Editing Rectal examination (section)

=== In [[colorectal cancer screening]] of asymptomatic adults aged 50 to 75 ===
* Even though 1 in 4 colorectal cancers (CRC) is located in the rectum, little evidence supports the effectiveness of using the DRE for rectal cancer detection<ref name=pmid17868406>{{cite journal |doi=10.1111/j.1463-1318.2007.01381.x |pmid=17868406 |title=The diagnostic value of digital rectal examination in primary care for palpable rectal tumour |journal=Colorectal Disease |volume=10 |issue=8 |pages=789–792 |year=2008 |last1=Ang |first1=C. W. |last2=Dawson |first2=R. |last3=Hall |first3=C. |last4=Farmer |first4=M. |s2cid=639158 |doi-access=free }}</ref><ref>{{Cite web|url=https://www.uptodate.com/contents/screening-for-colorectal-cancer-strategies-in-patients-at-average-risk#H9|title=UpToDate|website=www.uptodate.com|access-date=2019-02-18}}</ref> and it is not recommended in the colorectal cancer screening guidelines.<ref>{{Cite web|url=https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening#Pod2|title=Final Recommendation Statement: Colorectal Cancer: Screening - US Preventive Services Task Force|website=www.uspreventiveservicestaskforce.org|access-date=2019-02-07}}</ref> The DRE is inadequate as a screening tool for [[colorectal cancer]] because it examines less than 10% of the colorectal mucosa; [[sigmoidoscopy]] is preferred.{{cn|date=January 2022}}
* Although the DRE is commonly used as a way to obtain a stool sample for a FOBT ([[faecal occult blood|fecal occult blood test]]) in an office based setting, ''this is an insufficient way of screening for colorectal cancer and is not recommended.''<ref name=pmid16734049>{{cite journal |pmid=16734049 |url=http://www.aafp.org/link_out?pmid=16734049 |year=2006 |last1=Wender |first1=R. C. |title=Colorectal cancer screening: Don't just do it, do it right |journal=American Family Physician |volume=73 |issue=10 |pages=1707–8 }}</ref><ref name=pmid22766663>{{cite journal |doi=10.1097/SMJ.0b013e31825bfdc5 |pmid=22766663 |title=Digital Rectal Examination Versus Spontaneous Passage of Stool for Fecal Occult Blood Testing |journal=Southern Medical Journal |volume=105 |issue=7 |pages=357–361 |year=2012 |last1=Ashraf |first1=Imran |last2=Paracha |first2=Shafaq R. |last3=Arif |first3=Murtaza |last4=Choudhary |first4=Abhishek |last5=Matteson |first5=Michelle L. |last6=Clark |first6=Robert E. |last7=Godfrey |first7=Jonathan D. |last8=Hammad |first8=Hazem T. |last9=Bechtold |first9=Matthew L. |s2cid=22573405 }}</ref><ref name=pmid15657156>{{cite journal |doi=10.7326/0003-4819-142-2-200501180-00007 |pmid=15657156 |title=A National Survey of Primary Care Physicians' Methods for Screening for Fecal Occult Blood |journal=Annals of Internal Medicine |volume=142 |issue=2 |pages=86–94 |year=2005 |last1=Nadel |first1=Marion R. |last2=Shapiro |first2=Jean A. |last3=Klabunde |first3=Carrie N. |last4=Seeff |first4=Laura C. |last5=Uhler |first5=Robert |last6=Smith |first6=Robert A. |last7=Ransohoff |first7=David F. |s2cid=24639260 }}</ref> A single office-based FOBT (fecal occult blood test) performed following a digital rectal examination (DRE) is not an adequate screen due to low sensitivity for advanced tumor and colorectal cancer.<ref name=pmid15657155>{{cite journal |doi=10.7326/0003-4819-142-2-200501180-00006 |pmid=15657155 |title=Accuracy of Screening for Fecal Occult Blood on a Single Stool Sample Obtained by Digital Rectal Examination: A Comparison with Recommended Sampling Practice |journal=Annals of Internal Medicine |volume=142 |issue=2 |pages=81–5 |year=2005 |last1=Collins |first1=Judith F. |last2=Lieberman |first2=David A. |last3=Durbin |first3=Theodore E. |last4=Weiss |first4=David G. |author5=Veterans Affairs Cooperative Study #380 Group |s2cid=29833684 }}</ref> Screening for colon cancer this way does not meet [[HEDIS]], Medicare or [[American Cancer Society]] standards.<ref>{{Cite web|url=https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html|title=Colorectal Cancer Screening Tests|website=www.cancer.org|access-date=2019-10-12}}</ref> The FOBT has never been validated for any purpose other than as a take home colon cancer screening test.<ref name="auto"/>  A paper published in the ''[[Journal of General Internal Medicine]]'' states, "While FOBT done appropriately (taken home and used according to the instructions) is an important screening option, in-office FOBT may be worse than no screening at all because it misses 95% of cases of advanced tumor, giving many patients a false sense of reassurance."<ref name=pmid20383599>{{cite journal |doi=10.1007/s11606-010-1328-7 |pmid=20383599 |pmc=2896587 |title=Fecal Occult Blood Testing Beliefs and Practices of U.S. Primary Care Physicians: Serious Deviations from Evidence-Based Recommendations |journal=Journal of General Internal Medicine |volume=25 |issue=8 |pages=833–839 |year=2010 |last1=Nadel |first1=Marion R. |last2=Berkowitz |first2=Zahava |last3=Klabunde |first3=Carrie N. |last4=Smith |first4=Robert A. |last5=Coughlin |first5=Steven S. |last6=White |first6=Mary C. }}</ref>