How Mount Sinai is Using Artificial Intelligence to Improve the Diagnosis of Breast Cancer

Oct 11, 2023 | Featured, Your Health

Laurie Margolies, MD, a radiologist who is Chief of Breast Imaging at the Dubin Breast Center and Vice Chair, Breast Imaging, Mount Sinai Health System

More and more people are getting mammograms as the population ages, as more younger people are choosing to get screened, and as the benefits of accurate screening and early detection of breast cancer remain clear.

Breast cancer is the most common cancer among women in the United States, except for skin cancer. Each year, about 240,000 cases of breast cancer are diagnosed in women (and about 2,100 in men), according to the U.S. Centers for Disease Control and Prevention.

In response to this growing need, Mount Sinai has expanded its network of breast imaging sites, and  has deployed a new tool: artificial intelligence.

In this Q&A, Laurie Margolies, MD, a radiologist who is Chief of Breast Imaging at the Dubin Breast Center and Vice Chair, Breast Imaging, Mount Sinai Health System, explains how radiologists at the Mount Sinai Breast Cancer of Excellence for Breast Cancer are leveraging the power of artificial intelligence to achieve a more precise diagnosis, which allows surgeons and oncologists to start the right treatment sooner, giving patients the best possible outcome.

How does AI help patients in the diagnosis of breast cancer?

AI is a new tool that gives a second opinion on a mammogram. It assists the radiologist, it does not replace the radiologist. It’s like having a very well trained senior fellow sitting next to you. Multiple studies have shown that when you have radiologists working with AI, you find more breast cancers, and often smaller cancers. What’s great about AI is that it never gets tired, it can’t get distracted. But there’s no substitute for the experience of the radiologist.

How does it help with “call backs”?

This additional review can help radiologists determine instances where there is a very low probability of cancer. This helps to reduce the number of times that patients will be asked to return for another procedure to get a closer look at an area of possible concern, which many know as a “call back.” Fewer than 10 percent of women who are asked to return are typically found to have cancer. But these extra screenings make people anxious, they cost money, and they fill our breast centers with people who don’t need to be there.

How does AI work? What does the patient see?

Patients will not see any difference in the process. As your radiologist is reading your mammogram or sonogram on their computer, they can access a special program that will also review the scan. It takes a few extra minutes. In many cases, AI reviews the scan before the radiologist and highlights areas for the radiologist to pay extra attention.

Who can access this service?

Anyone who receives a mammogram or breast ultrasound performed at Mount Sinai will have access to this AI capability. There is no extra cost to patients.

Learn more about Mount Sinai's Center of Excellence for Breast Cancer

Three Nutrition Tips for a Stronger Immune System

Oct 6, 2023 | Diet and Nutrition, Your Health

Viruses are in the air and all around us, from the common cold to COVID-19. Eating a healthy, balanced diet primes and activates your immune system to fight these pathogens, even before you get sick.

In this Q&A, Taylor Stein, Associate Researcher and Registered Dietitian at The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, discusses what foods you should eat to support your immune system this cold and flu season.

How does nutrition affect my immune system?

If your diet contains a lot of saturated fatty acids, sugar, and refined carbohydrates, you will not have as strong of an immune response compared to someone consuming diets rich in micronutrients, antioxidants, and fiber. Certain nutrients—specifically vitamins A, D, E, and K—are fat-soluble, meaning they are stored in your fat and take time to accumulate, especially vitamin D. These vitamins support different functions of the immune system and are readily available to fight disease in advance.

Does this mean I need to consume these nutrients before I get sick?

Yes. When you are sick, your immune system is scavenging the body for nutrients, and if you don’t have enough fat-soluble vitamins stored, it can take you longer to get better. Additionally, being sick can affect your ability to eat and drink, so it is very important to have a balanced diet at all times to keep up your stores of these vitamins. Alternatively, vitamins that are water soluble, such as vitamin C and those in the B-complex group, cannot be stored, so you should strive to eat lots of these while you are sick. You also need to eat plenty of macronutrients—carbohydrates, proteins, fiber, and fats.

Follow these easy tips for a healthier immune system:

  1. Buy colorful produce (the brighter, the better).
  2. Snack on nutritious, high-fiber foods such as fruits, veggies, cheese, nuts, seeds, whole grains, bean dips, guacamole, etc.
  3. At meal time, fill one quarter of your plate with protein, one quarter with a whole grain or starchy vegetable, and the other half with brightly colored vegetables.

Taylor Stein, RD

What foods are good for my immune system, and why?

Immune system health largely depends on five food groups:

  • Animal meats, fish, dairy products, legumes, nuts, and whole grains. Proteins are the building blocks of cytokines, small proteins that send signals to the immune system telling it where to send white blood cells to fight infections. Since cytokines require different amino acids, you need to eat a variety of protein both from animal and plant-based products. High protein foods contain B-complex vitamins, which are necessary for cell proliferation, which plays an important role in immunity.
  • Brightly colored fruits and vegetables. Apricots, kiwi, blueberries, avocados, carrots, strawberries, Swiss chard, bell peppers, raspberries, red onions and other brightly colored produce are filled with both fat-soluble and water-soluble vitamins and are also a great source of fiber.
  • Fortified dairy products, eggs, and salmon. These are a great source of vitamin D, which helps activate T cells and has other important functions that affect your immune system. You can also get vitamin D in smaller amounts from nuts and mushrooms. Sunlight is also a great source of vitamin D.
  • Nuts, seeds, eggs, legumes, and fish. These all contain disease-fighting minerals, such as zinc, magnesium, and selenium. Pumpkin seeds, almonds, cashews, shellfish, tuna, chickpeas, and lentils are all good sources of these minerals.
  • High-fiber, pre-and-probiotic, and fermented foods. These foods are good for your gut, where more than 70 percent of your immune cells live. High-fiber foods include legumes, fruits, and vegetables. Pre-and-probiotic and fermented foods include yogurt, kefir, and buttermilk. These gut-healthy foods are important in maintaining lymphoid tissue in the gastrointestinal tract that helps fight disease.

What are some easy ways to incorporate these foods into my daily diet?

A great way to get more of these foods is to eat them as snacks. For example, snacking on nuts and seeds, bean or guacamole dip, whole grain toast with avocado, and fruit and cheese are all easy ways to get more of the nutrients that prime the immune system. You also need to include them in your main meals. Each dish should include a good source of lean protein—meats, poultry, or fish—and plant-based proteins such as beans, as well as non-starchy vegetables. A simple rule is to fill one quarter of your plate with protein, one quarter with a whole grain or starchy vegetable, and the other half with brightly colored vegetables.

How do these foods compare to taking supplements?

When it comes to immune system health, it is good to have a food-first mentality. Whereas supplements typically provide only one nutrient, a balanced diet filled with whole foods contains all the micro and macronutrients you need. These nutrients work most optimally when they are paired together and are easier to digest than supplements. However, supplements can be a great tool for someone who struggles to eat a variety of foods or has a condition that reduces their ability to consume or prepare healthy food. Keep in mind that supplements are not regulated by the Food and Drug Administration, so it is important to get a doctor or dietitian’s advice on what supplements you should use.

What else is important for my immune system?

Getting plenty of sleep and exercise will also strengthen your immune system. Sleep plays a vital role in hormone production, regulation, and function, which strengthens the immune system, and plays a role in building cytokines. Exercise creates stress in your body and activates the same pathways that are triggered when you’re sick, and gets your body primed and ready for when it needs to fight a pathogen. Lastly, recent studies have found that mental health disorders are associated with decreased immune function, which leads back to sleep hygiene and physical activity. However, mental health can be the cause and effect of not getting enough sleep or exercise. In any case, physical activity, sleep hygiene, and managing mental health are all important to maintaining a healthy immune system.

Did you know?

  • Orange-colored fruits and vegetables are high in beta-carotene, which the body converts into vitamin A, a fat-soluble vitamin
  • Avocados and kiwis provide vitamin E, an essential micronutrient for building T cells, which play a vital role in fighting disease
  • Green leafy vegetables and cruciferous vegetables, including broccoli, cauliflower, and cabbage, contain vitamin K, another essential fat-soluble vitamin
  • Leafy greens, bell peppers, and oranges contain Vitamin C, a powerful antioxidant that supports immune system function

Read more about Your Health.

Why Does My Baby Cry So Much?

Updated on Oct 5, 2023 | Children's Health, Your Health

A fussy and crying infant can be a tremendous challenge for parents. Just when you get past the stress of childbirth, learn how to feed your baby, your newborn’s weight gain, and possibly deal with a  jaundiced baby, your infant begins to spend more time awake, often fussing and crying frequently. Is your baby experiencing the dreaded colic or is something else wrong?

Jennifer Bragg, MD

In this Q&A, Jennifer Bragg, MD, Director, Mount Sinai Neonatal Intensive Care Unit Follow-Up Program, and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai, explains colic, how parents can tell if their baby may have it, and what to do to soothe a fussy baby.

What is colic?

“True colic” is defined as at least three hours of unexplained crying or fussing, at least three days per week, for at least three weeks in a row. It often starts around two weeks of age, peaks at four to six weeks, and goes away by three to four months. These hours of crying usually occur at a certain time of day, often in the evening hours. When not crying, the baby is usually happy. The crying is often high-pitched and many babies will pull up their legs, almost as if in pain, or turn red in the face. It is equally common in boys and girls, and slightly more common in first-born children.

What causes colic?

It is not entirely known what causes colic. Some believe it is caused by immaturity of the nervous system, while others believe it is caused by something upsetting the baby’s stomach. The most conventional wisdom is that colic is caused by a combination of the two. What we do know is that colic has no ultimate impact on a child’s temperament and personality later in life. Studies have shown that a colicky baby is no less likely to be a pleasant, happy, and well-adjusted child, teenager, and adult.

My fussy baby does not have “true colic.” What else could cause their constant crying? Should I see my pediatrician?

There are many explainable reasons for crying in a baby. Hunger, fatigue, and a dirty or wet diaper are simple, easily fixed causes. There are also some treatable medical problems such as sickness, fever, or pain. Babies also may be particularly fussy if their stomachs are upset due to a food sensitivity or gastroesophageal reflux disease.

Crying accompanied by a fever, vomiting, diarrhea, or runny nose may indicate that your baby is sick. A food sensitivity may be the culprit if your baby’s stool contains blood or mucus or if there is excessive spit-up or vomiting even after switching formula or, if breast-fed, the mother has eliminated certain items (dairy, caffeine, etc.) from her diet. Gastroesophageal reflux disease may be suspected if the baby is upset and appears to be in pain during spit-up and shortly after feeding; this can be treated with medication. Addressing these potential underlying causes of your baby’s crying should curtail the fussiness.

What can parents do to soothe their baby?

To soothe the fussy baby, it may help to use a method that mimics the baby’s environment in the womb. They are often referred to as the 5 S’s:

  • Swaddling, which entails wrapping a baby’s arms tightly to the side
  • Shushing, or using white noise to relax your baby
  • Swinging or rocking your baby
  • Sucking on either the breast or a pacifier may calm your baby
  • Holding the baby in the side/stomach position with a small amount of pressure on their belly can also be helpful

There is no evidence that over-the-counter remedies such a simethicone gas drops or gripe water helps, but they are certainly safe to try and many parents find them beneficial.

If the above does not help, it is important to understand that the crying is not a reflection on parenting skills. If possible, take breaks from the task by seeking help from other family or friends. In time, the crying and fussing will get better.

If symptoms cannot be explained by any of the above, and the crying persists for hours per day and for days or weeks straight, parents should make an appointment with their pediatrician.

Learn more about Your Health.

What Are Dense Breasts and Can They Increase My Risk of Cancer?

Oct 5, 2023 | Your Health

If you have dense breasts, you may worry that it could affect your chances of developing breast cancer—or your outcome of that disease.

Dense breasts are common. In fact, nearly half of all women who are 40 and older who get mammograms are found to have dense breast tissue, according to the National Cancer Institute.

In this Q&A, Stephanie Bernik, MD, FACS, Chief of Breast Service at Mount Sinai West and Associate Professor of Surgery at the Icahn School of Medicine at Mount Sinai, explains how having dense breasts can affect a mammogram and the chances of developing breast cancer.

What are dense breasts?

If your doctor tells you that you have dense breasts, it means that you have a lot of glandular tissue and less fat throughout the breast. You can’t tell if you have dense breasts just by looking at them; you need an imaging test. Mammograms are our number one screening tool.

How common are dense breasts?

Most women have dense breast tissue when they’re younger. As you get older, your breasts usually become less dense. That’s not true for everyone. There are older patients, people in their 70s or 80s, who still have dense breast tissue. But because young women very often have dense breasts, we don’t start screening with mammograms until you’re 40, unless you have a family history of breast cancer. Mammograms before that age are not really useful, because of the breast density.

Do dense breasts affect mammograms?

When we look at a mammogram, dense tissue appears white; it can obscure cancer because cancer also shows up as white on mammograms. So dense breasts can make it harder to read a mammogram. If we’re unsure at all, we follow up with another form of imaging to take a closer look—usually a sonogram or magnetic resonance imaging (MRI).

Does nursing affect breast density?

When people are breastfeeding, their breast tissues usually becomes denser because the glandular tissue is simulated. That’s why mammograms are less useful when you’re nursing. After you finish breastfeeding, the tissue isn’t being stimulated, so your breasts go back to how they were before.

Does breast density affect your chances of developing breast cancer? Why?

Women with dense  dense breast tissue are about four times as likely to develop breast cancer than other women. The reason for this is that dense breasts have more glandular tissue and that’s where the cancer grows, in glandular tissue. So women with more glandular tissue have more space for cancer to develop.

What are the signs of breast cancer in dense breasts?

The signs of breast cancer in dense breasts are the same as with any other person. You might feel a mass, or it shows up on a mammogram. Imaging tests (including mammograms) can also show calcifications, which are calcium deposits in the breast and can sometimes be a sign of cancer. But just because you have a possible sign of breast cancer doesn’t mean you actually have cancer. These findings may require more imaging or a biopsy. Most breast masses we find are benign; there are many different kinds of benign breast masses. Calcifications are generally benign, too.

Does having dense breasts affect the diagnosis and treatment of breast cancer?

Dense breasts can sometimes obscure cancer. So we might not find the cancer until it is a little bigger. But that usually doesn’t affect the outcome.

Is a breast self-exam less effective when you have dense breasts?

Not necessarily. The key to an effective breast self-exam is knowing your breast so you can tell if there’s a change. Most women start to do self-exams in their 20s. If you don’t know your breasts, you might do a self-exam and you think you feel something, but it turns out to be just a benign mass or normal breast tissue, which is not cancerous. That’s why there’s some controversy over self-exams. If you know your breasts and feel something new, that’s helpful. But if you don’t do the exams often enough (for example, monthly) to learn your breasts, it may be less helpful. For that reason, if you’re not comfortable with doing a breast exam, we don’t tell you that you have to do it.

What can someone with dense breasts do to lower their chances of getting breast cancer?

You can do the same thing anyone can do to decrease their cancer risk. Exercise, eat a healthy diet with lots of fruits and vegetables, maintain a healthy weight, limit alcohol consumption, and don’t smoke. This helps lower your risk of breast cancer—and other cancers.

Learn more about Mount Sinai's Center of Excellence for Breast Cancer

The Days Are Getting Shorter, Here’s Why You May Be Feeling Down

Updated on Oct 3, 2023 | Mental Health, Psychiatry, Your Health

Autumn brings about many things: leaves on the ground, cooler temperatures, and of course, Halloween. But while many look forward to a reprieve from the summer months, the start of the season can introduce new challenges. Seasonal depression—commonly known as seasonal affective disorder (SAD)—is a temporary condition estimated to affect 10 million Americans each year.

Mariana Figueiro, PhD, Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and Director of the Light and Health Research Center at Mount Sinai, explains the effects of SAD and how those who experience it can manage the disorder.

What are the symptoms of seasonal affective disorder, and what causes it?

Symptoms of seasonal affective disorder vary, but in general, it includes feeling down or depressed as well as experiencing a lack of interest and energy. People tend to be sleepier and tend to overeat, especially carbohydrates. And, as with any depressive episode, there could be suicidal thoughts. These depressive symptoms occur at specific times of the year, typically the fall and winter, and there is a full remission at other times of the year, such as the spring and summer.

Unfortunately, the cause of the disorder is still unclear, but there are some competing theories. One is that the start of autumn causes circadian rhythm disruption. Another is that the photoreceptors in the eye are not as sensitive to light, and another is serotonin reuptake dysfunction, which is an imbalance in serotonin levels. But the most prominent theory is that, due to the lack of or delay in getting morning light, the biological clock in the brain is out of phase with your natural light-dark patterns, affecting the timing of the sleep cycle. As such, your biological clock is telling you that it is 6:30 in the morning, but your watch is telling you differently. That mismatch can be the cause of seasonal depression.

Does the disorder only affect people who live in cities with long winters, or are people in warmer climates affected as well?

It tends to mostly affect people who live at higher latitudes, as these areas have less daylight availability in the winter months.

In the United States, higher latitude areas will be the northernmost states such as Alaska, Washington, Michigan, New York, and Maine. In the New York metropolitan area, we have about 15 hours of daylight at the height of summer but only about nine hours in the dead of winter. This contrast is starker in areas that are farther north. Barrow, Alaska—the northernmost city in our northernmost state—has 67 straight days of darkness in the winter.

Within high latitude populations, the prevalence of SAD varies between one and 10 percent. But it can happen at lower latitudes, it’s just less prevalent.

How can I recognize and manage SAD?

If you go to a physician, there are standardized questionnaires—such as the seasonal pattern assessment questionnaire—that you can take. But, in general, if year after year you begin to crave carbohydrates, lose energy, lose interest in things, overeat, and oversleep around October, that’s a good sign that you should seek a formal SAD diagnosis.

Once you consult a physician, they will discuss how you can manage the disorder. There are two common ways to treat SAD. One would be medication—typically an antidepressant or a selective serotonin reuptake inhibitor—that would be prescribed by a physician. The other is non-pharmacological: light therapy. Exposing yourself to light—be it morning, natural, or electric indoor light—will help resynchronize your biological clock so that it matches your local time. You can do this by adding more lights in the home, opening up your windows, and trying to be outside during daybreak. And if you work from home, try to sit facing a window. Making your environment brighter during the day will help get more light to the back of the eye, which is what you want in order to be an effective treatment for seasonal depression.

Has light therapy been used to treat other illnesses?

Yes, it has. The Light and Health Research Center at Mount Sinai has done a number of studies showing that—outside of treating seasonal depression—there is a definite benefit to exposing people to bright days and dim nights. For instance, in a study with Alzheimer’s disease patients, the lighting was changed in their nursing homes and assisted living facilities to simulate bright days and dim nights. The results were a very robust, positive impact on their sleep, mood, and behavior. In other applications, we worked with persons with mild cognitive impairment and sleep disturbance from mild traumatic brain injury to see how light therapy can help. And we have been working with breast cancer and myeloma transplant patients to see if delivering light therapy during a transplant or during chemotherapy will help to minimize fatigue and improve their sleep.

There are various applications. You can even use it to try to get your teenager to go to bed and wake up earlier. The addition of light can have many positive effects on life.

Learn more about the Light and Health Research Center at Mount Sinai
Read more from Mount Sinai about Your Health

The Latest on COVID-19: What to Know About Testing

Updated on Sep 29, 2023 | COVID-19, Your Health

The Biden administration recently announced that it is making four more COVID-19 antigen tests, also known as rapid tests, available to each U.S. household for the fall of 2023. You can order your tests through the federal government’s COVID.gov website.

A positive result on one of these tests is a reliable indication that you have COVID-19, especially when you are also experiencing symptoms like fever, cough, or shortness of breath, says Bernard Camins, MD, Medical Director of Infection Prevention for the Mount Sinai Health System.

Dr. Camins says that if you test positive and have symptoms, you should schedule a follow-up virtual or in-person visit with a health care provider, especially if you are at high risk for complications. The provider can prescribe an antiviral medication like Paxlovid™ (nirmatrelvir/ritonavir), which can help if taken within five days after your symptoms begin. The medicine works by stopping the virus from multiplying in the body.

(The Centers for Disease Control and Prevention (CDC) also recommends that if you test positive, you isolate from other people for five days or until your symptoms improve, whichever is longer. If you need to be around other people during this time, wear a high-quality mask.)

A negative rapid test does not necessarily mean that you do not have COVID-19, Dr. Camins says. Especially if you have symptoms, a negative test may just mean it was too early to detect the virus.

The Food and Drug Administration (FDA) recommends that people who have COVID-19 symptoms and test negative on a rapid test take another test 48 hours later. If you were exposed to COVID-19 but do not have symptoms, the FDA recommends that you test three times, with 48 hours between each test.

You can also take a laboratory test called a polymerase chain reaction (PCR) test, which is more reliable than a rapid test but must be given at a medical office. Mount Sinai Health System offers several ways to get a PCR test in the New York metropolitan region:

  • If you do not have any symptoms but need a test, contact your primary care provider or find a test site near you.
  • If you need a test due to mild symptoms, our Mount Sinai Urgent Care locations throughout New York City accept both walk-in and scheduled appointments 365 days a year.
  • Please wear a mask and practice social distancing. It is especially important to wear a face mask on the way to your appointment to help prevent the spread of any respiratory virus you may have.

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