Low Rates of Digital Rectal Exam in an Academic Health System Represent a Missed Opportunity.

Abstract

Background and objectives: Digital rectal exam (DRE) is an important screening tool for early cancer identification. DRE has become less routinely performed following removal from cancer screening guidelines. The effect of this decreased utilization has not been studied; this study sought to evaluate current DRE utilization and changes over time.

Methods: The electronic medical record database of a regional academic health system was assessed between 2015 and 2020 for encounters with patients aged 45-75. DRE rates and yearly trends were assessed using chi-squared and Cochran-Armitage tests, respectively.

Results: Of 191 329 outpatient encounters, DRE was documented on 8.5% of visits. DRE utilization declined from 2015 to 2020 (9.6% vs. 8.9%). DRE was more often identified as a procedure in surgical specialties, including surgical oncology (55.6%) and general surgery (2.8%), compared to primary care specialties, including family medicine (1.7%) and internal medicine (1.6%). DREs were less frequently documented for non-Hispanic Black patients versus non-Black patients (7.2% vs. 8.4%) and for Hispanic patients versus Non-Hispanic White patients (7.6% vs. 8.5%). Men had a documented DRE procedure more frequently than women overall (10.4% vs. 4.6%) and in encounters with primary care specialties (2.3% vs. 0.5%) and surgical specialties (20.4% vs. 13.5%) (all p < 0.001).

Conclusions: In this contemporary evaluation, DRE was less frequently coded during outpatient clinic visits overall and specifically in primary care compared with surgical specialties. Differences in DRE utilization across sociodemographic factors highlight disparities in cancer screening. Low DRE rates represent a missed opportunity for early identification of high prevalence cancers.