Positive Fecal Occult Blood Test After Clear Colonoscopy: What to Do? - Surgery

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When faced with a positive fecal occult blood test (FOBT) after a clear colonoscopy, it can understandably lead to confusion and concern regarding the next steps. In your case, the situation is further complicated by differing opinions from healthcare providers. Let’s break down the considerations and recommendations based on medical knowledge.

First, it’s important to understand what a positive FOBT indicates. The test is designed to detect hidden (occult) blood in the stool, which can be a sign of various gastrointestinal issues, including polyps, hemorrhoids, diverticular disease, or even colorectal cancer. However, a positive result does not definitively indicate the presence of cancer or any serious condition. It can also yield false positives due to dietary factors (such as consuming red meat, certain vegetables, or medications) or benign conditions.

In your case, the colonoscopy performed on April 9 was clear, meaning no abnormalities were detected at that time. This is a reassuring finding. However, the positive FOBT result on November 17 raises questions. The recommendation from your family physician to repeat the colonoscopy is based on the principle of thoroughness in evaluating any potential gastrointestinal bleeding. On the other hand, the oncologist’s perspective that the positive FOBT could be a false positive is also valid, especially given the recent clear colonoscopy.

Here are some key points to consider:
1. False Positives: As mentioned, FOBT can yield false positives. Factors such as diet, medications, and even menstrual bleeding in women can influence the results. If you have recently consumed foods that can cause false positives, this could explain the result.

2. Timing of Tests: The recommendation to wait until two years for another colonoscopy is based on guidelines that suggest routine screening for colorectal cancer typically occurs every ten years for average-risk individuals, or sooner if there are concerning symptoms or findings. However, your situation is unique due to the positive FOBT.

3. Clinical Judgment: It’s essential to consider the clinical judgment of the healthcare providers involved. If the oncologist believes that the FOBT result is likely a false positive, it may be reasonable to monitor the situation closely rather than immediately proceeding with another invasive procedure. However, if there are any symptoms such as changes in bowel habits, unexplained weight loss, or abdominal pain, further investigation would be warranted.

4. Patient Advocacy: You have the right to seek a second opinion or to discuss your concerns further with your healthcare providers. If you feel uncertain about the recommendations, expressing your worries about potential delays in diagnosis is crucial.
5. Follow-Up Testing: Depending on your symptoms and the clinical judgment of your healthcare team, they may recommend additional non-invasive tests, such as a repeat FOBT or a stool DNA test, before deciding on another colonoscopy.

In conclusion, while the clear colonoscopy is a reassuring factor, the positive FOBT cannot be ignored. It’s essential to weigh the risks and benefits of further testing against the likelihood of a false positive. Open communication with your healthcare providers about your concerns and preferences is vital in making an informed decision about your health. If you remain uneasy, seeking a consultation with a gastroenterologist who specializes in colorectal health may provide additional clarity and guidance.