At what age should Fecal Occult Blood Testing (FOBT) be stopped?

When to Stop Fecal Occult Blood Testing (FOBT)

FOBT screening should be discontinued at age 75 for average-risk individuals who have had regular screening with normal results. 1

Age-Based Recommendations for FOBT Discontinuation

• FOBT screening should begin at age 50 for average-risk individuals and continue until age 75 1
• There is no specific upper age limit mentioned in most guidelines, but the decision to discontinue should be based on:
  • Patient's overall health status and life expectancy 1
  • Prior screening history 1
  • Potential benefits versus harms of continued screening 1

Factors to Consider When Deciding to Stop FOBT

• Age over 75 years: The benefit-to-harm ratio decreases significantly after age 75 1
• Limited life expectancy: Individuals with less than 10-year life expectancy are unlikely to benefit from continued screening 1
• Prior normal screening results: Consistent negative results over previous screenings reduce the likelihood of developing colorectal cancer 1
• Comorbidities: Significant comorbidities that increase procedural risks or limit life expectancy should prompt consideration of discontinuation 1

Pitfalls in FOBT Screening to Avoid

• Single-sample digital rectal examination FOBT: This approach has very poor sensitivity (4.9% vs 23.9% for the standard 6-sample at-home test) and should never be used as a screening method 2
• Inappropriate use in hospitalized or symptomatic patients: FOBT is designed as a screening tool for asymptomatic individuals, not as a diagnostic test for those with symptoms 3
• Failure to follow proper collection techniques: Patient adherence to manufacturer's instructions for specimen collection is essential for accurate results 1, 4
• Ignoring medication and dietary restrictions: Certain medications and foods can cause false-positive results if not restricted before testing 3

Benefits of Proper FOBT Implementation

• Regular FOBT screening reduces colorectal cancer mortality by 13-16% when performed correctly 4
• Individuals who refuse FOBT screening have significantly higher colorectal cancer incidence and mortality rates compared to those who accept testing 5
• When performed correctly, FOBT can have effectiveness similar to colonoscopy in reducing the risk of developing and dying from colorectal cancer 1

Types of FOBT and Their Characteristics

• Guaiac FOBT (gFOBT): Traditional test with lower sensitivity (13-25%) for colorectal cancer detection 4
• Immunochemical FOBT (iFOBT/FIT): Newer test with higher sensitivity (approximately 81%) and better patient acceptance 4
• High-sensitivity gFOBT (e.g., Hemoccult SENSA) should be used instead of older, lower-sensitivity versions (e.g., Hemoccult II) 1

Remember that any screening is better than none, but proper implementation according to guidelines is essential for maximizing benefits while minimizing potential harms 6.