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 rectal exams.
"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."