Faecal occult blood testing: a review of its use and common misutilisation

Abstract

Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide, with early detection being crucial for improving patient outcomes. While colonoscopy is the gold standard for CRC screening, stool-based tests such as guaiac-based faecal occult blood test and faecal immunochemical test offer non-invasive and cost-effective alternatives. These tests have proven value in the outpatient screening of asymptomatic, average-risk individuals; however, their frequent misuse in inpatient settings limits their diagnostic accuracy and utility. Inappropriate use of faecal occult blood tests (FOBTs) in hospitalised patients often results in false-positive or false-negative findings, leading to unnecessary diagnostic procedures, delayed treatment, increased healthcare costs and potential patient harm. Addressing this issue requires promoting adherence to guideline-based use of FOBT, alongside targeted provider education to reduce misuse, improve diagnostic precision and optimise patient care.