Obviously, I'm not a medical professional. I had a colonoscopy in 2014 which showed diverticular disease with diverticular pouches, no polyps at all. Colorectal cancer screening participation among citizens not recommended to be screened: a cohort study. Have you been referred for a colonoscopy already? If gave me a better understanding to what the screening and what it means to have abnormal results. How accurate is the FIT result? This morningI did blood tests, this evening I got a text from the surgery. Positive result. I am 32 and have suffered from IBS for a number of years. BMC Gastroenterol. FIT, like any other test, might provide an aberrant result even if there is nothing wrong. I've gone onto so many forums, read so many stories and in some ways it helps and others it really doesn't. This spring we need you to join in ActiveApril It's simple. in Medical Journals, visit www.icmje.org. It means there is some blood in your stool, but not that much. International Committee of Medical Journal Editors (ICMJE), which meets annually. But because you use FIT every year, 10 screenings over 10 years make it just as good as one colonoscopy every 10 years, Wender said. There are many things that can cause a positive fit test, ranging from hemorrhoids to aspirin use, gastroenteritis, etc, and at your young age I'd says it's not likely to be colorectal cancer. In recent years fecal immunochemical tests (FITs) have been offered as a primary screening test for colorectal cancer (CRC) in a growing number of countries. Blood vessels in colon tumors. My anxiety was through the roof. FIT only detects human blood from the lower intestines. It cannot tell us from which part or why. For the guaiac-based Fecal Occult Blood Test (gFOBT), a positive test result indicates that abnormal bleeding may . This must be taken seriously, although may not necessarily be bowel cancer. Thinking of you and I will post updates every step of the way if it helps. Participant-Related Risk Factors for False-Positive and False-Negative Fecal Immunochemical Tests in Colorectal Cancer Screening: Systematic Review and Meta-Analysis. I could easy convince myself that's the case if it wasn't for the abnormal gyne bleeding after opening my bowels .. It detects minute amounts of blood in faeces (faecal occult blood). Because FIT is a relatively new test in this province, there has been some confusion about the test, particularly when there is an abnormal result. This site needs JavaScript to work properly. pagination, the shorter form provides sufficient information to locate the reference. colonscopy went really well, it wasnt the nicest thing to have but made my mind rest, nothing sinster found, one small polyp but the specialist said its not cancer. According to OSHA, a fit test tests the seal between the N95 masks, or respirators, facepiece and your face. It typically takes 15-20 minutes to complete and should be performed when this type of mask is first used and then at least annually. years now, since about 16, I have been having occasional blood in stool, abdominal pain, and gas and seeing blood on the outside of poo . I explained that every time I get a phonecall it sends me into an anxiety attack. Will they remove hemorrhoids during a colonoscopy? Fever is still an issue which is a worryanyway will keep updating in the hope it helps someone. The content of this field is kept private and will not be shown publicly. This is to rule out CRC as much to rule it in. I have been experiencing blood in my stool quite regularly, which I could see. The lady on the phone was rather blunt about it. i expressed I was scared and wanted to know what going on with my body and she said 'you just have to wait'. I knew it wasn't right so contacted the doctor. I am relieved but genuinely terrified if I'm honest. Do something active every day for the whole of April and get sponsored. Self-starter, strong communications . Many other things can do this too, but cancer is usually the most serious of the causes. Keywords: The BC Medical Journal is a general medical journal published by Doctors of BC. Medical Journals, Physician burnout during the COVID-19 pandemic, Unspecified psychosis and stimulant drugs: A commentary on current trends, Opioid overdose following surgery or pain treatment: A missed opportunity for intervention, Only the first three authors are listed, followed by "et al.". I hope you are right x. All the best Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them. On Friday the GP rang me as my test had come back with an abnormal result. Diverticular disease and positive faecal occult test. Anything over 10 is considered a positive result, but some people's results go in to the 100s. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. i was referred for an urgent colonoscopy and found that it is an the start Inflammatory bowel disease. The most important thing I have learned is to see the Dr straight away, and it's been a wake up call to look after the body and eat well. The worst part was having to drink the prep the day before. Colonoscopy is necessary after an abnormal FIT to ensure that no cancer is present. My appetite has left the building so I have lost 8lbs in the last week (I'm overweight!). in 1978 to establish guidelines for the format of manuscripts submitted to their journals. First doctor I had was a female so she was a little more explanation about what tests she was going to do etc. Is it true you are denying treatment to these patients (or words similar) and the reply was brief and twisted. How can I get the FIT? Epub 2016 Jun 21. Johnstone MS, Miller G, Pang G, Burton P, Kourounis G, Winter J, Crighton E, Mansouri D, Witherspoon P, Smith K, McSorley ST. Ann Clin Biochem. Male sex (OR = 1.30, 95%CI 1.03, 1.62), age 65 years (OR = 1.27, 95%CI 1.01, 1.59), a BMI 30 kg/m2 (OR = 1.81, 95%CI 1.36, 2.40), current smoking (OR = 1.63, 95%CI 1.18, 2.25), use of aspirin (OR = 1.36, 95%CI 1.02, 1.82) and a new diagnosis of IBD (OR = 9.13, 95%CI 2.18, 38.19) or other non-neoplastic findings (OR = 1.86, 95%CI 1.37, 2.51) at screening colonoscopy were independently associated with significantly increased odds of a positive FIT. because of that, but usually they're quite good and a positive result needs to be taken seriously as an indicator of a likely need for a colonoscopy (I've had four of those). This does not mean that a cancer was foundover 96% of those with an abnormal FIT will not have cancer. Obviously that is abit worrying, but I was expecting it.. as I have been alternating between self diagnosing from a CRC to a gynecological one ( gynecology app isn't until September ) atleast one cause of my issues can be ruled out soon. 17 is really only barely positive. I' m sorry about your diagnosis although it's brilliant news it is not cancer. I see peoples fit tests year old female and my doctor told me today that the results from my FIT blood test were elevated, She took my blood and gave me a pot for a stool sample and a FIT test. I will definitely provide an update after my appointment on 10th June and pray that your uni has some compassion given everything you are going through. It's difficult, particularly when starting out, but if you're desperate then you'll try anything, and it might just work for you. Thanks. &0LJFA4`BYv]L&rS=>n;,IoQ7U6VE9&~kl:bKM/ *{eM=ziCjlR|Y%vLq jwg+Z8y~~y!&ErQe>L6yx" Is]4 0Z>+iS-~c9oDQy]4uD[GiH^>er^osYoS`&^D"~` 38hZUfoNJu)nzRe6?qL"sE4#eV.D!R+}&M The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, Hi ritz667I had no visible blood but On going abdo pain I to an 56 My fit test came back 158 I had colonoscopy and everything was was clear! I think with a result of 17, the likelihood is that it won't be anything sinister. If you're worried about possible bowel cancer symptoms or are awaiting diagnosis, you can ask questions and get advice here. It is a very sensitive test, and that polyps, hemorrhoids (both internal and external), and ulcers can all cause a positive fit test. BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows: For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work Hemorrhoids are a. 2015 Mar;81(3):596-607. doi: 10.1016/j.gie.2014.08.006. Xx. I can only describe the taste as tears with artificial sugar. Medical Journals She said anyone with cancer that needed urgent treatment, would be given treatment and the rest would have to be patient and wait. In recent years fecal immunochemical tests (FITs) have been offered as a primary screening test for colorectal cancer (CRC) in a growing number of countries. That being said, now you should get a colonoscopy to ensure there is no worrisome pathology involved. FIT test result >400 feeling full often and bloated. I was hoping someone would help calm my nerves a little. If the test is positive, you will need a colonoscopy to remove any cancer or polyps. In this cross-sectional study within the German population-based screening colonoscopy program, participants were invited to provide a stool sample for FIT prior to colonoscopy. Screening for Colorectal Cancer: An Updated Systematic Review [Internet]. National Library of Medicine (NLM), were first published in 1979. Have you heard anything from your uni? Its crazy! sharing sensitive information, make sure youre on a federal Patients who are considering colorectal cancer screening with fecal immunochemical testing (FIT) might be interested in their probability of testing positive and requiring subsequent colonoscopy. If polyps are found during a colonoscopy, they are removed during the same single procedure. A. The group became known as the I have had intermittent blood in my stool for a while but put it down to piles. FIT is a quantitative test with a threshold of 50 nanograms per millilitre of hemoglobin. ? I think the worrying part is the waiting. FIT is a screening test that can only detect blood in the stool. You are young but it doesn't mean you should have to wait longer than anyone else based on your age. Since you were having such visible amounts of blood, I think you (and me too) were not surprised that the FIT test came back positive, because that is what the test is looking for, specicially, just looking for blood in the stool. This is a false positive. Sorryi dont know about fit number results. Am terrified of, Thank you ! Faecal occult blood tests should be offered to adults without rectal bleeding who were classed as low risk, but not no risk of having colorectal cancer. it may also be worth asking for blood tests as well as it may help to figure out what is going on in your body. I'm here if you have any questions or just want to chat. To view profiles and participate in discussions please. Get up, stretch out and sign up today. This does not mean that a cancer was foundover 96% of those with an abnormal FIT will not have cancer. In Alberta, there are 2 easy ways to get your free FIT kit. The FIT sampling technique is simpler and easier to collect compared to that of gFOBT document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2023 FAQS Clear - All Rights Reserved I was so terrified. FIT is also positive in patients with IBD as you would expect. Even the really high results are probably more likelynotto be cancer than to be, as lots of things can cause blood in the stool. I really hope that you can get the sigmoidoscopy soon and not have this weigh so heavy on you, particularly as you mentioned that you are going through a pregnancy as well. Faecal haemoglobin concentrations are associated with all-cause mortality and cause of death in colorectal cancer screening. What can cause microscopic blood in stool? Typically, your diet for 2 to 3 days before the test and while collecting the stool samples needs to include a specified amount of fat but certain types of fats should be avoided. One is stool DNA, or sDNA. Good morning @lilbee, a very warm welcome to the forum although I am so sorry to hear of your ongoing health problems. As expected, our study showed that hemorrhoids are significantly associated with FP FIT results. years now, since about 16, I have been having occasional blood in stool, abdominal pain, and gas nothing. But try to not worry until further investigations are done. Thank you for your message - I appreciate the support. A negative or abnormal FIT result indicates that blood was present in your stool at the time of the test. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in I just had gas and air for colonoscopy used it on way in then watched everything on way out on the screen found one small poylop which was a coincidental find and nothing to do with symptoms so they removed it ( histology all good) they then tattoo where it's taken from in case you have a problem they know where to return to. False positive results are common with non-colonoscopy screening tests. have your symptoms got any better? Take very good care, Kim, @lilbee A positive result on a fecal occult blood test doesnt mean you have cancer. Background: In guaiac-based faecal occult blood tests (FOBT), blue colours are considered positive. A positive FIT can also be due to a polyp, a pre-cancerous polyp, or colorectal cancer. Have you got help/partnerto look afterthe kids. Because FIT is a relatively new test in this province, there has been some confusion about the test, particularly when there is an abnormal result. This change in bowel habits can cause cramping, bloating, and abdominal pain, as well as colon cancer. Obviously they say not to use Google and so on but how can you not, I feel really naive and shocked that there are diseases out there that can literally just pop up out of nowhere potentially. Ive been dismissed by doctors over the years with regards to pain and bloating claiming its IBS too much use of ibuprofen. now im scared it could of been something else all along. You cant see the inside of your rectum easily, but a clinician can. Some Dangers From Pandemic Fatigue. Just before the Dr. began the procedure she told me that a positive FIT test is not an uncommon thing. Was it all overpain in your tummyfrom bloatingor sharp pains in a specific area. You could have an inflammatory bowel disease which may also return a high Fit test but I think it's unfair to make you wait for 25 weeks. Hemorrhoids are a possible cause of FP FIT results; however, studies on this topic are extremely rare. Since this test detects only human blood, other sources of blood, such as those from the diet, do not cause a positive result. Just a reminder - this group is here to offer support, share experiences, and offer our thoughts - but this is not medical advice, and you should always consult your medical professional(s). The Fecal Immunochemical Test (FIT) is a home stool (poop) test that looks for blood in the stool. A stool DNA test (also known as a multitargeted stool DNA test [ MT-sDNA] or FIT-DNA) looks for certain abnormal sections of DNA from cancer or polyp cells and also for occult (hidden) blood. Have they identified the source of your pain? These conditions include: Hemorrhoids (piles) Intestinal polyps Inflammatory bowel disease Ulcers This test is pass or fail. Although considered false positive in the context of CRC screening, the identified factors associated with apparently false-positive FIT results are known risk factors for and may point to conditions other than colorectal neoplasms that may be potential sources of gastrointestinal bleeding, potentially requiring further medical follow up. Typical charges for a fit test range from $30-50. A review article, Rockey DC: Occult gastrointestinal bleeding. The first, simplest test is a rectal examination. Just leaving an update, had my colonoscopy today. You also need to be cleared out for the colonography so they can get a clear picture. but researching again im upset and scared as it says a ct colonography can miss things and if there is something wrong its another horrific waiting game. I would be happy to receive news and updates from Cancer Chat, NICE suspected cancer referral guidelines, Cancer Research UK for Children & Young People, Breast swelling and pickiness during pregnancy. Can hemorrhoids cause a positive occult blood test? Report No. Hi, my Dr asked me to do a fit test as I contacted her about blood in my poo and soft stools and runny diarrhoea. Required fields are marked *. I also have lower stomach pain. I hope it showed nothing sinister and you are beginning to feel better so you can enjoy your baby. not result in a positive FIT. Those are pretty good odds. * To protect your identity do not use your full name. . The false positive rate for the FIT test is approximately 25%. A FIT test screens for colorectal cancer by checking for blood in the stool. For this test, you collect an entire bowel movement and send it to a lab, where it is checked for cancer cells. And, like any test, FIT may give an abnormal result even though there is nothing wrong. Hi Jazzy1990, I'm sorry this is going on and such a hard time for you. Other reasons the test may come back positive include bleeding from piles, menstrual blood or polyps. A positive FIT test does not necessarily indicate that you are suffering from bowel cancer. I know it's difficult to relax but the odds really are on your side. patients. So hopefully so will yours, I had fit test 136. They found 3 small hemmoroids and a anal fissure, biopsy were taken to see if it could be colitis causing the bleeding. How often should face fit testing be done? I want to reassure anyone going through this try not to stress, more often than not the bleeding is a result of something other than cancer. Are you still getting problems? Distinct green colours are said to be due to bile and it is stated that these should be interpreted as negative. I had one of those and it turned out the reagent was faulty and the FIT test program was discontinued for quite some time for my area (6 months?) You just have to hold on to that thought. A stool DNA test uses a stool sample to look for signs of colon cancer. It tests for hidden blood in the stool, which can be an early sign of cancer. de Klerk CM, Vendrig LM, Bossuyt PM, Dekker E. Am J Gastroenterol. A positive FIT test will tell your doctor that you have bleeding occurring somewhere in your gastrointestinal tract. Please do keep us updated and we are thinking of you! colorectal cancer; early detection; false positive; fecal immunochemical test; screening. Who Can Benefit From Diaphragmatic Breathing? ; Crohn's disease: A type of chronic inflammatory bowel disease that causes inflammation of the digestive . A fit test is a test protocol conducted to verify that a respirator is both comfortable and provides the wearer with the expected protection. In recent studies of initial fecal immunochemical testing, 7% to 8% of tests were positive. I really feel for you being in one of the most difficult positions of having ongoing tests and then waiting for the results. I have anamazing support network but i feel alone. I was seen quite quickly and my colonoscopy was clear of any polyps or growths. Chronic anal fissure and a positive FIT test. Jennifer J. Telford, MD The fit test looks for blood in the stool so if you were having a flare up of some sort then that's probably what the test has picked up. Likewise, it's recommended not to ingest . But because you use FIT every year, 10 screenings over 10 years make it just as good as one colonoscopy every 10 years, Wender said. Both FITs were negative in 90% of participants, both positive in 5.5% of participants, and there were discordant results (one positive and one negative FIT) in 4.2% of participants. Thank you for the explanation on the FIT test. PMC It is totally normal to be concerned when a test comes back positive. What are some of the causes other than colon cancer that can show a positive fecal occult blood test? I had a similar episode in July last year but it was as I was admitted to hospital for Covid so I figured it was a symptom of covidbut now am worried that I've had symptoms for nearly a whole year and haven't done anything about it. Youre in the system now though and thats positive. Ibez-Sanz G, Garcia M, Rodrguez-Moranta F, Binefa G, Gmez-Matas J, Domnech X, Vidal C, Soriano A, Moreno V; Adverse Effects on Colorectal Cancer Screening in Catalonia (EACC) Study Working Group. Accessibility Fecal Immunochemical Test (FIT) - 24% of large polyps detected Colonoscopy is the gold standard for finding polyps. What is the requirement? Bethesda, MD 20894, Web Policies I am sure you will find the forum to be both understanding and supportive, so please ask any questions at all. Individuals at average risk are screened using the fecal immunochemical test (FIT), which has been available in British Columbia for the past 5 years and has been covered by MSP since April 2013. What is a fit test? I contacted the hospital and complained that I have been left in limbo. i suffer from severe anxiety so this is causing major greif as I have 3 kids to look after. Do you get results immediately after a colonoscopy? Have they been able to schedule the sigmoidoscopy for you yet? I have very similar symptoms to you, im 30 but with visible blood in my stool, change in bowl habits, excessive gas and bloat. Patients who are considering colorectal cancer screening with fecal immunochemical testing (FIT) might be interested in their probability of testing positive and requiring subsequent colonoscopy. The higher the FIT value is above 20 the greater is the likelihood that there are polyps or a malignancy. When blood is detected, gastroenterologists perform a colonoscopy to . A positive FIT test will tell your doctor that you have bleeding occurring somewhere in your gastrointestinal tract. current guaiac faecal occult blood test (gFOBt) which requires samples to be taken from three different stools. I have struggled with health anxiety all my life - its now through the roof. Btw, Ithink the scores go up to 1000 so 258 is deffinately a long way fromthe top. Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. just hope number 17 is my lucky number. It is possible that the Cologuard result is a false-positive, meaning there is no pre-cancer or cancer present. So, what are you waiting for? Due to coronavirus colonoscopies are not available! Abnormal FIT test. These are patients who are: Over 50 with unexplained abdomincal pain or weight loss. Sending the same good luck to anyone else getting scoped :], Thank you for letting us know the outcome of your colonoscopy @lilbee. Im single mum and was in a really happy place until this. now I cant focus at all. There is nothing we can do until we know what we are dealing with. This is because FIT screening detects blood in and around the stool. Federal government websites often end in .gov or .mil. and transmitted securely. How long do you stay contagious after testing positive for COVID-19? It is a very sensitive test, and that polyps, hemorrhoids (both internal and external), and ulcers can all cause a positive fit test. 114 0 obj <>/Filter/FlateDecode/ID[<347C876C55E31C4795096253D0AC20B1><77C5C8BB43C33E4C8B64110BA30D4995>]/Index[97 30]/Info 96 0 R/Length 85/Prev 54918/Root 98 0 R/Size 127/Type/XRef/W[1 2 1]>>stream Hemorrhoids (swollen blood vessels near the anus and lower rectum that can rupture, causing bleeding), Anal fissures (splits or cracks in the lining of the anal opening). Hi - I am 72 and have had a very similar experience to yours (apart from having a baby recently - that happened 32 years ago). I hope once you have had your scan, you will be in the system and get a colonoscopy soon too but thats something I just pray everyday will happen for everyone out there. Yes, face fit testing is a legal requirement for anyone who wears a tight (or close) fitting mask for work. Terrified, Breast swelling and pickiness during pregnancy. I hope you get your colonoscopy soon to putyour mind at rest. It was gross. What percentage of fit tests come back positive? This includes people with: A strong family history of colorectal cancer or certain types of polyps (see Colorectal Cancer Risk Factors) A personal history of colorectal cancer or certain types of polyps. The Vancouver Group expanded and evolved into the Cologuard is not intended to replace diagnostic colonoscopy or surveillance colonoscopy in high-risk patients, including those with inflammatory bowel disease (IBD). 2022 Jul;59(4):277-287. doi: 10.1177/00045632221076771. Last week I had difficulty passing stools followed by what can only be described as very watery diarreah. The blood has always been bright red so fresh. Once you're through the test, I suggest you return to your GP and ask about the FODMAP exclusion diet. People with a positive FIT test result are advised to have a colonoscopy to investigate the cause of the bleeding because a FIT test alone cannot diagnose cancer. It came back postive and I am so stressed out, She has arranged a consultation with the hospital, Recently I have started to feel more tired, but no anemia has showed up. Ive been having worse IBS symptoms for at least 2 months. On average, 15% of individuals screened with FIT will have an abnormal FIT result and will require additional testing. This allows for the test to have a greater level of specificity for colon cancer screening than other types of stool tests. This important new program offers colorectal cancer screening to asymptomatic men and women between the ages of 50 and 74. When should I be concerned about blood in my stool? Experience in writing Test plans, test cases and automation test scripts. In the case of diverticulosis can the fit test be interpreted as a positive? Are you experiencing any blood in your stool or anything like that? I was diagnosed with non complicated diverticulitis years ago back in 2006. This test is a turbidimetric latex agglutination test in which the Hb present in the patient sample combines with latex-coated antibodies to cause a change in the absorbance. Glad everything went ok. I write the times I use the toilet, colour, consistency, I also log my temperature as I have fever every evening for some reason. In addition, as we only performed colonoscopy in FIT-positive individuals, test sensitivity or specificity among users and non-users could not be calculated. Having positive FIT results can cause a lot of anxiety, and I would recommend doing your best not to get ahead of being sure you have colorectal cancer. Thanks for Bringing this Up. A stool DNA test finds cells in a stool sample. My query is tho, I have had rectal bleeding for about 15 years now ( hemorrhoids ) but at the time of doing the sample I saw no visible blood could it still cause a positive FIT? We investigated whether hemorrhoids are associated with FP FIT results. The effect of the different drugs on the PPV might also depend on the actual FIT cutoff defining a positive test. We are so glad that your colonoscopy showed no signs of cancer. Just know that before this diagnosis i was petrified, thinking the worst every second of the day. 126 0 obj <>stream Reading about positive fit tests all state a high fit test only point towards cancer, Fecal Immunochemical Test (FIT): common questions. What is poop like with colon cancer? 2016 Oct;48(10):1249-54. doi: 10.1016/j.dld.2016.06.011. try not to worry too much, stress is not good for the body. Its difficult not to googlebut from whatGoogle saysit could be anything,theres like loads of things it could be from something as simple as piles andthey all have similar if not exact symptoms. Unauthorized use of these marks is strictly prohibited. What can cause a false positive on a cologuard test? 97 0 obj <> endobj ~Nicole, GCCA Staff Member & Colon Cancer Connected Site Administrator. Colon cancer can be stopped in its tracks. Alsoall my bloods came back ok. * To protect your identity do not use your full name. There can be many reasons that blood may be found in the stool, including colorectal cancer. Helicobacter pylori infection can be detected by stool testing, for instance; this is the bacteria better known for its role in causing stomach ulcers.Stool Tests Can Help Diagnose: Your email address will not be published. Other conditions that may produce a positive result on a fecal occult blood test include ulcers, hemorrhoids, polyps, and benign tumors. Where have you had pain. Does anyone know how the numbers work with a fit test. ,zz:itE]a< s$i[y D7u Have you had your colonoscopy? Four thousand six hundred and fifty six participants aged 50-79 years with no known history of CRC or inflammatory bowel disease (IBD) and no findings of neoplasms at screening colonoscopy were included in the current analyses. Take care, Kim. On Friday the GP rang me as my test had come back with an abnormal result. A light beam is passed through the reaction cells, and changes in the intensity of the light beam are measured. Alternative diagnoses and demographics associated with a raised quantitative faecal immunochemical test in symptomatic patients. A fit test tests the seal between the respirators facepiece and your face. Paternal side there's no known history of cancer. But straining or irritation when passing stool can cause: Painless bleeding during bowel movements. Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them. Fitness to work refers to the process of assuring that an employee can complete a task safely without presenting a risk to themselves, their colleagues, the company, or a third party.

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