Study Suggests Lost Opportunities for Cancer Screening at DRE

WASHINGTON--Gastroenterologists and urologists routinely perform digitalrectal examinations (DREs) on their patients and therefore are in a goodposition to also do regular colorectal cancer screening via fecal occultblood testing and to look for prostate abnormalities via a prostate examination.

Yet a study from Mount Sinai Medical Center, New York City, suggeststhat gastroenterologists are remiss in performing prostate examinationsin the regular course of a DRE, while urologists, on the other hand, areunlikely 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 sessionduring Digestive Disease Week 1997. They randomly selected eight gastroenterologistsand eight urologists affiliated with Mt. Sinai Medical Center, and reviewedrandomly selected charts of the initial visit of male patients over theage of 50.

Patients were excluded if they were referred specifically for symptomsrequiring cancer screening or had a specific cancer risk factor for eithercolorectal or prostate cancer. Differences between the two groups of physicianswere compared using the nonparametric Mann-Whitney test.

A total of 389 patient charts were reviewed. The urologists were moreconsistent 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 frequentlyby gastroenterologists, while screening prostate examinations were donesignificantly more often by urologists.

When the frequency of fecal occult blood tests and prostate exams wasanalyzed as a percentage of patients having digital rectal exams, the differencebetween specialties appears especially striking (see table).

While performing digital exams, gastroenterologists also did fecal occultblood tests in 87.6% of patients, compared with only 1% of patients whovisited 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 bothneglect to perform basic screening tests for cancer at the time of digitalrectal exams.

"If the opportunity for screening is utilized, higher detectionrates could result, leading to lower mortality from prostate and colorectalcancers," Dr. Khvatyuk said. "Additional emphasis on preventiveaspects of medicine in training of subspecialists may prove to be usefulfor implementing more successful cancer screening programs."