Updated on May 23, 2024 | Featured, Psychiatry
For a patient and their loves ones, preparing for an organ transplant is never easy, and the same holds true for someone considering donating an organ. Mount Sinai’s transplant psychiatry program is one of many resources there to help with the process and, in the end, help save lives.
Mount Sinai Transplant is a premier program for organ transplantation, offering comprehensive treatment for patients who desperately need organs such as hearts, lungs, kidneys, and livers. Among the program’s renowned specialists are transplant psychiatrists who are specially trained to help both organ recipients and living donors.
Ambika Yadav, MBBS
“Across the United States, about 100,000 people require an organ transplant. There’s a huge need,” says Ambika Yadav, MBBS, Assistant Professor, Psychiatry, at the Icahn School of Medicine at Mount Sinai, who specializes in transplant psychiatry, focusing on liver and kidney donors and recipients.
“The goal of transplant psychiatry is to mitigate whatever psychosocial risks exist so we can help as many people as possible get the organs that will save their lives,” she says.
Transplant Psychiatry at Mount Sinai
Mount Sinai’s transplant psychiatrists are based at the Recanati/Miller Transplantation Institute, where they work closely with other members of the transplant team. They provide a range of services for organ recipients and for living donors who choose to donate a kidney or portion of a liver. Those services include:
- Evaluating a patient’s suitability as a transplant donor or recipient
- Establishing treatment plans for patients with preexisting psychiatric conditions
- Helping patients develop coping skills and manage expectations around organ transplantation
- Managing psychiatric symptoms that can arise as a result of surgery or medication side effects
- Dealing with complicated emotions after transplant
Helping Organ Recipients Prepare for Transplant
All transplant recipients receive an extensive medical and psychosocial evaluation to determine their suitability for transplantation. Typically, a transplant social worker provides the initial psychosocial evaluation. But transplant psychiatrists often get involved to further assess patients and mitigate any risks.
The goal of that assessment isn’t to rule out whether a person is a suitable candidate for a new organ. Rather, the transplant psychiatrists focus on identifying factors that might cause setbacks and find ways to manage those factors.
“Our goal is always to optimize patients for organ transplant. By identifying risks, we can come up with a plan ahead of time so they can get the organ they need and continue to have a life,” Dr. Yadav says.
For example, when patients have diagnoses such as anxiety or depression, psychiatrists can work with them to develop a treatment plan to reduce the risk that symptoms will get in the way of their transplant recovery. Psychiatrists can also come up with plans to support patients with alcohol use disorder or other substance use disorders, a common history among patients with liver failure.
“In those cases, we’ll do a risk assessment of the severity of their substance use disorder and determine how we can best help prevent them from relapsing so they can be good stewards of their new organ,” Dr. Yadav says.
When possible, these meetings happen in an outpatient setting. But in many cases, patients are evaluated for transplant after they become critically ill and so are already in the hospital. “Because Mount Sinai is a major transplant center, many patients are transferred here because they are surgically complicated or otherwise high-risk,” Dr. Yadav says. She and her colleagues meet regularly with hospitalized patients to assess their needs and help them prepare for transplant.
Managing Life After Organ Transplant
Psychiatrists also help people manage issues that arise after an organ transplant. Agitation and delirium can be side effects of surgery, and immunosuppressant medications that prevent organ rejection can cause psychiatric side effects and may also interact with other psychiatric drugs in complicated ways, according to Dr. Yadav.
“Community psychiatrists may not have much experience managing those psychiatric side effects and interactions,” she says. “Once a patient is stabilized after transplant, we can refer them to a community psychiatrist and provide our recommendations for managing their treatment.”
Psychiatrists also help patients deal with complicated emotions following a transplant. Patients might feel guilty or unworthy after receiving an organ from a deceased donor. They may expect life to be completely different after a transplant and feel let down by ongoing medical challenges and other life stressors. “We can help people manage their expectations and find ways to cope,” Dr. Yadav says.
Supporting Living Organ Donors
On the other end, transplant psychiatrists play a key role in assessing living donors and helping them prepare for the procedure. Living organ donors can donate a kidney or a portion of their liver to recipients—including friends and family members, and in some cases, anonymous recipients. Psychiatrists screen patients for preexisting psychological conditions that could affect their decision and well-being, and ensure they understand the risks they’re taking.
Increasingly, living donors contribute kidneys in “paired exchanges”—for example, a donor who is not a match for his wife may donate to a stranger on the waiting list, while someone related to that stranger donates to the first man’s wife. Such paired exchanges can involve multiple steps of exchanges. “Given the intricacies and the many points at which things might not go as planned, we hold these patients to a higher standard and make sure they know what to expect,” Dr. Yadav says.
Donating an organ is a big decision. “These are people who are completely healthy, undertaking a surgical procedure with zero benefit to themselves,” Dr. Yadav says. Mount Sinai’s transplant programs go above and beyond to keep living donors’ well-being at the forefront. “Our living donor team is really special. They put the donor first, and always prioritize their needs separate from the needs of the organ recipient,” she adds.
Moving Transplant Psychiatry Forward
Dr. Yadav and her colleagues are also engaged in research to improve their approach to assessing patients and mitigating psychosocial risks.
“As a major transplant center, Mount Sinai has many complicated cases and we have a lot of data regarding our risk assessments and patients’ psychosocial outcomes,” she says. “We’re always trying to use data to come up with better assessment tools and ultimately improve outcomes for patients.”
Transplant psychiatry is a subspecialty of the Consultation Liaison Psychiatry services at the Icahn School of Medicine at Mount Sinai. Learn more about Mount Sinai Transplant and Living Donor Transplantation.
Updated on May 24, 2024 | Featured, School
Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai, addressing the school at the 55th Commencement ceremony.
Cloudy skies could not dampen the excitement of the class of 2024 of the Icahn School of Medicine at Mount Sinai, who had gathered at the David Geffen Hall at Lincoln Center for their Commencement on Friday, May 10. It was, after all, a milestone of their medical school journey—one that began right as the COVID-19 pandemic took off in New York City.
“You arrived here nearly four years ago, when New York City was under siege,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of Icahn Mount Sinai. It was a class that experienced major disruptions to coursework, but also one that witnessed how physicians can be challenged to care for patients and deal with viral outbreaks. “At Mount Sinai, you will forever be known as the ‘pandemic class,’” Dr. Charney said, to much laughter.
At the 55th Commencement of Icahn Mount Sinai, degrees were granted to 191 recipients: 115 MDs, 57 PhDs, and 19 dual degrees—eight MD/PhD, two MD/MPH, and nine MD/MSCR. (Master’s degrees will be conferred at a separate ceremony in June.)
The journey of the class of 2024 was a challenging one: starting medical school completely remotely, learning anatomy through what felt like a video game, and getting to know classmates through a computer screen, recalled Candida Damian, MD, who gave one of the student Commencement speeches. These challenges were made harder by isolation as lockdowns happened during COVID-19 outbreaks. However, she quipped, “Like Mount Sinai says, ‘We Find a Way.’”
Jumping into the future is daunting, but that’s because the graduating class stands at the frontiers of science and medicine, noted Sally Claridge, PhD, who gave the other student Commencement speech. “You cannot look in the back for the answer key; you’re writing the textbook,” she said. “Now that we have made it here, to this auditorium, to this moment, it is still inspiring and overwhelming because across all of us graduating today, we have now already written ‘the textbook’ many times over and then some.”
In this year’s recap, hear from various students about their time at Icahn Mount Sinai and the memories they’ll treasure as they embark on the next steps in their medical and research careers.
Ava Adler, MD
Next step: General surgery residency at Mount Sinai
During one of our Objective Structured Clinical Examination sessions where we practice being a doctor, my first time going in I was very nervous. I tried to sit on the stool and it completely came out from under me and I fell on the floor. I was so embarrassed and so upset about it, and all my friends were there and said, ‘It’s OK.’ They told me to brush it off and said it will get better. It was a very funny but also very memorable moment for me. I’m definitely not the same person as I was when I first started. Being around patients and seeing how it’s a privilege to be there for them, knowing the difference you can make by giving them a smile, giving them an ounce of happiness during a hard time, it is so incredible that it makes every single day worth it.
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Michael Fernando, PhD
Next step: Postdoctoral fellow at Rockefeller University, New York City
It is a rainy day, but we’re all here celebrating big splashes that we’ve done at the Icahn School of Medicine at Mount Sinai. I’ll always cherish all of the hard work that we’ve collectively done to advance science and medicine, and the hours that we’ve spent in the lab pursuing development of ourselves both personally and professionally. I’d like to thank my advisors, Kristen Brennand, PhD, and Paul Slesinger, PhD. I owe all of my success in the lab and outside the lab to them, and the cultures that they’ve fostered within their scientific environments.
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Arman Azad, MD
Next step: Emergency medicine residency at University of California, Los Angeles
I can’t believe it: I’m going to be a doctor! It’s been four crazy years—crazy fun years. I’ve met the best people, and I think I’m ready. Mount Sinai just has the best medical students in the world. They’re all so smart, but they’re also just the kindest, warmest people. And our staff, our faculty, our professors, everyone has been just rooting for us for so long. I’m going to miss them so much. I’ve learned that it’s important to focus on your studies and your work, but also on yourself and the relationships with the people around you. That’s one thing we had the space to do and I’m really thankful for it.
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Ning Ma, PhD
Next step: Postdoctoral fellow at Mount Sinai
Something I’ve learned is to never give up. If you never give up, you will achieve something. It’s what kept me successful in getting this degree. At the beginning, it was challenging to figure out the project—what’s the hypothesis of your research, literature review, and back-and-forth with your mentors. But the key is to always have a passion for what you want to pursue.
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Candida Damian, MD
Next step: Triple board residency at Brown University, Providence, Rhode Island
I’m incredibly grateful and excited for the future. It’s been a long journey, and I can’t wait to get to work! In the beginning, I faced challenges and often doubted whether I was good enough to become a doctor. I overcame these feelings by being vulnerable and seeking out support. My family, my mentors at Mount Sinai, and most definitely my classmates all helped me along the way.
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Amara Plaza-Jennings, MD/PhD
Next step: Neurology residency at Mass General Brigham, Boston
I’m feeling very grateful and excited for everything that I’ve accomplished over the past eight years at Mount Sinai. I learned that I’m capable of more than I’ve thought I was. If there’s something I don’t know, I have the ability to figure it out and to teach myself new skills.
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Nicola Feldman, MD
Next step: Pediatrics residency at Boston Children’s Hospital
I’m in awe that this moment has actually come, and that these next steps are actually happening. It’s amazing to look in the audience and see so many family and loved ones of my classmates, and that they are all celebrating us. About a year ago, my uncle unexpectedly passed away. It would be really amazing for him to be here today—he’s a lot of fun—and we’d be having even more fun with him here. That’s something I’m missing today, even though overall it’s a really happy day.
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Megan Schwarz, PhD
Next step: Postdoctoral fellow at Mount Sinai, then joining the biomedical research industry
During the pandemic, I was stuck at home, and I couldn’t be in the lab except to check on some mice. My PhD advisor, Ernesto Guccione, PhD, called me up. We’re a cancer lab, and he asked if I wanted to do this unrelated COVID-19 project. He said it will probably be done by summer of 2020. Fast forward to June 2022, we’re publishing a paper, involving many clinicians, patients, institutes—many continents involved—and that all started with this phone call because we were bored. It taught me that I’m capable of adapting and collaborating.
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Benjamin Oseroff, MD
Next step: Neurology residency at Mount Sinai
A highlight of my time at Icahn Mount Sinai was having my daughter born 10 days before orientation. Carrying her across the stage at graduation feels like such an achievement; I feel so fortunate. I’d like to thank my wife—she’s done so much for me and our family.
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Ethan Veit, PhD
Next step: Looking for job opportunities
I’m so thankful for my Principal Investigator, Matthew Evans, PhD; all of the graduate school administration; and Basil Hanss, PhD, Senior Associate Dean for Student Affairs and Career Development, who was one of the first people involved in recruiting me to Mount Sinai. One of my biggest achievements was being able to participate in the numerous Virus-Host Symposiums and also win the best presentation award at that symposium.
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Rishab Revankar, MD
Next step: Intern year at University of North Carolina at Chapel Hill, dermatology residency at University of Virginia
One of my best memories at Mount Sinai was being able to have our White Coat Ceremony. Usually, it is held in the first week of medical school, but we had it between our second and third year because of COVID-19. That was one of the first times we were all together in person, and it was an amazing moment to relish our resilience and togetherness. I came to Mount Sinai to pursue an MD degree, looking to be a doctor, but I feel like I got so much more than that. I got an understanding of what it means to be a physician-leader. I want to make Mount Sinai proud by being a good doctor, but also be a good leader in my community and in society.
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Navigate with the arrows to learn more about the Class of 2024 and their time in medical and graduate school.
Updated on May 16, 2024 | Community, Diversity and Inclusion, Featured
Mount Sinai’s Post-Baccalaureate Research Education Program (PREP) helps prepare scholars who are interested in biomedical careers to apply successfully for doctoral programs. PREP scholars take graduate level courses, participate in career development activities, and receive personalized research mentorship. They spend one or two years in the program, with most of the experience taking place in laboratories conducting biomedical research.
Mount Sinai has a long, rich history with PREP, beginning 23 years ago when Terry Krulwich, PhD, received the first National Institute of General Medical Sciences funding for the program and directed it for 18 years, before leadership was transitioned to Eric Sobie, PhD.
Today, the program is led by Kirk Campbell, MD, Irene and Dr. Arthur Fishberg Professor of Medicine and Professor of Pharmacological Sciences at the Icahn School of Medicine at Mount Sinai and Inaugural Director of the Mount Sinai Center for Kidney Disease Innovation, and Jamilia Sly, PhD, Assistant Professor, Population Health Science and Policy, who recently renewed Mount Sinai’s grant. The PREP program focuses on growing a diverse research community and provides a launching pad for students pursuing their PhD or MD-PhD degrees.
More than a decade ago, Principal Investigators from Mount Sinai, Albert Einstein College of Medicine, and the University of Pennsylvania began an annual research symposium in May, with the programs rotating hosting duties. This year the schools participating expanded to include Cold Spring Harbor Laboratory and Weill Cornell Medical College.
Organizers say programs like PREP, which focus on developing a diverse pool of well-trained postbaccalaureates ready to engage in rigorous biomedical research-focused doctoral degree programs, have never been more important in today’s research landscape.
Mount Sinai’s Graduate School of Biomedical Sciences hosted the PREP Northeast Regional Symposium for 2024 on Monday and Tuesday, May 6-7.
The event began with a welcome reception during which students and faculty from all five institutions shared their experiences with their PREP programs. At one point, the room filled with excitement when Kaya Adelzadeh, a PREP scholar at Mount Sinai, found out she had been accepted to the MD-PhD program at the University of California, Davis. Since August 2022, Ms. Adelzadeh, who earned a Bachelor of Science in Biomedical Engineering at Boston University College of Engineering, has been a post-baccalaureate research assistant in the orthopedic research laboratories of James Iatridis, PhD, and Woojin Jan, PhD. She was cheered on by her colleagues and by PREP leaders, a reminder of what the PREP scholars are working to accomplish.
Dr. Campbell and Dr. Sly, along with Marta Filizola, PhD, Dean for the Graduate School of Biomedical Sciences, and Talia Swartz, MD, PhD, Senior Associate Dean for MD-PhD Education, delivered opening remarks. They discussed the history of the symposium, welcomed new participants, and encouraged the PREP scholars to apply for the participating institution’s PhD and MD-PhD programs.
Scholars from the five institutions shared their oral presentations. The two scholars from Mount Sinai were Taelor Matos, who shared research she is conducting with Jessica Ables, MD, PhD; in her presentation “Axonal Plasticity in Learning”, and Tony Valencia, who shared research he is conducting under the mentorship of Benjamin Chen, MD, PhDs, in a presentation “Investigating Asymmetry of HIV-1 Envelope Protein and its Impact on Packaging.”
In her keynote address, Yasmin Hurd, PhD, Director of the Addiction Institute at Mount Sinai, discussed the neuroscience of addiction. She highlighted the role of the endocannabinoid system in neuronal development, differential psychological effects of cannabinoid components and provided insights into therapeutic utility of cannabidiol in opiate use disorder.
Dr. Hurd discussed her own career journey, noting data regarding the lack of diversity in the scientific workforce. She encouraged students not to let data about who is or isn’t a scientist determine the path for their academic training and career goals. She reminded students during the question and answer session that being a good scientist doesn’t mean knowing all the answers to scientific questions, rather that a good scientist asks a lot of questions about the things they do not know.
A PREP alumni panel featured former scholars from Mount Sinai and Albert Einstein College of Medicine. The panel was moderated by Tia Robinson, a current Mount Sinai PREP scholar, and included alumni Yoselin Paucar, Stephen Ruiz, Bryan Ticoche, and Jeury Veloz. Scholars from each institution had the chance to ask questions and inquire about the experiences of PREP alumni both during and after their programs.
Two rounds of poster presentations gave PREP scholars opportunities to share their research with peers from other schools and to practice their presentation skills. Mount Sinai had eight scholars participate in the poster sessions. This was followed by an awards ceremony recognizing the PREP scholars with the top oral and poster presentations. Alexandra Ramirez, University of Pennsylvania PREP, received an award for the Best Oral Presentation. She has been accepted to Icahn Mount Sinai’s PhD in Neuroscience program as a student starting this fall. Kendall Moore, Icahn School of Medicine PREP, won for Best Poster Presentation.
In closing remarks, Dr. Campbell and Dr. Sly reiterated why collaboration is so important between PREP programs, and they encouraged scholars to continue their great work and to look forward to next year’s symposium.
Learn more about our PREP program to see how it can guide your journey to joining a doctoral program in biomedical sciences.
Updated on May 17, 2024 | Featured, Research
Top, from left: Rheoneil Lascano, MSN, FNP, Vishal Kapur, MD, David Song, MD, Prakash Krishnan, MD, FACC, FSCAI, Raman Sharma, MD, and Moinuddin Syed, MBBS. Bottom, from left: Dr. Song, Samin K. Sharma, MD, Annapoorna S. Kini, MD, Dr. Kapur, Dr. Krishnan, and Raman Sharma, MD.
A team at the Mount Sinai Fuster Heart Hospital has successfully performed the first procedure in the United States using an innovative drug-eluting, below-the-knee resorbable scaffold.
The team was led by Prakash Krishnan, MD, FACC, FSCAI, Assistant Professor, Medicine (Cardiology and Radiology), and Director of Endovascular Interventions at The Mount Sinai Hospital’s Cardiac Catheterization Laboratory. The Food and Drug Administration approved the device in April.
“FDA approval of this long-awaited new technology of a dissolving bioabsorbable scaffold is a remarkable addition in the treatment of lower limb arterial blockages where balloon and regular stents results are suboptimal, and these scaffolds are poised to restore blood flow for a long time,” says Samin K. Sharma, MD, Director of Interventional Cardiology for the Mount Sinai Health System. “We are proud of Dr. Krishnan, who played a major role in getting this innovative device approved.”
More than 20 million people in the United States are living with peripheral artery disease (PAD) yet there have been limited treatment options. The new procedure is the first to treat people with chronic limb-threatening ischemia (CLTI) below-the-knee, a severe stage of PAD. The goal is to prevent amputation, heart attack, and stroke among these patients.
For individuals battling chronic limb-threatening ischemia, blocked vessels restrict blood flow to the lower extremities. While balloon angioplasty serves as the current standard of care, recurrent blockages often necessitate further intervention.
Unlike traditional metal stents, the drug-eluting below-the-knee resorbable scaffold is a temporary implant. Crafted from naturally dissolving material, this scaffold gradually disappears after opening a clogged artery, presenting a significant advancement in sustaining open arteries below the knee.
“A resounding applause to the team at Mount Sinai Fuster Heart Hospital for their relentless pursuit of excellence in advancing patient care,” said Dr. Krishnan. “Many times doctors tell patients amputation is the only option, so this new technology is a game changer.”
May 8, 2024 | Diversity and Inclusion, Featured, Your Health
As the country celebrates the cultural diversity of Asian Americans, Native Hawaiians, and Pacific Islanders in May for Asian/Pacific American Heritage Month, it is time for a reminder for members of those communities to keep up with their cancer screenings. Specifically, experts at the Mount Sinai Health System are calling on Asian American and Pacific Islander (AAPI) people to be vigilant about breast and colorectal cancer screenings.
“Breast cancer is the leading cause of cancer death for women worldwide, and the second leading cause of cancer deaths for women in the United States,” says Desiree Chow, MD, Assistant Professor of Medicine (General Internal Medicine) at the Icahn School of Medicine at Mount Sinai. “However, for Asian Americans and Pacific Islanders, these groups have been found to consistently score lower than their non-Hispanic white counterparts for breast cancer screening.”
A similar theme echoes in colorectal cancer, notes Sanghyun (Alex) Kim, MD, Chief of Colon and Rectal Surgery at Mount Sinai Beth Israel, Mount Sinai-Union Square, and Mount Sinai Morningside. “Not only are we seeing lower screen rates for AAPI communities in colon cancer, but over the last 20 years, we’ve seen a twelvefold increase in colon cancer rates in these populations,” says Dr. Kim. “This is why it’s very important for physicians who see AAPI patients to be proactive in reminding them to be screened regularly.”
Left: Desiree Chow, MD. Right: Sanghyun (Alex) Kim, MD.
What are the disparities in cancer screening rates among different races/ethnicities?
While breast and colorectal cancer screening rates have steadily grown over the years, Asian American and Pacific Islander (AAPI) populations screen at a lower rate than the non-Hispanic white population. Here’s a snapshot of how each group screens for those cancers from 2008 to 2018, according to a report from the Centers for Disease Control and Prevention (CDC).
Source: Health, 2019, National Center for Health Statistics, CDC
As the COVID-19 pandemic hit, screening rates declined in 2020—by as much as 97 percent for breast cancer for AAPI communities compared with the previous five-year average, according to an April 2023 memo from the CDC. To address the decline in screening among certain populations, the agency is partnering with health care providers to resume timely use of preventive tests for early detection of breast, cervical, colorectal, and lung cancers.
Drs. Chow and Kim share their thoughts on the importance of being up to date with breast and colorectal cancer screenings, respectively.
Why are we calling for our AAPI communities to be vigilant about breast and colorectal cancer screening?
Dr. Chow: In general, Asian American women tend to have dense breasts, which is an independent risk factor for breast cancer and it decreases the ability for mammograms to detect small lesions. So in addition to the higher risk, Asian Americans having lower rates of screening, which is concerning and needs to be addressed.
Dr. Kim: Some 20 years ago when I went into colorectal surgery, the number of surgeries for colorectal cancer for Asian Americans was lower than for their white, Hispanic, or Black counterparts. Since then, that number has increased 12 times—not 12 percent—in America. On top of that, AAPI individuals are known to be less up to date on colorectal screening. Part of it could be a greater focus on other kinds of cancers—such as stomach and liver—instead, and part of it could be attributed to a tendency to play down illnesses and not be very good at following up with doctors.
Who should be thinking about screening? How often should it be done?
Dr. Chow: The United States Preventive Services Task Force (USPSTF), the body that sets guidelines for screening in the country, has recently updated their recommendation for women to start screening for breast cancer at the age of 40, every two years. However, there are other factors that could push one to start screening earlier or screen more frequently, and that is a conversation to have with a health care provider. These could include having a family history of breast cancer or having a genetic predisposition to breast cancer, such as a BRCA gene mutation.
Dr. Kim: The USPSTF recommends screening for colon cancer as early as the age of 45. Colonoscopies are the gold standard and would only have to be done every five to ten years. There are stool-based tests, which would have to be done every one to three years to provide comprehensive detection. This recommendation is the same for both men and women, although men have a higher prevalence of colon cancer. If a patient has a family history of cancer—could be of various types, including pancreas, stomach, liver, breast, endometrial or bladder—that person should consider early screening as well. A simple guideline would be: whatever age the family member had the cancer, the patient’s screening should be done at an age 10 years below that—thus for a patient whose family member had pancreatic cancer at age 50, the patient should get a colonoscopy at age 40.
What is involved in breast and colorectal cancer screenings? Is it painful/time-consuming?
Dr. Chow: The mammogram is the only screening method that has been shown to decrease mortality related to breast cancer. The best way to get a mammogram would be to get a referral from your primary care provider, or your OB/GYN. Under the Affordable Care Act (ACA), public and private insurance must provide preventive women’s health screening with no cost sharing. For those who do not have health insurance, there are ways to obtain low- or no-cost mammograms, as New York City and New York State have programs, such as free mammogram buses, that provide such screening.
The procedure itself is pretty simple, and a technician helps the patient position their breast in a machine that takes images of the breast tissue. Most women do not report significant pain—perhaps some discomfort as they might have to hold certain positions for imaging. But from start to finish, a patient could be in and out of the clinic in about 30 minutes.
Patient service representative Monet Douglas at the Mount Sinai Mammogram Screening Unit Truck
Dr. Kim: For stool-based tests, such as Cologuard®, a patient sends a stool sample to a lab, where it’ll be studied to see if it contains blood products and/or polyp components. However, such tests might miss some polyps, hence a need to do them more frequently. A colonoscopy, in which a tube with a camera is put into the rectum and colon, can not only discover polyps and cancerous tumors, but also treat and remove them. Under the ACA, colorectal cancer screening must be covered by public and private insurance without cost-sharing.
A colonoscopy does involve some preparation. The patient is instructed not to eat for about half a day, and to take a concoction that would rinse out the bowels. For the actual procedure, the patient is put to sleep and the doctor would examine the colon and rectum for polyps or signs of cancer. If polyps are removed, or cancer tumors are biopsied, there might be some pain or bleeding afterwards, but for most patients, colonoscopies are very well tolerated. The actual procedure itself takes about 30 minutes, although a patient might take an hour to recover after the exam.
What might be the consequences for not being vigilant about breast and colorectal cancer screening?
Dr. Chow: Missed breast cancer is the biggest consequence. By the time women feel a lump in their breast, the cancer is at a later stage, is harder to treat, and may have already spread to other parts of the body. The point of screening is to detect these cancers at an early stage, when they are still easily treatable and even curable. At an early stage, a patient is more likely to be offered breast conserving surgery, where only a portion of the breast is removed, rather than a mastectomy, where the entire breast is removed.
Dr. Kim: The thing about colon cancer is that it is a preventable cancer. If you can screen and detect signs before it presents as colon cancer, you can avoid more intensive treatment. When the cancer has penetrated into deeper layers of the colon, the surgery needed means you’ll lose more length of colon. If the cancer has advanced even more and spreads out of the colon, you will need not only surgery, but chemotherapy and radiation, and these are very intense on the body. For patients who get rectal cancer—that risk is higher for smokers—if not picked up early, there’s a chance to lose the anus, and that could mean needing a colostomy bag—a pouch in which stool comes out of the abdominal wall.
Any other advice for our AAPI communities to stay on top of their cancer screening?
Dr. Chow: I’ve noticed that some segments of the AAPI population might be less willing, or less able, to access health care. They should still try to form a close relationship with a primary care doctor, so that the doctor is aware of their risk factors and can advise them accordingly. For Asian Americans specifically, there’s a misconception that Asian women don’t get breast cancer as frequently. That’s not so true anymore, as the incidence of breast cancer has been steadily rising since 2000. And lastly, there’s a misconception that if a patient leads a healthy lifestyle, with no family history of breast cancer, they won’t get it. That’s great in that they’re at lower risk, but the majority of breast cancer cases are de novo, meaning the mutation happens for reasons we don’t know. If you meet the guidelines for breast cancer screening and have not done it, do seek it out as soon as you can.
Dr. Kim: I’ve noticed among my Asian patients that the cultural tendency of not wanting to speak up about pain or discomfort is actually working against them for their health. Keeping concerns to yourself hinders proper care. Another thing I’ve noticed is that some—usually older, immigrant individuals—trust their doctors too much and expect their doctors to know and handle everything, while others—sometimes younger, American-born individuals—don’t trust their doctors enough, might have a distrust of the system, or believe they know their body better than the doctor does. Either extreme is not good. The solution to break through to both is patient education and building trust. First, getting information out there about why cancer screening is important helps patients understand the risks. Then, the primary care doctor needs to build a close relationship with the patient, so that the patient actually goes to the screening, but just as importantly, trusts the doctor enough to come back for any follow-ups.
May 2, 2024 | Featured, Your Health
Hepatitis is inflammation of the liver—an organ we depend on to digest nutrients, filter blood, and overcome infection. There are many different types of hepatitis, including hepatitis A, B, C, D, and E, with symptoms that include fever, abdominal pain, nausea, jaundice (yellowing of the skin and eyes), and fatigue.
However, most people with chronic viral hepatitis do not experience any symptoms and often do not know they have the infection even while it silently damages their liver. Hepatitis B and C are among the most common types of hepatitis. While they both affect the liver, they are very different.
Douglas Dieterich, MD
In this Q&A, Douglas Dieterich, MD, Professor of Medicine (Liver Diseases) and Director of the Institute for Liver Medicine at the Icahn School of Medicine at Mount Sinai, explains the differences between hepatitis C and B, how they are transmitted and treated, who is at risk, and more.
What is the difference between hepatitis C and B?
Hepatitis C virus (HCV) and hepatitis B virus (HBV) are vastly different viruses. Hepatitis B is highly contagious through sex, using drugs with shared straws and needles, blood transfusions, and even saliva, which can put people living in the same household at risk. The good news is hepatitis B is entirely preventable with a vaccine, which has been around since 1991. The Centers for Disease Control and Prevention now recommends universal vaccination for hepatitis B for all adults under 60 who did not get vaccinated by their pediatrician starting in 1991. People over 60 can also request the vaccine and should, especially if they have ongoing risk factors. If people do get hepatitis B, there are very good drugs to control it and to suppress the virus down to zero so it doesn’t do any damage or infect others. We also have exciting clinical trials happening to study medications that can cure Hepatitis B.
Currently, there is no vaccine for hepatitis C, which is a different class of virus. It actually belongs to a class that you may have heard of—West Nile virus, dengue fever, yellow fever, and Zika, which has been in the news the last few years. None of those become chronic, however, while hepatitis C does. Over time, it can cause the same liver damage that hepatitis B can, including liver cancer, which can lead to death. The good news is, it’s now easily curable. We have fantastic new drugs for hepatitis C—most patients need to take only 8 to 12 weeks of easy-to-take pills with virtually no side effects and a 99 percent cure rate. It’s absolutely important to find out if you have hepatitis C or B because we can cure hepatitis C and control hepatitis B.
What do I need to know about hepatitis D?
Hepatitis D, also known as hepatitis Delta virus (HDV), is the most severe form of viral hepatitis. This is a type of hepatitis that can only infect people who have hepatitis B. Approximately 70 percent of people who have hepatitis Delta will develop cirrhosis (liver scarring) within 5 to 10 years of infection. This is a much higher and faster progression than for most people with hepatitis C and hepatitis B.
Hepatitis Delta can only function in a body that is also infected with hepatitis B. Not everyone with hepatitis B has hepatitis Delta, but everyone with hepatitis Delta also has hepatitis B. That’s why we recommend everyone with hepatitis B get screened for hepatitis Delta too.
New effective treatments for hepatitis Delta are coming soon and are already available to some patients, depending on their specific health situation. Our providers can screen you for hepatitis Delta and help get you onto treatment if needed.
Who is at risk for contracting hepatitis B and C, and who should get screened?
The CDC recommends all adults be screened for hepatitis B and C at least once in their life, even if they don’t think they have any risk factors. Many people have been exposed but don’t know it. The major method of transmission for hepatitis B, globally, is from mother to infant at birth. Other people who are at risk are those who have never been vaccinated—primarily people born before 1991—and we see that happening now. When people born before 1991 come in contact with people who have hepatitis B, they can catch it quite easily. Hepatitis C is more difficult to catch. The major risks for hepatitis C are having had a transfusion of blood or blood products, such as gamma globulin, before 1992, or using IV drugs or intranasal drugs. Just snorting drugs with a straw is enough to spread Hepatitis C. People who have unprotected sex—especially men who have sex with men—are also at risk for hepatitis C. It’s very important to get diagnosed early so you can get treated and cured. If you know you have ongoing risk factors, you should be screened at least once a year.
Why is hepatitis more common in New York City?
About 48 percent of the people who live in New York City were born outside of the United States. Many of those people come from countries where hepatitis B or C is endemic, and that’s the major risk factor for hepatitis B. Endemic means that a high percentage of people in an area have the disease and therefore the risk of getting the disease is high. The New York City Department of Health and Mental Hygiene estimates that 243,000 New Yorkers, or 2.9 percent of the population, have chronic hepatitis B. The Department also estimates that approximately 86,000 New Yorkers, or 1 percent of the population, have chronic hepatitis C. If we catch viral hepatitis early, we can help you prevent liver scarring and liver cancer.
What is the best way to prevent hepatitis B and C?
The best way to prevent hepatitis B is to get vaccinated for hepatitis B. The CDC now recommends everyone aged 18 to 59 be vaccinated for hepatitis B. If you weren’t vaccinated as a kid, it’s easy to check if you have antibodies to hepatitis B, or if you have hepatitis B, we can treat that. Ask your doctor about testing and vaccination.
Hepatitis C is mostly spread blood to blood. Shared needles—if you’re using IV drugs, and shared straws if you’re using intranasal drugs—things like that—are really high risk for spreading hepatitis C. Getting a tattoo or piercing from an unlicensed technician may also put you at risk if they are not properly cleaning their needles. If you are using drugs, don’t share needles, don’t share straws. And get tested for hepatitis C, because if you have it, we can cure it. Once cured, you can become reinfected with hepatitis C, so it’s very important to continue avoiding infection after getting cured, which means not sharing needles or straws and practicing safe sex, and only getting tattoos and piercings from licensed technicians.
What resources are available at Mount Sinai for screening and treatment of hepatitis?
We have numerous resources dedicated to screening and treatment of hepatitis B and hepatitis C at Mount Sinai. We’re the largest independent liver program in the country. We have liver clinics all over Manhattan and the metropolitan area—from Long Island to Westchester. Our care coordinators will support you from screening through treatment and cure, working closely with your provider to ensure you get the best care.
