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Family Medicine Conference Warns of Trend for Early-Onset Colorectal Cancer and Highlights Topics Important to Family Medicine

Family medicine providers gathered for UAMS’ virtual 2025 Family Medicine Spring Review April 23 -25 and learned that the colorectal cancer death rate in people younger than 55 is climbing one percent each year since the mid-2000s, but that this group is more open to a yearly stool-based screening test such as the fecal immunochemical test (FIT) or Cologuard than other age groups.

The colorectal cancer screenings updates from Whitney Jones, M.D., a gastroenterologist from Kentucky, and Francis Colangelo, M.D., a primary care physician with Allegheny Health Care in Pittsburgh, were part of the first day of the three-day conference.

Francis Colangelo, M.D., primary care physician, speaking on early-onset colorectal cancer.

“Around 41 percent of these (younger patients) had symptoms for at least six months before visiting a provider,” said Colangelo. “And if you see rectal bleeding, always assume it is colorectal cancer in the younger patient.”

The conference was presented by the Department of Family and Preventive Medicine’s Community Health and Education division, which has produced continuing medical education for 47 years.

Amanda Deel, D.O., associate dean of the New York Institute of Technology’s College of Osteopathic Medicine, spoke on compassion in healthcare.

“Following a compassion-centered script with patients may feel artificial, but in a study, patients didn’t sense that. Physicians miss opportunities to practice compassion 70 percent of the time and interrupt patients on average in the first 11 seconds,” said Deel.

Angela Driskill, M.D., is a wound care specialist practicing at Baptist Health. She said there must be a distinction between pressure injuries and skin that fails because pressure injuries imply failure of care or harm.

“If you don’t document a wound 12 to 24 hours after admission, it will throw up a red flag to CMS. Say it’s been 24 hours before anyone does a skin assessment, they are classified as ‘unwounded’ when they came in. Then we document there’s a stage 3 or 4 wound of the sacrum, and CMS begins to recoup the cost of that care, which can be $50,000 to $70,000,” said Driskill.

Sleep medicine physician Caris Fitzgerald, M.D., offered trouble-shooting tips for patients who wear a CPAP, a machine that treats sleep apnea with continuous positive airway pressure. CPAP manufacturers estimate that more than eight million people wear a CPAP each night. One common complaint is dry mouth.

Picture of Caris Fitzgerald, MD — **Caris Fitzgerald, M.D.**

“A leak makes or breaks the experience with a CPAP,” said Fitzgerald, who sees patients at the Central Arkansas Veterans Healthcare System. “If a patient complains of dryness, fix the leak, don’t just increase the humidity. The nose is a humidifier. If your pressure system is sealed well and the patient is nasal breathing, they will not need a humidifier.”

My goal with patients is 10LPM unintended leak. 10LPM is generally a good goal for 95% Unintended Leak. Most under 10LPM can do without a humidifier which means a lot less cleaning and expense. And those with co-occurring good use have almost always resolved the complaints associated with OSA.

In his talk on metabolic issues, James Tucker, M.D., bariatric surgeon with Arkansas Heart Hospital, said bariatric surgery is not a cure for disease of obesity but a treatment. Sleeve gastrectomy is the more common surgery where 50 to 70 percent of the stomach is removed.

“With insulin-dependent patients who’ve had the surgery, 60 percent to 80 percent experience remission from the disease,” said Tucker.

On the third day of the conference, Amy Grooms, M.D., with the UAMS Department of Psychiatry, spoke about using transcranial magnetic stimulation for patients with treatment-resistant depression. She said transcranial magnetic stimulation uses a magnetic pulse that stimulates the dorsolateral prefrontal cortex and rebalances it with the subgenual anterior cingulate cortex. Around 30 percent of patients who use this treatment have a standard response, but 18 percent of patients report that their depression is gone.

Bill Fantegrossi, Ph.D, who works in the UAMS Department of Pharmacology and Toxicology, ended the conference with a talk on emerging drugs of abuse. He said new synthetic opioids grip more tightly to the opioid receptors in the brain. With such a strong bond, reversing an overdose is difficult with standard treatments such as naloxone (Narcan). Naloxone knocks opioids from brain receptors, but it struggles to unbind new synthetic opioids from receptors. This means it can only partially reverse an overdose or may fail.

Synthetics - fentanyls. Lethal doses of heroin, fentanyl and the ultra-potent analog carfentanyl.

Other conference topics included an update on the HPV vaccine with Portia Knowlton, who works with St. Jude’s HPV prevention program, renal cysts and masses with UAMS’ Marcelo Bigarella, M.D., and long-term effects after curative cancer treatments with Viriginia Laliberte, APRN. Ashley Acheson, Ph.D., and Jami Jones, who work with the National Center for Opioid Research & Clinical Effectiveness at Arkansas Children’s Hospital, spoke on the research they are conducting on children and adolescents who have been affected by the opioid crisis and other drug addictions.

Physician Wins Award for High Colorectal Cancer Screening Rate

Dr. Clinton Smith with 1^st 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, 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, 1^st 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. 1^st 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.