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College of Medicine: Department of Family and Preventive Medicine

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Physician Wins Award for High Colorectal Cancer Screening Rate

Dr. Clinton Smith with 1st Choice Healthcare was named the Arkansas Cancer Coalition Healthcare Provider of the Year at the Arkansas Cancer Summit March 7 for his 75 percent rate of colorectal cancer screening with his patients.

The family physician has participated in the UAMS Partnerships in Colorectal Cancer Screening for Arkansas (PiCS-AR!) since 2020, a Centers for Disease Control and Prevention grant that seeks to raise colorectal cancer screening rates in the state. His 75 percent rate is closing in on the national goal of 80 percent set by the National Colorectal Cancer Roundtable.

Clinton Smith, DO
Clinton Smith, DO, physician with 1st Choice Healthcare in Corning, Arkansas

Smith’s first year with the PiCS-AR! grant showed a screening rate of 65 percent. His rate grew to 70 percent in 2021 and has escalated in one year to 75 percent.  He said the reasons for his higher screening rate stem from frequently reminding the patients of screening, making it easy for them to screen, and relaying the facts.

“Each time I have a checkup with a patient (not even necessarily a wellness checkup), I try to mention (screening) and see if they’re due for anything. And if they are, we try to go ahead and facilitate that and get it set up,” said Smith. “The best time to (mention) it, in my opinion, is when you see them. Sometimes people are non-compliant and you may not see them for a while.  Now, it does take extra time, and sometimes I get behind, but I feel that prevention is the key.  It’s better to prevent a problem than to have to treat it later.”

Smith gives his patients several screening options: stool-based tests and a colonoscopy. The stool-based tests (FIT or Cologuard) require that the patient send a sample of their stool in the mail, which takes minutes and is not invasive and requires no dieting, fasting or anesthesia. The colonoscopy is considered the most accurate for colorectal cancer screening, but with his rural patient population in northeast Arkansas, arranging a colonoscopy can be cost- and time-prohibitive.

“I tell them about the options and let them decide. I think the FIT tests have helped a lot. We’re rural, so to get a colonoscopy, you not only have to take a day off of work, you have to drive 30 miles outside of town,” said Smith.

Colorectal cancer is the second deadliest cancer for Americans, and it’s on the rise with younger age groups, according to the American Cancer Society. The rate of new colorectal cancer cases among Americans younger than 55 increased from 11 percent of all cases in 1995 to 20 percent in 2019.  The recommended screening age for those with average risk is 45, which the U.S. Preventive Services Task Force lowered from age 50 two years ago because of this new trend. Screening at an earlier age means cancer will be caught in its first stage and is highly treatable if detected early.

Smith also credits his employer, 1st Choice Healthcare, for allowing him to spend more time with his patients who are often chronically ill and require more than the suggested 15 minutes many physicians are tethered to. 1st Choice is one of two healthcare partners working with the PiCS-AR! five-year grant. Mid-Delta Healthcare System in eastern Arkansas is the latest system to join.

Colorectal Cancer Screening Up Eight Percent in Northeast Arkansas with Community Health and Education’s PiCS-AR! Project

September 2022 – Colorectal cancer screening rates jumped by almost eight percent in northeast Arkansas clinics that partnered with the University of Arkansas for Medical Sciences (UAMS) during the first year of a five-year project to increase screening in the state.

The Partnerships in Colorectal Cancer Screening (PiCS-AR!) is a project of the UAMS Department of Family and Preventive Medicine’s Community Health and Education Division. In 2020, the division received a $2.5 million grant from the Centers for Disease Control and Prevention to carry out the project.

Since then, its first clinic partner, 1st Choice Healthcare, exceeded its initial screening goals in five out of six clinics it operates in Salem, Pocahontas, Paragould, Corning and Ash Flat. The provider’s screening rate was 37% a year ago, and most of the clinics now hover in the mid-40s, with the Pocahontas clinic making the biggest jump, from 29% to 45% in one year.

Denise Boyer, RN, a patient navigator for 1st Choice Healthcare clinics in Ash Flat and Salem, displays her “Fit Just Takes a Bit” button that clinic staff wore to initiate patient conversations about colorectal screening, and a cookie shared during an educational activity on stool-based screening.

The project targets primary care clinics, especially in counties with low screening rates and low average household incomes. It works directly with providers to teach them best practices and help them implement techniques for increasing screening in their clinics.

Since September of 2020, UAMS and the Arkansas Foundation for Medical Care (AFMC) have coached patient navigators at the clinics. The navigators – experienced registered nurses who educate patients about the risk of developing colon cancer and explain screening options – are credited for making a noticeable impact on screening rates in a short period of time.

“More and more conversations between providers and patients are happening about the importance of colorectal screenings,” said Alysia Dubriske, M.Ed., director of the Community Health and Education Division. “Not only is that an objective of the project, but it’s also the first step in preventing late-stage colon cancer.”

She said provider reminders and chart alerts in the clinics’ electronic health system also worked particularly well, noting, “When patients visited, the clinic staff would check to see if they were due for a screening, and set up appointments for those who were.”

“Screening for colorectal cancer is extremely important in that it is one of the few measures that can prevent cancer from developing,” said Jonathan Laryea, M.D., chief of the Division of Colon and Rectal Surgery at the UAMS Winthrop P. Rockefeller Cancer Institute. “There are very few cancers that can be prevented that way. Not only does it prevent cancer, but it allows cancer to be identified at an early stage, which improves survival and also prevents the complications of cancer.”

A colonoscopy is the clearest, most complete screening, but another option is an at-home screening test that is designed to detect DNA abnormalities or blood in the stool, both of which could be indicators of colon cancer or precancerous conditions.

“The best colorectal cancer screening test is the one that patients are most likely to complete,” said Marybeth Curtis, RN and program manager for the PiCS-AR! Campaign, quoting a senior health analyst at the Mayo Clinic.

“I love that quote,” she said. “Forty-six percent of colorectal cancer deaths in the United States are a result of missed screening opportunities. Patient adherence to screening is the key.”

Curtis said one goal of the grant project is to educate providers and patients that stool-based tests are an effective, low-cost alternative to colonoscopies in screening average-risk patients for colorectal cancer.

She noted that stool-based tests are actually preferred by patients, “which leads to improved follow-up in completing their screening.”

“Screening is the best way to beat colorectal cancer,” Laryea agreed. ”My best advice to all adults 45 years and older is, ‘Get your rear in gear and get screened.’”

“Ultimately, our goal is to reduce the amount of late-stage colorectal cancer in Arkansas and the number of colorectal cancer deaths in Arkansas,” Dubriske said.

Nationwide, colorectal cancer is the second most common cause of cancer deaths for men and women combined and is expected to cause about 53,000 deaths during 2021, including 500 deaths in Arkansas, according to the American Cancer Society.

MaryBeth Curtis, RN, of the UAMS Department of Family and Preventive Medicine (second from left), holds a card alerting patients that 45 is the new baseline age for colorectal screening. Curtis, PICS AR program manager, is surrounded at 1st Choice Healthcare’s Ash Flat clinic by clinic employees (from left) Deborah King, APRN; Starla Smith, APRN; and Denise Boyer, RN and nurse navigator. The card says “45 is the new FIT-ty” and will be sent to patients as they turn 45, along with a kit they can use for their at-home test.
MaryBeth Curtis, RN, of the UAMS Department of Family and Preventive Medicine (second from left), holds a card alerting patients that 45 is the new baseline age for colorectal screening. Curtis, PICS AR program manager, is surrounded at 1st Choice Healthcare’s Ash Flat clinic by clinic employees (from left) Deborah King, APRN; Starla Smith, APRN; and Denise Boyer, RN and nurse navigator. The card says “45 is the new FIT-ty” and will be sent to patients as they turn 45, along with a kit they can use for their at-home test.