancer 74(1): 141-144, 1996

Diagnostic accuracy of immunochemical versus guaiac faecal occult blood tests for colorectal cancer screening. Journal of Gastroenterology 45(7): 703-712, 2010

Guaiac versus immunochemical tests: faecal occult blood test screening for colorectal cancer in a rural community. Australian and new Zealand Journal of Public Health 29(4): 358-364, 2005

Guaiac and immunochemical tests for faecal occult blood in colorectal cancer screening. British Journal of Cancer 65(6): 942-944, 1992

Comparison between a guaiac and three immunochemical faecal occult blood tests in screening for colorectal cancer. European Journal of Cancer 48(16): 2969-2976, 2012

Comparative analysis of results of guaiac and immunochemical tests for faecal occult blood in colorectal cancer screening in two oncological institutions. European Journal of Cancer Prevention 3(5): 399-405, 1994

Immunochemical faecal occult blood tests are superior to guaiac-based tests for the detection of colorectal neoplasms. European Journal of Cancer 44(15): 2254-2258, 2008

Positivity rates and performances of immunochemical faecal occult blood tests at different cut-off levels within a colorectal cancer screening programme. Digestive and Liver Disease 44(8): 700-704, 2012

Implementation of Failure Mode and Effects Analysis to the specimens flow in a population-based colorectal cancer screening programme using immunochemical faecal occult blood tests: a quality improvement project in the Milan colorectal cancer screening programme. Bmj Open Quality 7(1): E000299, 2018

Immunochemical testing of individuals positive for guaiac faecal occult blood test in a screening programme for colorectal cancer: an observational study. Lancet. Oncology 7(2): 127-131, 2006

Cost analysis in a population based screening programme for colorectal cancer: comparison of immunochemical and guaiac faecal occult blood testing. Journal of Medical Screening 4(3): 142-146, 1997

Population screening for colorectal cancer: comparison between guaiac and immunological faecal occult blood tests. British Journal of Surgery 81(3): 448-451, 1994

Superior diagnostic performance of faecal immunochemical tests for haemoglobin in a head-to-head comparison with guaiac based faecal occult blood test among 2235 participants of screening colonoscopy. European Journal of Cancer 49(14): 3049-3054, 2013

Cost-effectiveness of the faecal immunochemical test at a range of positivity thresholds compared with the guaiac faecal occult blood test in the NHS Bowel Cancer Screening Programme in England. Bmj Open 7(10): E017186, 2017