WASHINGTON--Gastroenterologists and urologists routinely perform digital
rectal examinations (DREs) on their patients and therefore are in a good
position to also do regular colorectal cancer screening via fecal occult
blood testing and to look for prostate abnormalities via a prostate examination.
Yet a study from Mount Sinai Medical Center, New York City, suggests
that gastroenterologists are remiss in performing prostate examinations
in the regular course of a DRE, while urologists, on the other hand, are
unlikely to perform the fecal occult blood test at the same time as a DRE.
O. Khvatyuk, MD, and colleagues presented their study at a poster session
during Digestive Disease Week 1997. They randomly selected eight gastroenterologists
and eight urologists affiliated with Mt. Sinai Medical Center, and reviewed
randomly selected charts of the initial visit of male patients over the
age of 50.
Patients were excluded if they were referred specifically for symptoms
requiring cancer screening or had a specific cancer risk factor for either
colorectal or prostate cancer. Differences between the two groups of physicians
were compared using the nonparametric Mann-Whitney test.
A total of 389 patient charts were reviewed. The urologists were more
consistent in performing digital rectal examinations: 195 of 200 patients
(97.5%) received them versus 128 of 189 patients (68.4%) seen by a gastroenterologist.
Screening fecal occult blood tests were done significantly more frequently
by gastroenterologists, while screening prostate examinations were done
significantly more often by urologists.
When the frequency of fecal occult blood tests and prostate exams was
analyzed as a percentage of patients having digital rectal exams, the difference
between specialties appears especially striking (see table).
While performing digital exams, gastroenterologists also did fecal occult
blood tests in 87.6% of patients, compared with only 1% of patients who
visited a urologist. In contrast, prostate exams were performed by 100%
of urologists as part of the digital rectal exam but by only 31% of gastroenterologists.
The researchers conclude that gastroenterologists and urologists both
neglect to perform basic screening tests for cancer at the time of digital
"If the opportunity for screening is utilized, higher detection
rates could result, leading to lower mortality from prostate and colorectal
cancers," Dr. Khvatyuk said. "Additional emphasis on preventive
aspects of medicine in training of subspecialists may prove to be useful
for implementing more successful cancer screening programs."