Fecal hemoglobin concentration: more than just a screening tool

The fecal occult blood test (FOBT) is used as standard for screening colorectal carcinoma. But even a below benchmark result has clinical relevance.

Key take-aways

Do not be fixated on the cut-off value

FOBTs are considered positive above a certain cut-off value. As a rule, only people whose test is above the cut-off are referred to colonoscopy. A Dutch study with over 260,000 participants has now investigated whether negative results - i.e. those that did not reach the cut-off value - could also have a prognostic relevance.

Carcinoma after negative tests

The study included people who had had two FOBTs two years apart that had turned out negative. After a retest, 3.3% of the participants had a positive result above the cut-off value. Over the course of the study, 1.2% of the study population were diagnosed with advanced adenoma, and 0.2% with colorectal carcinoma.

The higher the haemoglobin level, the higher the risk

The researchers found that the level of haemoglobin in the stool sample was associated with the risk of carcinoma. Thus, those whose result was higher in the first two (negative) samples had a significantly higher risk of developing malignancy. Therefore, the probability of cancer was highest in the group with just below the cut-off mark.

Conclusion for medical practice

The study results impressively show that the fecal occult blood test has clinical relevance even below the threshold value. The level of haemoglobin correlates with the risk of carcinoma.

  1. Meester R, van de Schootbrugge-Vandermeer H, et al.: Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model. Gut 2023; 72: 101–8.
  2. Screening auf kolorektale Karzinome: Hämoglobin in den Fäzes ist quantitativ mit Risiko für kolorektale Tumore assoziiert. Dtsch Arztebl 2023; 120(4): A-147 / B-129Gerste, Ronald D.