Joey Wahler (Host): They can literally save lives. So, we're discussing colonoscopy screenings. Our guest is Dr. Jed Freeman. He's a cancer care physician. This is Valley Vitals, the pulse of healthy living in our community, brought to you by Carson Valley Health. We're going beyond the checkup to bring you real conversations with the experts you trust. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Freeman. Welcome.

Jed Freeman, MD: Hi, Joey. Thanks for having me.

Host: Great to have you. We appreciate the time. So first, in a nutshell, Doctor, going back to what I mentioned a moment ago, just how much of a difference can screening make in diagnosing colon cancer? Because it could really be the difference between life and death for some patients, right?

Jed Freeman, MD: Yeah, that's absolutely correct. We do very well. We're very successful at treating diseases that we can get to early on in colonoscopies, like mammography or mammograms in women, find very early diseases. And usually, you just have to have them cut out and don't need any other therapy after that.

Host: Unfortunately, not enough people heed those warnings, which is why we try to have discussions just like this. So, speaking of which, the colon screening gold standard, of course, is a colonoscopy. And the recommended age to start getting them, Doc, has changed in recent years, right?

Jed Freeman, MD: Yes, absolutely. We're starting to see colon cancer in earlier age groups. Colon cancer is now the leading cause of death in people under 50. So, lung cancer is the leading cause of death in all groups. But under 50, colon cancer has taken over that lead.

Host: And part of that is because of the fact that because more people are getting screened, more of these cases are being detected, right?

Jed Freeman, MD: It's a little bit more complex than that. The younger age that we're starting to see is probably based on our dietary habits, a lot of the processed foods that we eat. More people are doing fast foods as opposed to the usual, the prior family dining in together, and mom cooking or dad cooking. So, I think that's where we're starting to see more actual colon cancers in younger people.

Host: Yeah. You nailed it for so many families nowadays, compared with years ago, it's a lot of takeout and bring in right.

Jed Freeman, MD: It's not the Leave It To Beaver setting. I don't know how many people will catch that analogy anymore. But, you know, the classic family where we sit down and dine at home. No, we don't see that now.

Host: No question about that. So, what symptoms might suggest someone should consider a GI screening sooner rather than later?

Jed Freeman, MD: So certainly, the symptoms are blood in the stool, stomach cramping, change in bowel habits. But I want to emphasize that, at that time, it may be already too late. We recommend screening for people that are asymptomatic, and that's why we're picking ages in groups of people that are at higher risk. So, you want to get your screen before you're sick.

Host: No question about that. And picking up on that, Doc, someone could conceivably have colon cancer and yet experience no obvious symptoms, correct?

Jed Freeman, MD: Yes, that's absolutely correct, and that's where the screening comes in. We're trying to find it at its very earliest point, And in fact, colonoscopies find precancerous, and that's what we're looking for, the polyps that are going to develop into cancer. If we can remove those, then we hope you never get cancer.

Host: And I'm going to ask you more about those in just a moment. But first, for those unfamiliar, simply put, what does a colonoscopy involve? People seem to dread it, but often they don't know enough about it, right?

Jed Freeman, MD: Worst part is the prep, in my opinion. And I've had four colonoscopies, because I tend to make polyps. The prep is horrible. There's no getting around that. It's not horrible in the sense that you can't do it. It's just the challenge of drinking all the material to clean out your bowels so that the colonoscopist can see everything clearly.

The colonoscopy itself, you're asleep for it, and you won't even remember that you had it. So, that's the easy part. But the prep, that's more challenging. I, as a doctor, thought I'd be smart and I don't recommend this, but I got the lemon lime mixture and added some tequila to my first glass. I was just going to drink margaritas all night. It made me sicker actually. So, please don't do that as a recommendation. Just suffer through the prep.

Host: The old don't try this at home warning, right?

Jed Freeman, MD: Absolutely.

Host: As a matter of fact, it is interesting that you mention that though, because another GI doctor I spoke to recently said that his patients take a prep that involves Gatorade just to make it taste more palatable, right?

Jed Freeman, MD: Yes, absolutely. Yes. That can be much more—but it's also the volume of what you have to drink to do it. And they also have you doing it throughout the night, so you'll start at five o'clock in the evening, you'll go till eight o'clock And then, they wake you up at one o'clock to continue the second half of the prep. And in between, while you're trying to sleep, you're going to the bathroom. So, it's kind of an unhappy night, but it's worth everything that we do to avoid seeing me on the other end of being diagnosed with cancer.

Host: Oh, there's no question about that. And of course, that's—

Jed Freeman, MD: Four times out of my life so far has certainly been worth it.

Host: No question, Doc. That's the message we're trying to deliver here. As a matter of fact, having had multiple colonoscopies myself, I always try to keep in the back of my mind during the prep and leading up to the procedure what I'm going to finally eat when I'm able to break the fast. So, that's what I recommend to people, but I didn't go to medical school. So, what do I know?

Jed Freeman, MD: Joey, that's a great idea. That's way to prep your mind.

Host: Absolutely, prep for the brain. So if screening finds a problem, what are the next steps in terms of diagnosis and treatment then? And for one thing you mentioned, and just to pick up on it, that polyps and precancerous things that are far less serious than cancer itself can be detected.

Jed Freeman, MD: They can have their own problems, they can make their own problems. But the biggest problem is that they'll progress onto a cancer. And then, you'll have serious issues that need to be dealt with with surgery and possibly chemotherapy, radiation. So, the real goal is to avoid getting to that stage. And colonoscopies will do that for you.

Host: And so, once an issue is found, let's say polyps, what do you do?

Jed Freeman, MD: They take them out right then and there during the procedure. They'll remove all the polyps. And if you have more than three, they'll say you probably have to have a colonoscopy within five years or three years. I'm on the three-year callback list now. I can't wait. But I tend to make more polyps than others. If you have no polyps, it's 10 years, and that's the difference between colonoscopies potentially and Cologuard, because you can remove the polyps at the time of the procedure. And Cologuard doesn't do anything about polyps, doesn't even identify them. And that's my little take here, that colonoscopies are the gold standard. Cologuard will not allow us to remove those precancerous polyps. So by the time Cologuard identifies cancer, you know, the horse is already out of the barn. And then, you're closing the barn door.

Host: Well, you led me beautifully into my next question because there is an option to a colonoscopy in terms of screening known as Cologuard, which has come along in recent years. Explain to people what that is exactly.

Jed Freeman, MD: It's really trying to identify cancer DNA in the stool. You're taking your stool and you're looking for the cancer DNA, but the problem is you have to have cancer to identify it. And so, it's a much easier test, no question about it, but it doesn't allow us to get the pre-cancerous polyps. You also have to do it more often. It's every three years. Whereas if you have no polyps on your colonoscopy, it's every 10 years.

Host: And to be clear, for those that don't know about Cologuard, it involves an at-home kit where you're taking a stool sample and literally putting it in a box and mailing it to be examined. But as you say, not as thorough, not as accurate by any means compared with a colonoscopy. Right?

Jed Freeman, MD: Correct. And certainly don't re recommend it. I mean, there are people that are going to. Do it. That may be at low risk. Certainly the people at high-risk, those people with a family history of polyps, a family history of colon cancer, the various syndromes where people are likely to develop colon cancer, they certainly shouldn't do that. For me, I'm kind of old school and old-fashioned, I don't think we've replaced the colonoscopy yet.

Host: Absolutely. A couple of other things for you, Doc, in terms of the importance of screening. People that have late stage colon cancer, unfortunately, am I right? Oftentimes, they're way, way overdue for a colonoscopy and, in many cases, have never been for one at all, right?

Jed Freeman, MD: You're absolutely correct. And in those people we see at later stages, and those are the people that then require chemotherapy and bowel resections and sometimes have colostomies, et cetera.

If I may, one pet peeve I have about screening is when to stop screening. There's been a big debate with people and in the literature. And my recommendation is that, although many people say you can stop your screens at 70 or 72 or 75, those recommendations were based on our life expectancy 30, 40 years ago. If you take a woman, for example, who hasn't had a life-threatening event by the age of 52, her average survival is 92, meaning half those women will live longer than 92. So unless you are infirm, meaning you have dementia or you're in a nursing home and you're, you know, on oxygen, I recommend people get screened until they can't go to the next step, which would be surgery. So, I continue your colonoscopy. If you are 80 and playing pickleball three times, four times a week, and you're in good shape, I'd get my colonoscopy in too, because you're going to survive surgery if we have to do it. So until you can't handle the next step, I would continue screening.

Host: You make such a great point there. I think, Doc, because basically what you're saying is we're not all created equal. Not all 70 and 80-year-olds are alike, right?

Jed Freeman, MD: Absolutely. You're absolutely correct, Joey. And I think you hit the nail right on the head. There are very fit 80-year-old people in their 80s that, you know, we call it the new 70s. The 70-year-olds, we call the new 60 or 50. I think that's real and I think that people are much more physically fit and are going to live a long time and live well a long time.

Host: Yeah, as you say, it is real. It's not just something you see on a bumper sticker, right?

Jed Freeman, MD: Absolutely.

Host: And finally, in summary here, Doctor, for those joining us that are for whatever reason still hesitant about getting screened, maybe they're stubborn, maybe they're scared, they're leery, how do you convince them to just go ahead and get it done? Because as we've both attested to from personal experience, the colonoscopy gets a bad rap. It's a big nothing, right?

Jed Freeman, MD: The better way to look at it is you can always come make an appointment with me if you don't get your colonoscopy, And that will be much more regrettable than just having a colonoscopy. Trust me.

Host: Very well said. Perfectly put right there. Well, folks, we trust you are now more familiar with colonoscopy screenings. Get it done sooner rather than later. Dr. Freeman, keep up all your great work. Such sound advice. Hopefully, people heed your warning and thanks so much again.

Jed Freeman, MD: For having me, Joey. Hopefully, this reaches a lot of people and we've managed between the two of us to convince them to get it done.

Host: That is what it's all about. Well, for more information, we ask that you please visit carsonvalleyhealth.org. Also, please make sure to subscribe to our podcast, share and connect with us on social media and stay tuned for more engaging discussions just like this one. If you found this episode helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Valley Vitals. Let's move mountains.