A Comprehensive Analysis of Integrating Guaiac Fecal Occult Blood Test and Fecal Immunochemical Test for Colorectal Cancer Screening

Document Type : Review Article

Authors

1 Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 MD, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Nurse, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

5 Public Health Specialist, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

6 MD, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

7 MD, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Colorectal cancer (CRC) accounts for a significant share of cancer mortality globally, highlighting the critical importance of early detection through screening. Non-invasive methods such as fecal immunochemical tests (FIT) and guaiac-based fecal occult blood tests (gFOBT) are established to identify occult blood in stool specimens. Integrating FIT and gFOBT may improve diagnostic accuracy for CRC screening.
Methods: A comprehensive literature review was conducted across PubMed/MEDLINE, Scopus, and Google Scholar, utilizing targeted keywords to identify relevant human studies. The primary aim was to explore whether combining FIT and gFOBT could yield improved diagnostic performance and screening efficacy for CRC and adenomatous lesions.
Findings: A review of the literature revealed no studies explicitly assessing the integration of FIT and gFOBT compared to each test individually or to colonoscopy.  Nevertheless, several investigations assessing both modalities in comparable cohorts indicated that, despite the lower overall sensitivity of gFOBT, positive results from gFOBT can emerge even when FIT results are negative. The proposed integration of these tests holds the potential to enhance sensitivity, specificity, and cost-effectiveness in CRC screening.
Conclusion: Integrating FIT and gFOBT offers a promising approach to enhancing the effectiveness of CRC screening through complementary detection mechanisms, better management of intermittent bleeding patterns, and improved detection of proximal lesions. While this hypothesis presents several challenges and limitations, preliminary validation could be performed using existing data from previous studies. Further research is necessary to evaluate this integrative approach rigorously.

Highlights

Azar Baradaran: Google Scholar 

Behnoosh Mohammadi Jazi: Google Scholar

Keywords

Main Subjects

References

  1. Ladabaum U, Dominitz JA, Kahi C, Schoen RE. Strategies for Colorectal Cancer Screening. Gastroenterology 2020; 158(2): 418-32.
  2. Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Screening for Colorectal Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325(19): 1965-77.
  3. Doubeni CA, Jensen CD, Fedewa SA, Quinn VP, Zauber AG, Schottinger JE, et al. Fecal Immunochemical Test (FIT) for Colon Cancer Screening: Variable Performance with Ambient Temperature. J Am Board Fam Med 2016; 29(6): 672-81.
  4. Kaur K, Zubair M, Adamski JJ. Fecal occult blood test. Treasure Island (FL): StatPearls Publishing; 2023.
  5. Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal tract bleeding: performance differences in fecal occult blood tests. Mayo Clin Proc 2002; 77(1): 23-8.
  6. Tangka FKL, Subramanian S, Hoover S, Cariou C, Creighton B, Hobbs L, et al. Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska. Implement Sci Commun 2022; 3(1): 133.
  7. Maes-Carballo M, García-García M, Martín-Díaz M, Estrada-López CR, Iglesias-Álvarez A, Filigrana-Valle CM, et al. A comprehensive systematic review of colorectal cancer screening clinical practices guidelines and consensus statements. Br J Cancer 2023; 128(6): 946-57.
  8. Mousavinezhad M, Majdzadeh R, Akbari Sari A, Delavari A, Mohtasham F. The effectiveness of FOBT vs. FIT: A meta-analysis on colorectal cancer screening test. Med J Islam Repub Iran 2016; 30: 366.
  9. Shapiro JA, Bobo JK, Church TR, Rex DK, Chovnick G, Thompson TD, et al. A Comparison of Fecal Immunochemical and High-Sensitivity Guaiac Tests for Colorectal Cancer Screening. Am J Gastroenterol 2017; 112(11): 1728-35.
  10. Rabeneck L, Rumble RB, Thompson F, Mills M, Oleschuk C, Whibley A, et al. Fecal immunochemical tests compared with guaiac fecal occult blood tests for population-based colorectal cancer screening. Can J Gastroenterol 2012; 26(3): 131-47.
  11. Young GP, Symonds EL, Allison JE, Cole SR, Fraser CG, Halloran SP, et al. Advances in Fecal Occult Blood Tests: the FIT revolution. Dig Dis Sci 2015; 60(3): 609-22.
  12. Almeida-Lousada H, Mestre A, Ramalhete S, Price AJ, de Mello RA, Marreiros AD, et al. Screening for Colorectal Cancer Leading into a New Decade: The "Roaring '20s" for Epigenetic Biomarkers? Curr Oncol 2021; 28(6): 4874-93.
  13. Cheng WC, Chen PJ, Kang JW, Chen WY, Sheu BS. Age, male sex, smoking and metabolic syndrome as risk factors of advanced colorectal neoplasia for fecal immunochemical test negative patients. J Formos Med Assoc 2022; 121(1 Pt 2): 402-8.
  14. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM. American College of Gastroenterology guidelines for colorectal cancer screening 2008. Am J Gastroenterol 2009; 104(3): 739-50.
  15. Niedermaier T, Balavarca Y, Brenner H. Stage-specific sensitivity of fecal immunochemical tests for detecting colorectal cancer: systematic review and meta-analysis. Am J Gastroenterol 2020; 115(1): 56-69.
  16. Rockey DC, Auslander A, Greenberg PD. Detection of upper gastrointestinal blood with fecal occult blood tests. Am J Gastroenterol 1999; 94(2): 344-50.
  17. Niedermaier T, Tikk K, Gies A, Bieck S, Brenner H. Sensitivity of Fecal Immunochemical Test for Colorectal Cancer Detection Differs According to Stage and Location. Clin Gastroenterol Hepatol 2020; 18(13): 2920-8.e6.
  18. Levy BT, Bay C, Xu Y, Daly JM, Bergus G, Dunkelberg J, et al. Test characteristics of faecal immunochemical tests (FIT) compared with optical colonoscopy. J Med Screen 2014; 21(3): 133-43.
  19. Morikawa T, Kato J, Yamaji Y, Wada R, Mitsushima T, Shiratori Y. A comparison of the immunochemical fecal occult blood test and total colonoscopy in the asymptomatic population. Gastroenterology 2005; 129(2): 422-8.
  20. Guittet L, Bouvier V, Mariotte N, Vallee JP, Levillain R, Tichet J, et al. Comparison of a guaiac and an immunochemical faecal occult blood test for the detection of colonic lesions according to lesion type and location. Br J Cancer 2009; 100(8): 1230-5.
  21. Meseeha M, Attia M. Colon polyps. Treasure Island (FL): StatPearls Publishing; 2025.
  22. Ghomashi N, Safari F, Noursina A. Reducing the need for colonoscopy with adjusted FIT and FOBT for stool weight and serum Hb levels. Front Med (Lausanne) 2023; 10: 1274024.
  23. Katsoula A, Paschos P, Haidich AB, Tsapas A, Giouleme O. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis. JAMA Intern Med 2017; 177(8): 1110-8.
  24. Aniwan S, Ratanachu Ek T, Pongprasobchai S, Limsrivilai J, Praisontarangkul OA, Pisespongsa P, et al. The optimal cut-off level of the fecal immunochemical test for colorectal cancer screening in a country with limited colonoscopy resources: a multi-center study from Thailand. Asian Pac J Cancer Prev 2017; 18(2): 405-12.
  25. Lin JS, Perdue LA, Henrikson NB, Bean SI, Blasi PR. Screening for colorectal cancer: an evidence update for the US Preventive Services Task Force. Agency for Healthcare Research and Quality (US); 2021.
  26. Fenton JJ, Elmore JG, Buist DS, Reid RJ, Tancredi DJ, Baldwin LM. Longitudinal adherence with fecal occult blood test screening in community practice. Ann Fam Med 2010; 8(5): 397-401.
  27. Smith A, Young GP, Cole SR, Bampton P. Comparison of a brush-sampling fecal immunochemical test for hemoglobin with a sensitive guaiac-based fecal occult blood test in detection of colorectal neoplasia. Cancer 2006; 107(9): 2152-9.
  28. Graser A, Stieber P, Nagel D, Schäfer C, Horst D, Becker CR, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut 2009; 58(2): 241-8.
  29. Parra-Blanco A, Gimeno-García AZ, Quintero E, Nicolás D, Moreno SG, Jiménez A, et al. Diagnostic accuracy of immunochemical versus guaiac faecal occult blood tests for colorectal cancer screening. J Gastroenterol 2010; 45(7): 703-12.
  30. Guittet L, Bouvier V, Mariotte N, Vallee JP, Arsène D, Boutreux S, et al. Comparison of a guaiac based and an immunochemical faecal occult blood test in screening for colorectal cancer in a general average risk population. Gut 2007; 56(2): 210-4.
  31. Allison JE, Sakoda LC, Levin TR, Tucker JP, Tekawa IS, Cuff T, et al. Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst 2007; 99(19): 1462-70.
  32. Dancourt V, Lejeune C, Lepage C, Gailliard MC, Meny B, Faivre J. Immunochemical faecal occult blood tests are superior to guaiac-based tests for the detection of colorectal neoplasms. Eur J Cancer 2008; 44(15): 2254-8.
  33. Chan SCH, Liang JQ. Advances in tests for colorectal cancer screening and diagnosis. Expert Rev Mol Diagn 2022; 22(4): 449-60.
  34. Fisher DA, Princic N, Miller-Wilson LA, Wilson K, Limburg P. Healthcare costs of colorectal cancer screening and events following colonoscopy among commercially insured average-risk adults in the United States. Curr Med Res Opin 2022; 38(3): 427-34.
  35. Kim SY, Kim HS, Park HJ. Adverse events related to colonoscopy: Global trends and future challenges. World J Gastroenterol 2019; 25(2): 190-204.
  36. Shaukat A, Kahi CJ, Burke CA, Rabeneck L, Sauer BG, Rex DK. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol 2021;116(3):458-79.
  37. Schreuders EH, Grobbee EJ, Nieuwenburg SAV, Kapidzic A, van Roon AHC, van Vuuren AJ, et al. Multiple rounds of one sample versus two sample faecal immunochemical test-based colorectal cancer screening: a population-based study. Lancet Gastroenterol Hepatol 2019; 4(8): 622-31.
  38. Fisher DA, Karlitz JJ, Jeyakumar S, Smith N, Limburg P, Lieberman D, et al. Real-world cost-effectiveness of stool-based colorectal cancer screening in a Medicare population. J Med Econ 2021; 24(1): 654-64.
  39. Leufkens AM, Van Duijnhoven FJ, Siersema PD, Boshuizen HC, Vrieling A, Agudo A, et al. Cigarette smoking and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study. Clin Gastroenterol Hepatol 2011; 9(2): 137-44.
  40. Gram IT, Park SY, Wilkens LR, Haiman CA, Le Marchand L. Smoking-Related Risks of Colorectal Cancer by Anatomical Subsite and Sex. Am J Epidemiol 2020; 189(6): 543-53.
  41. Fagunwa IO, Loughrey MB, Coleman HG. Alcohol, smoking and the risk of premalignant and malignant colorectal neoplasms. Best Pract Res Clin Gastroenterol 2017; 31(5): 561-8.
  42. Abancens M, Bustos V, Harvey H, McBryan J, Harvey BJ. Sexual Dimorphism in Colon Cancer. Front Oncol 2020; 10: 607909.
Journal of Isfahan Medical School
Volume 43, Issue 814
2nd Week, July
July and August 2025
Pages 495-502

Files

History

  • Receive Date: 20 January 2025
  • Accept Date: 16 August 2025

Share

How to cite

Statistics