The Poop Test

I kid you not, out of all the consultations I file at the family clinic most are regarding gastroenterology. Many patients, especially those in the older population, have problems with their bowels be it blood in their stool (better known as “poop”) or abdomen discomfort. A good way to regularly have your intestines checked out is to complete the FOBT. Don’t worry! It does not cutting you open or anything. It is just a simple test that can be done at home, by your toilet. It is called the Fecal Occult Blood Test (FOBT) or the Stool test but I like to call it the Poop test.

  • WHO: Anyone in your family between age 50-74, like your parents or grandparents
  • WHAT: The Fecal Occult Blood Test (FOBT)
  • WHEN: Starting the age of 50 or earlier if you have a family history of colorectal cancer and every 2 years after that
  • WHERE: By your toilet
  • WHY: Because Ontario has one of the highest rates of colorectal cancer…IN THE WORLD. The FOBT is the first step in detect abnormalities in your intestines.

***Just want to clarify the cartoon above! In Ontario, it is recommended that you do a FOBT when you turn 50, NOT a colonoscopy. You only need a colonoscopy if your FOBT lab results come back positive. Read more in this post!

The following is based on the information I know and are my own opinions. I encourage you to do research on your own outside of this blog about cancer screening tests so that you can make an informed decision for your family and own health. 

What is Colorectal Cancer

Cancer is a process starting at the molecular level. Due to various possible events, those healthy cells may undergo change that makes them start to multiply uncontrollably. This is cancer, in short.

For colorectal cancer, it all starts with a polyp or small growth protruding from the lining of the colon. These polyps can grow in numbers and size, and can become cancerous over time. However, simply removing these polyps during a colonoscopy can prevent them from getting to that cancerous stage.

In 2013, an estimated 8,700 Ontarians will have been diagnosed with colorectal cancer, and approximately 3,350 Ontarians will die from it.” – Cancer Care Ontario.

How can it be prevented

Ontario has three ongoing cancer screening programs, covered by OHIP, for the purpose of detecting abnormal cells that can become cancerous: breast, cervical and colorectal. Take advantage of them! 90% of colon cancer is preventable if it is detected early. You cannot feel these polyps growing inside you. These changes can occur without symptoms in someone who looks rather healthy.

Removing a polyp

The colorectal screening can help those who look seemingly healthy to identify these pre-cancerous cells. How you ask? The answer all lies in your poop.

The Fecal Occult Blood Test (FOBT)?

The reason I call the FOBT test the Poop test is because the lab literally looks for abnormality in your poop! The lab uses chemicals to look for blood in your poop that you cannot see with the naked eye. The FOBT has been shown to reduce death from colorectal cancer by identifying pre-cancerous changes in the colon and rectum. Currently, out of all the Ontarians eligible for the screening test, only about 30% of them completed it.

The FOBT kit includes the following, all packed in a large envelope:

Information and Instructions, Three applicator sticks, Foil Envelope (with patient name on it), Card to smear stool on (with patient name on it), Requisition Form (printed by Doctor)
Information and Instructions, Three applicator sticks, Foil Envelope (with patient name on it), Card to smear stool on (with patient name on it), Requisition Form (printed by Doctor)

You can pick up the FOBT kit and requisition form at your family doctor’s clinic. Someone at the clinic will explain to you how to do it properly.

  1. Three days before and during the three days of completing the test, no intaking any vitamin C supplements, citrus juices and fruits. Do not do test if you are experiencing diarrhea, constipation or period.
  2. Write down the date and time poop was taken. Using something to hold your poop so that it does not touch the toilet water. Use the applicator stick to smear one side of the poop onto the designated space on the card. Use the other side of the stick to smear another side of the poop.
  3. Place completed card in the foil envelope (which should have patients label on it), seal it, and return it IN PERSON to the nearest lab WITH the requisition form within 7 days of completing it.

To further encourage the patient to complete it…I explain to them WHY they are doing it. The benefit of doing the FOBT once every two years is catching abnormal polyps early enough to remove them before they become cancerous! HUZZAH!

If the patient does not speak English, I will find someone who speaks their language to effectively communicate the instructions to them. I will also include in the kit an instruction sheet in their language so that they can read it at home before completing the test.

Do I need one?

Understand that no one in healthcare will force you to do anything you do not want to do. Technically speaking then, you do not need one but it is recommended  and encouraged that you do complete the FOBT kit once every two years starting the age of 50.

What If I Get a Positive Result Back?

If you get a positive result for your FOBT test, it means that the lab found blood in your poop…(you sure you didn’t do it during your period?). Your family physician will refer you to get a colonoscopy to determine the source of the blood.

A colonoscopy

A colonoscopy is an endoscopic examination of your large intestine and your small intestine. A fibre optic camera attached to a flexible tube is passed through the anus and will continue up the gastrointestinal (GI) tract. There is nothing to be afraid of since the patient will be sedated during the procedure. The recovery is quick and painless. If the doctor sees any polyps, he will remove them and send it to the lab for a biospy for malignancy.

FOBT Rejected Kits

What is more frustrating than doing the FOBT? Having to do it again! Just think about it, “I have to touch my poop again?!” Yea, I agree that it is pretty gross to examine your own poop when completing the kit. That is why it is our job to make sure the patient/person completing the kit understands all instructions and does everything right the first time! Also, keep reminding them the FOBT kit may save their lives!

Most common reasons for FOBT kit rejection:

  • Not labelled, ID mismatch
  • Card w/o requisition, Requisition w/o card
  • Expired specimen, Expired Card
  • Damaged Card

As you can see, these are silly things that can easily be avoided if explained clearly to the patient and prepared properly. If there is a language barrier, try giving instruction sheets in the language they speak or find someone who speaks their language to explain the instructions to them.

Resources:

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