Stool test: Information for men

Colorectal cancer screening is voluntary. If you would like to have an FOBT, you have to ask your doctor about it. The test will typically be handed out to you by a doctor who specializes in one of the following areas:

• General medicine (family doctors or general practitioners)
• Internal medicine
• Urology

The doctor's practice will be able to answer any questions you have about using the test. The instructions that come with the test should be helpful too. The test is done at home. The test results will only be accurate if the stool sample is tested within five days. The doctor's practice will tell you when it has to be handed in by so that it can be tested in time.

The test package will contain everything that you need for taking the sample. Special paper is put into the toilet to catch the stool. The sample is then removed using a small stick. The sample is placed in a tube that can be sealed so it is airtight. The tube is put in an envelope and dropped off at the doctor's office. They send the sample to a lab for analysis.

Please note that the doctor's practice will only notify you if blood traces are found. If you don't hear anything, then the test results were normal.

FOBTs are relatively simple to do and have no direct side effects. But they aren't always very reliable. The test results are often abnormal, without cancer being the underlying cause. This is called a "false positive" test result. It can happen because other problems can result in bleeding too, including hemorrhoids or inflammations in the stomach or bowel.

Also, colorectal cancer and polyps don't always leave traces of blood in stool. Because of this, any one blood test will fail to detect about 30% of tumors and many polyps. This is called a false-negative test result. So it's important to take any bowel problems that concern you seriously – even if your last test results were normal.

Blood traces are found in the stool of about 50 out of 1,000 men who have FOBTs. These men are then invited to have a colonoscopy. The other men can have the test again every one to two years. The stool test is only helpful if you have it done regularly over the course of many years. But this will increase the chances of having abnormal results. The following illustration shows what results can be expected if 1,000 men regularly have an FOBT for ten years from the age of 50.

Several studies have looked into what men can expect from regularly testing for hidden (occult) blood traces in their stool. The research shows that these stool tests can lower the risk of dying of colorectal cancer. But there is no proof that they can lower the risk of getting this kind of cancer. The following tables summarize the main results separately – for men who are 50 years old and for men who are 60 years old. These results apply to a period of ten years, starting at the age given.

Some doctors offer men other types of stool tests for colorectal cancer screening that they would have to pay for themselves (in Germany these are known as "individual health care services," or IGeL for short). These include the M2-PK test and a stool DNA test. The M2-PK test looks for an enzyme that is thought to be a sign of bowel cancer when found in stool. The DNA test looks for fragments of genetic material from cancer cells found in stool. But tests for blood in the stool (FOBTs) are the only tests that have so far been shown to lower the risk of dying of colorectal cancer. So you can safely turn down offers of any other types of tests.