Fecal Occult Blood Test (FOBt) Survey

Interesting idea - but I would need to know who you are, what your commercial interest is, etc, before answering.

In principle, anything at all that encourages people to do their own (controlled!)(eg, no previous red meat, brocoli, nosebleeds etc!) FOB has to be good. FOB testing should, I'd have thought (posssibly naievely!) be something that everyone should do routinely, at whatever regular intervals necessary to detect CRC early enough for successful treatment.

But when you take an FOB, you also have to undertand its (quite significant) diagnostic limitations as well, so that needs to be taken into account.

Actually, despite your research, I can't see why it's such a big deal taking an FOB - you catch some in the toilet paper, scoop out enough with the mini-trowel, bung it into the collecting tube, seal it up and bingo. Then wash your hands really, really, REALLY well! What's the problem with that??

I like the idea of an 'instant scan' telling you the result (and it really can only say 'Blood' or 'No blood' - nothing else - it's not within the scope of an FOC to give smiley/unsmiley faces, because of the diagnostic limitations!), but it would have to have clear reliability guidelines - false reassurance is worse than no test at all! Waiting six weeks for results (I assume this is DIY 'home screening' via a commercial company) may sound a long time, but if the screening is just 'regular' (ie, you do it once a year 'on the safe side' or whatever) then I daresay that won't matter???

Julie

Found out that "Occult" in this context means "hidden". The cancer sites I looked out mentioned these home-testing kits, but did warn that it is possible for blood NOT to appear one day (ie could be the day you test) and then be present the next. However, any tests that can be done at home are I suppose quite useful, especially if people feel embarrassed opening this subject with their GP.

I read whilst looking this up, that a trial of mass screening for bowel cancer for people aged in their 60s is taking place in Warwickshire at the moment. The health authorities are trying to see if this does help catch people suffering from bowel cancer at a much earlier stage. If so, hopefully they will extend this throughout the country.

Penny. PS Julie I think you are right to say "Who are you?", as the What Now Site did make it quite clear that companies or individuals with a vested interest in selling or promoting any product had to be upfront with full details of who/what/why. We all have to be carefull opening up links.

I should say that no, I detected no blood loss in faeces, but the loss was identified in the much easier routine Haemoglobin blood test done at the Blood donor centre. After the droplet failed to sink in the copper sulphate solution, the Blood service carried out a couple more tests and notified me of a reduced Haemoglobin level. It has to be 12.5, and mine was only 10. My doctor would have sent me for tests long before he did, had I permitted him, and I lost 2 stone and my Hb went down to 7 before I agreed to go for tests. My cancer was I think no worse than Stage II, and was Dukes C, still within the bowel wall. (I think when it was first diagnosed it was Dukes B, but gained some ground in the 6 weeks before the op. The bigger it got, the stronger and faster. Excellent surgeon)

In the Blood service's Spring 2007 newsletter, a similar story was published and this made me think it was worth investigating. Of course only blood donors could benefit by this, but perhaps the Service should be more proactive in referring rejected Hb donors to their GPs. Also, being a blood donor is a privilege, and I can't wait to go back. I didn't have any infused blood during the op, so I can.

Dear Ruth

Well, I think your DX story certainly shows that you were rewarded for doing good! ie, that giving blood actually gave you a vital early warning sign that all was not well in the innards.

Maybe that's something the Blood Donation Service should emphasise - that you actually get some health benefit YOURSELF directly, from giving blood (not just add to the pool that you can draw from if you need it.)

Personally, I always get a bit cross about blood donation in this country - they just don't make it easy enough! I always moan and grumble because where I live, they tend to hold the sessions in schools during holidays and half terms, because the school hall is nice and big, BUT that is so very often at a useless time for parents as guess what folks, during school hols and half terms an AWFUL lot of parents are just not around then to give blood! I really had to work hard to find a local venue that was NOT in a school, but in a local hall. (Mind you, the service has a good point when they say it can cost a lot more to hire a non-school premise.)(and it certainly isn't as though the school hall is empty of donors, either, so it obviously works very well for many people!)

Also, full marks to the service for operating 'our of hours' so to speak so people can turn up after work and so on.

But I do wish there were more mini-mobile donation units touring company/industrial estate and supermarket carparks, which, to me, seems the ideal venue (and for all sorts of other 'on the spot' health checks/screens)(you could take a ticket to get a place in the queue - like in busy shops - go and do your supermarket shopping, then go and get the check done). Over and over again, as all retailers etc know, if you make it EASY for people to fit in these 'extras' into their normal routines, you get SO much better a response rate. The moment someone has to do something 'different' like go somewhere else, then the response rate really drops off - you lose all the 'impulse purchasers' and all the people who have busy, highly-shceduled lives with little time-slack in them, plus you just hit the inertia 'oh, I'll do it someday' wall.

But, then again, maybe I'm talking through my hat (quite a frequent event with me!!!), and such mini-mobile units simply can't work for very good reasons that I haven't thought of!

But, back to CRC FOB tests! (I love the word 'occult' - makes me think of magic!)(and it WOULD be pretty magical to be free of the fear of one kind of killer cancer at any rate, by any measure, no?)

Yes, I think the government is (finally?!) wheeling out routine FOB tests for the over 60s, but since CRC is 'on warning' from 50 onwards, (like so many cancers, it seems)(though, of course, that sets a whole different 'risk' scenario for people who do get such cancers 'early' as the docs can so often say 'oh, you're far too young for it to be cancer)(this happened to one mum I know with CRC - took ages to DX for that reason).....I'd say you really need to start the FOB checks on your half century, if not earlier.

They are NOT 100% reliable though, I know, and can give false positives and false negatives - like the point made about some days the cancer doesn't bleed and some days it does .....! - but nevertheless at least they are a start.

The good thing about an FOB is that unlike the body scans, they really don't cost much to have done privately - a simple "FOB test" search on the net shows up quite a few - the first one I've just looked at is on a special offer, too - reduced from £26 to £20! How cheap is that to save your life maybe??????

As for the haemoglobin test, well, again, the internet seems full of companies that will either do it for you or sell you a kit for about £20, which shouldn't break the bank of most people?

Of course, there is the overall question of general reliability of such home testing - the very worst scenario would be that you rely overly on them, get an 'all clear' and then don't bother the doc with anything but don't realise that the 'all clear' wasn't 100%. I guess the thing to do is, if you do want to use the DIY tests, that you tell your doctor you've done so, and they can then assess whether they think the results were valid/worrying/clear, etc. ?

Mind you, I guess in principle I'd like to see docs routinely running 'health MOTs' on ALL patients at ALL ages, regularly, (again, at whatever intervals med science deems necessary to be sure of catching anything 'nasty' going on early enough!) because I just think that in the long run, even on the sheer hard cash economics (let alone the human cost!)that preventative health care ends up being SO much cheaper than curative health care. BUT shifting to that model requires a lot of initial cash to fund both 'streams' - ie, preventative and curative, until the former 'overtakes' the latter and the cost of curative care plummets (because it won't be needed any more except for things like broken legs!!!)(and legs broken NOT from fracturing bone lesions!!!!!)

Oh dear, I've rambled again. Sorry. I shall go and do something useful like put the washing on!

Julie.

Chinese medical services worked on the basis that you paid your doctor to keep you well. We are working towards that, but there are all those sick people who need healing. That was the theory of it, but no doubt, Chinese doctors had to work with sick people too.

Happy Monday

Ruth

Hi, thanks for your comments so far, I had tried to keep the posting brief, but possibly I was too brief! I’ll try an answer your questions.

•Who are we? We are a small company based in Scotland (Wireless Biodevices) and are interested in developing a quick, easy to use, ‘less mess’ FOB system.

•The purpose of the survey is to get people’s feedback on our ideas for a better user experience. I’ll emphasise that any information provided in the survey is confidential and is used solely for the purpose of research. We are not currently trying to sell or promote anything; this is why I originally left off company details in case it was interpreted in this way.

•From our research it has become apparent that people do not like to perform a test where they are in close proximity to their ‘sample’.

•Screening: The NHS is slowly rolling out a screening programme in locations around the UK, 50+ are screened in Scotland but 60+ for England and Wales. As was pointed out by Julie 90% of cancers are found in 50+ this leaves a good portion of the ‘at risk’ population unscreened unless they actively seek a test. From a previous survey of 200 people in 4 major UK cities, only 20% had ever tried a test which is quite a low number for the 3rd most common cancer in the UK. In producing a user friendly device we hope to increase this.

•Important Note: This device is not trying to replace a visit to the GP by anyone concerned.

Thanks for looking, please keep the comments coming.

Thank you for your post plotting us in. So far as I'm concerned, speaking entirely personally, I don't mind companies such as yourselves in the cancer screening market - in fact, I'm extremely glad your'e there! For all the reasons I've droned on about (extensively and repetitively!) I think as a whole society MUST move towards a norm of preventative medicine, of which routine and regular cancer screening (and all other screening as well) is a fundamental principle.

Whilst I appreciate the flaws and degree of unreliability of existing screening tests (and maybe there will NEVER be a 'flawless' method of screening - as we in Cancerworld know, even trained oncology radiologists can still 'miss stuff' or find it difficult or ambiguous to interpret scans etc), neverthless they are, basically 'a start' when it comes to preventing people developing diseases which are curable (or far more so) the earlier they are diagnosed.

Although, for that reason, I'm happy enough to do your survey (I did read it through, as you can probably tell from my earlier comments about smiley faces etc!), I have to say I'm not bothered by existing methods. I appreciate that some people may indeed be squeamish about getting up front and personal with their faecal effluence (!) but let me put it this way - it's a lot less nasty than having cancer.....!!!!!

(I'm constantly appalled and horrified whenever I hear about people not bothering to turn up for their breast cancer screening, or droning on about 'being frightened' by screening tests...)(You want fear? Try sitting in front of your GP when they say the word 'Malignant' to you, with an expression on their face that says they would give anything rather than say that word...THAT'S FEAR!!!!!)( But then, I guess so many people just don't want to think about cancer and so don't protect themselves adequately - I admit freely I never thought about it until I became middle-aged and realised oh boy, this body ain't gonna last for ever like I thought it would when I was 20, and started getting seriously health-conscious/aware)(an attitude which means that if I HAD got cancer in my youth, as tragically, so many do, I would have been absolutely mentally unprepared for it, which I suspect is pretty commonplace alas)

Still, in practice, anything that gets people to do the bowel screening DIY test - including your scheme for keeping the faecal effluence at a distance! - has to be a good thing. I do like the idea of an 'instant result' but would repeat that it really can and should ONLY say 'blood' or 'no blood' because that IS all the test can show. It cannot say whether you do/do not have cancer/polyps/colonitis/haemorrhods/prior nosebleed etc etc etc. Only further testing can tell that (ie, probably a controlled repeat FOB test via the GP followed by a colonoscopy whether 'real' or virtual/scan?)

It's interesting (one word for it!) to discover Scotland already screens from 50 plus - as so often, the Scots seem to be a lot more proactive in health care, but then I guess their longevity/mortality stats are worse than in England. (And cynics might say the Scots are generous with health care as it's not their money they're spending on it, but that of their 'enemy', England!!!!!!! :) :) :) !!!!) (just like England was generous on spending the revenues from Scottish oil on English taxpayers, of course!!!!! :) :) :) !!!!)

But speaking personally, I definitely think they've got the right idea to screen from 50+, and I hope the benefits of earlier DX - and therefore far less mortality - will start to accrue over the years.

Again, speaking personally, I do wish the England/Wales NHS would, at the very least, advert the 50 plus folk to the increased risk of bowel cancer, and make them aware of commercial screening tests being available, BUT I suspect that this would hit an 'ethical' wall similar to that of the pernicious co-payments scandal. NHS doctors are probably banned from recommending that their patients turn to the private sector for tests/treatment not available to the NHS?????

Julie