When my sister was diagnosed with late stage colorectal cancer at age 43, my siblings and I were told that we each needed to get a colonoscopy. I was only 36, but I knew that the procedure was necessary. So the night before the test, I went through the infamous colon cleansing prep and arrived at the clinic the next morning thinking that I was ready to go. My nurse approached me and said, “Who is picking you up after the procedure?” Thanks to my inability to read directions, I was soon on the phone to my husband executing an alternate plan.
Getting sidetracked for a bit may have helped delay the deer-in-the-headlights effect, but eventually, apprehension must have shown brightly in my eyes. Dr. Robert Madoff (or Rob as he often tells people to call him) walked into the room with a wonderful smile. He put on classical music, grabbed my hand, looked into my eyes and said, “We are going to take that fear out of your eyes in just a few minutes.” And he did.
I’m honored to introduce the second doctor on our “Ask the Doctor” team.
Robert D. Madoff, M.D., F.A.C.S.
Professor of Surgery and Chief of the Division of Colon and Rectal Surgery
University of Minnesota
Robert D. Madoff, M.D., F.A.C.S., was born in Boston in 1953 and received his B.A. from Harvard University in 1975 and his M.D. from the College of Physicians and Surgeons at Columbia University in 1979. He served his internship, residency, and fellowship at the University of Minnesota School of Medicine.
Dr. Madoff is Professor of Surgery and Chief of the Division of Colon and Rectal Surgery at the University of Minnesota, and holds the Stanley M. Goldberg, MD Chair in Colon and Rectal Surgery. He is Editor-in-Chief of Diseases of the Colon & Rectum, and has served as a Co-Editor of the journal from 2001-2007. He is a board member of the American Board of Colon and Rectal Surgery. Dr. Madoff is the Director of the William C. Bernstein, MD, Family Cancer Registry at the University of Minnesota. From 2001-2008, he served as a member of the Residency Review Committee of the Accreditation Council for Graduate Medical Education for Colon and Rectal Surgery. Dr. Madoff served as the director of the University of Minnesota’s Division of Colon and Rectal Surgery’s annual continuation course, Colon and Rectal Surgery: Principles and Practice from 1990-2005.
Dr. Madoff has published over 90 academic research papers in peer-reviewed medical journals and has authored or co-authored more than 40 textbook chapters. His scientific interests include colorectal cancer, benign colorectal disease, fecal incontinence, and anal intraepithelial neoplasia.
Q. Dr. Madoff, one of the things we are reviewing is the impact fitness and nutrition may play on cancer diagnosis and survival. It is always interesting to hear what top doctors think about this subject and what they do in their daily life. What can you share with me about your own fitness and nutritional habits throughout your life? And, what are your thoughts about their impact on colon cancer diagnosis?
A. I’ve never been a fitness buff per se, but I’ve done regular exercise since I was in college. I have always tried to maintain an active and healthy life. Today, I’m very fit and I maintain this lifestyle by doing a variety of things such as running, rowing, cycling and skiing.
Nutritionally, I’ve migrated from a typical high meat, high fat “Western” diet over the last few years to what would now be described as a “Mediterranean” diet-many more vegetables, less meat, and less dairy than I used to eat.
One message I think that is important to convey is that you can’t control everything by doing everything right. People feel cheated when they live the healthy lifestyle and get sick. Individuals can make good choices to improve their health – but some still get cancer. Certainly, a healthy lifestyle has its own benefits, but individuals should neither blame themselves for becoming ill, nor have unrealistic expectations that living healthfully guarantees that no illness can ever occur.
Q. I had an interesting conversation with a colon cancer survivor about how sometimes you can almost see cancer in people’s faces. What are your thoughts around this?
A. Individuals with very advanced cancers often look malnourished and chronically ill, but the look is not absolutely specific to cancer. Most cancer patients, and especially those diagnosed early, look indistinguishable from comparable healthy individuals.
Q. Recently, one woman wrote to us and asked what our thoughts were about the association between cancer and people who work in salons. While I’ve seen multiple studies, including one around increased breast cancer rates with Vietnamese women working in salons in the Bay Area, I haven’t seen a consistent ruling on it. The American Cancer Society, for example, recommends reduced exposure to chemicals based on studies with laboratory animals.
There are also studies which state that some chemicals pose no risk and some may even be beneficial. With four advanced cancers in my own immediate family, we were also told that those cancers had no environmental basis. Your thoughts?
A. It is really difficult to prove environmental associations with cancer in most cases-with cigarette smoke being one obvious exception to this rule. I am unaware of convincing data confirming an association between hair salon work and colorectal cancer. There is more data to suggest an association with ‘typical’ American dietary habits, and quite convincing data about genetic factors.
Q. With colorectal cancer, there are just as many women diagnosed as men. Do you see a difference between the sexes in screening, early detection or survival rates?
A. Men and women are equally affected by colorectal cancer, and survival is comparable stage for stage between the sexes.
Q. Another interesting topic that has come up is the incidence of colorectal cancer diagnoses in women who are pregnant. We’ve heard that hormones may play a role in speeding up the cancer. Do you agree?
A. Fewer than 300 cases of colorectal cancer in pregnant women have been reported, though many more cases have gone unreported. The diagnosis is often difficult to make because the symptoms are often attributed to the pregnancy. Both estrogen and progesterone receptors have been found in some colorectal cancers, but their actual relationship to cancer growth has not been shown.
Q. Is there an association between colorectal cancer and women who choose not to breast-feed, or choose not to breast-feed by a certain age?
A. That is an important issue in breast cancer, but its relationship to colorectal cancer is unknown.
Q. Dr. Madoff, in your role as the head of the University of Minnesota program and in the work you have done with the CDC, I know you are always on top of research and developing topics. What are your top 1-2 items today for research?
A. We’ve made incredible advances in our understanding of the molecular basis of colorectal cancer, and we continue to see incremental advances in surgical techniques and biological and chemotherapy. We could make a quantum leap forward if we could better understand which patients truly needed additional therapy, and which tumors responded to what specific agents. But as a practical matter, if we could get our entire population screened, we would see dramatic improvements in colorectal cancer incidence and survival.
Q. What made you want to become a colorectal surgeon?
A. I trained in general surgery, and subspecialized in colorectal surgery because the field deals with a broad range of conditions that can be successfully treated. I was especially drawn to the opportunity to use advanced surgical techniques to improve surgical outcomes.
Q. What does “Get Your Rear in Gear” mean to you?
1. Be attentive to what you are supposed to do for your own health and do it.
2. Get screened-no excuses.
2. Be attentive to your family history and take care of your family. Speak to your doctor or see a genetic counselor if you have a lot of cancer in your family– especially if you have a lot of one type of cancer.
4. Take care of your friends. Get them to address their medical issues, particularly if they are having problems.
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