Inappropriate use of the faecal occult blood test outside of the National Health Service colorectal cancer screening programme.

Objective The faecal occult blood test (FOBT) is thescreening test validated for use in the National HealthService (NHS) Bowel Cancer Screening Programme(BCSP) after trials demonstrated a 16% reduction incolorectal cancer-specific mortality. FOBT is not validatedfor use outside the BCSP. The aim was to investigate thenumber of FOBTs performed outside of the NHS BCSP ata single centre.Methods All FOBTs performed over 1 year were identified.Basic patient demographics, requesting physician andFOBTresults were obtained. Referrals and outcomes of theinvestigation following the FOBT were collected.Results A total of 758 FOBTs were requested in 701patients (352 female; median age 69; range 16–99). Themajority (91%) were requested by general practitioners.A total of 515 out of 758 tests (68%) were performed inpatients outside the NHS BCSP age range. Thirty-sevenout of 86 positive FOBTs were investigated, diagnosingfour rectal cancers and two polyps. Forty-nine out of 87patients with a positive FOBTwere not investigated furtherby the requesting physician or the test repeated. Of theremaining 672 FOBTs, 615 were negative and 57 wereeither incomplete or unsuitable for analysis. A total of 111patients (18%) were referred to hospital and 105 of thesehad FOBT performed as part of the referral process.Conclusion Our study demonstrates significant misuse ofthe FOBT outside the NHS BCSP. Inappropriate use leadsto false positives and exposes patients to unnecessaryrisk. False negatives provide reassurance to patients whomay have symptoms that should be investigated. TheFOBT should not be available to physicians in eitherprimary or secondary care and be restricted to NHSBCSP. Eur J Gastroenterol Hepatol 00:000–000