Faecal Occult Blood Test

What is a faecal occult blood test?

The faecal occult blood test (FOB test) detects small amounts of blood in your faeces which you would not normally see or be aware of. (Faeces are sometimes called stools or motions. It is the waste that you pass out from your anus. Occult means 'unseen' or 'invisible'.)

Why is the test done?

There are several disorders which may cause bleeding into the guts (intestines). For example: ulcers, colitis, polyps, and colorectal (bowel) cancer. If these bleed heavily then your faeces would be obviously 'bloody' or a very black colour. However, sometimes these disorders only bleed with a trickle of blood. If you only have a small amount of blood in your faeces then the faeces look normal. However, the FOB test will detect the blood. So, the test may be done if you have symptoms in the abdomen such as persistent pain. It may also be done to screen for bowel cancer before any symptoms develop (see below).

Note: the FOB test can only say that you are bleeding from somewhere in the gut. It cannot tell from which part. If the test is positive then further tests will usually be arranged to find the source of the bleeding. For example, endoscopy, colonoscopy, various scans, etc.

How is the faecal occult blood test done?

A small sample of faeces is smeared on to a piece of card. You obtain a sample by using a small scraper to scrape some faeces off toilet tissue which you have just used after going to the toilet. A chemical is added to the sample on the card. If there is a change in colour after adding the chemical, it indicates that some blood is present.

A doctor may do this test in the GP surgery, or send a sample to the 'lab' for testing. Also, if required, there are test kits that you can get at pharmacies which enable you to do the test at home. Some people are issued with test kits to do testing at home.

Sometimes two or three FOB tests are done on two or three separate samples of faeces, obtained on different days. This is because a bleeding disorder of the gut may only bleed 'now and then'. So, not every sample may contain blood. A series of two or three samples done on several days may be more accurate in detecting a bleeding gut disorder.

Screening for bowel cancer

Screening means looking for early signs of a particular disease in otherwise healthy people who do not have any symptoms and when treatment is likely to be curative. Colorectal cancer (bowel cancer) screening aims to detect colorectal cancer at an early stage when there is a good chance that treatment will cure the cancer.

As colorectal cancer is much more common in older people, the decision has been made for people of a certain age to be invited to participate in the colorectal cancer screening programme. This involves testing three samples of your faeces (stools or motions) for blood. The NHS Bowel Cancer Screening Programme has been introduced in the UK as follows:

• In England, people aged 60 to 69 will be routinely offered screening every two years. If you are aged 70 or over and screening has started in your area, you can phone the freephone helpline on 0800 707 60 60 to request the kit, if you would like to have screening. From 2010, screening will be extended to cover people up to age 75 as standard.
• In Scotland, people aged 50 to 74 will be offered screening every two years.
• In Wales, people aged 60 to 69 will be offered screening every two years. From 2010, the screening programme will be extended to cover people aged up to 74. By 2015 it will be open to everyone who lives in Wales between the ages of 50 and 74.
• In Northern Ireland, the age range for screening is still to be confirmed.

If you are in the relevant age groups you will automatically be sent an invitation, then your faecal occult blood (FOB) screening kit, so you can do the test at home. After your first screening test, you will then be sent another invitation and screening kit every two years until you reach the maximum age. You can then request further kits if you would like to continue to be included in the screening programme.

See separate leaflet called 'Screening for Colorectal (Bowel) Cancer' for more detail.

Further help and information

The NHS Bowel Cancer Screening Programme

England - Helpline: 0800 707 6060 Web: www.cancerscreening.nhs.uk/bowel/index.html
Scotland - Helpline: 0800 012 1833 Web: www.bowelscreening.scot.nhs.uk
Wales - Helpline: 0800 294 3370 Web: www.wales.nhs.uk/sites3/home.cfm?orgid=747
Northern Ireland - watch out for news at www.cancerni.net