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
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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.

Why it Is Important for Men to Get Tested for Prostate Cancer

Updated on Sep 9, 2024 | Featured, Your Health

Prostate cancer is the second most common cancer among men in the United States, after skin cancer, and the number of cases has been rising yearly. About one man in eight will be diagnosed with prostate cancer during his lifetime, according to the American Cancer Society.

Prostate cancer comes in many different forms, which is why Mount Sinai offers a wide variety of treatment options while conducting research to find new and innovative treatments and expanding care to those communities most at risk.

“The most important thing people can do is find this cancer early, when it is easier to cure. That starts with understanding your own risk, and talking with your doctor before there are any symptoms,” says Ash Tewari, MBBS, MCh, FRCS (Hon.), Professor and Chair, Milton and Carroll Petrie Department of Urology and Director of the Center of Excellence for Prostate Cancer at The Tisch Cancer Institute at Mount Sinai.

One key message remains unchanged: Prostate cancer screening is critical to detecting this cancer early, before you have any symptoms, when you have more treatment options.

Click here to watch a series of short videos on prostate cancer from the Department of Urology and learn more about the importance of your family history and how to minimize your risk for prostate cancer.

In this Q&A, Dr. Tewari, who is also Surgeon-in-Chief of the Tisch Cancer Hospital at The Mount Sinai Hospital, explains when men should be tested for prostate cancer and what options are available to those who may be diagnosed with prostate cancer.

What should patients and consumers know about the rise of prostate cancer?

Ash Tewari, MBBS, MCh, FRCS (Hon.)

It is likely that this perceived rise of prostate cancer is not a true rise in prostate cancer incidence but rather there has been increased awareness about testing and screening. This is a good thing because we can prioritize delivering care to those who need it and make sure they are managed appropriately.

 Who should be tested for prostate cancer, and when?

The decision of when to initiate screening should be an individual one that is based on shared decision making between physician and patient. There are several factors to consider including race, family history of cancer (not only prostate but also breast, ovarian, and pancreatic cancer), and age. According to the U.S. Preventative Services Task Force, all men over the age of 55 should have this conversation with their physician about the decision to begin screening with Prostate-Specific Antigen (PSA) testing. Patients who are at higher risk, such as those with family history, should start this conversation earlier, and some as early as age 40.

 Who is most at risk for prostate cancer?

 Those who are most at risk of prostate cancer include:

  • Black men
  • Men with a family history of prostate cancer and other cancers
  • Men over 55 years old
  • Men who have done genetic testing and were found to have mutations, such as BRCA2, that are known to be correlated with a higher risk of prostate cancer

How is prostate cancer diagnosed?

Prostate cancer is diagnosed when a PSA test rises above a certain threshold, and a biopsy becomes indicated. A biopsy can be done even if PSA is not above threshold—for example if a patient has other factors that might put him at risk or has a concerning magnetic resonance imaging (MRI) test. This biopsy can be performed transperineally or transrectally. Sometimes, this biopsy is guided by imaging tests such as an MRI and micro-ultrasound imaging to increase the sensitivity of the biopsy.

How do doctors use the PSA test?

The PSA test is a blood test that can be used for screening. It also is used as a marker to track treatment response and for surveillance to detect recurrences after treatment. A single PSA test is often insufficient to draw meaningful conclusions. A single elevated PSA during screening is followed up with another PSA test to corroborate that the rise was not due to other factors, such as the result of inflammation or infection in the prostate.

What treatments are available for prostate cancer?

If you are diagnosed with prostate cancer, what follows next would be a discussion with your doctor about next steps. The conversation depends largely on the type of prostate cancer diagnosed. There are a number of different types and grades of prostate cancer, and treatment must be appropriate for the individual patient. Some patients are diagnosed with a disease that is confined to the prostate. Options for these patients range from active surveillance for low-risk disease to radical treatments such as radiation or surgery for intermediate-risk and high-risk disease. There are also emerging experimental therapies, called focal therapies, that are being investigated for their appropriateness and safety for certain patients. For advanced and metastatic disease, sometimes hormones and other treatments that target the entire body, such as chemotherapy may be used. This is also a very active field of research. There is a tremendous effort to improve the outcomes and quality of life for patients.

What is active surveillance, and why is that important?

Active surveillance is an approach that is used for patients who have low-risk and very low-risk cancer confined to the prostate. Because these cancers are usually slow growing and do not involve complications or pain, we prefer not to implement radical treatments if they are not necessary, and so active surveillance can be a good option for them. This protocol often involves periodic imaging and biopsies to monitor the disease and intervene only if necessary.

Can I reduce my risk for prostate cancer?

There is no evidence that one lifestyle choice will either cause or prevent prostate cancer. Studies show that patients who eat more vegetables and less red meat, and patients who exercise regularly, are at lower risk for prostate cancer. Overall, leading a healthy lifestyle has many wide-reaching benefits.

What steps is Mount Sinai taking to bring prostate cancer screening to the community?

In 2022, we launched the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit, a state-of-the-art mobile facility equipped with advanced PSA tests and trained staff that visits predominantly Black neighborhoods across New York City. We are very excited about this initiative. We want to reach patients who cannot easily access a urologist, and we want to make it easier to screen for prostate cancer and treat them if necessary to save their lives. So far, we have screened more than 3,000 patients and of those, we have found several hundred with elevated PSAs that required further follow up. We detected cancer in 30 patients and conducted surgery to remove the cancer in half of these patients. In addition, we are following up with these patients to make sure they have the most appropriate testing and treatment.

Learn more about our services and make an appointment

How Do I Know if I Could Have Celiac Disease?

Sep 20, 2023 | Featured, Your Health

Celiac disease, an autoimmune disorder affecting the small intestine, is normally a condition you inherit and runs in families. The condition affects approximately 1 percent of people in the United States and is triggered by consuming gluten, a protein found in wheat, barley, and rye.

The small intestine, which is responsible for absorbing nutrients from food, is damaged by this immune process, and this can lead to other health concerns. People with celiac disease are at increased risk for malnutrition, osteoporosis, small bowel cancers, depression, and infertility. Yet only about 30 percent of people with celiac disease are properly diagnosed, according to the Celiac Disease Foundation.

To schedule an appointment with Christopher Cao, MD, a celiac disease specialist, call 212-241-4299 or schedule online.

In this Q&A, Christopher Cao, MD, Assistant Professor, Gastroenterology, Icahn School of Medicine at Mount Sinai, who treats patients and conducts research on celiac disease, explains how to know if you have this condition and how to optimize your diet and improve your quality of life.

How do I know if should screen for celiac disease? What screenings are available? 

Celiac disease may produce various gastrointestinal and systemic symptoms. Common gastrointestinal symptoms include abdominal discomfort, bloating, diarrhea, constipation, and nausea or vomiting. You may also experience a skin rash, joint pains, fatigue, or weight loss. As celiac disease is hereditary, it is important that family members of individuals with celiac disease be screened. Individuals with known autoimmune disorders should also be screened for celiac disease. Screening for celiac disease uses a combination of blood work, genetic testing, and endoscopic evaluation. These services are offered through the Mount Sinai Celiac Disease Program.

What foods should I eat or avoid if I have celiac disease?

The only effective treatment for celiac disease is a strict gluten-free diet, as there are no medications approved by the Food and Drug Administration for the management of celiac disease. By eliminating gluten from their diet, individuals with celiac disease can prevent further damage to their small intestine and alleviate their symptoms. Dieticians specializing in celiac disease will work closely with patients to develop personalized gluten-free dietary plans to ensure optimal health and well-being.

How do I prevent a flare up? 

The lifelong management of celiac disease with a gluten-free diet can be difficult and should not be understated, as even tiny traces of gluten may trigger a reaction. The Mount Sinai Celiac Disease Center is dedicated in providing comprehensive and compassionate care for those with celiac disease. Our team consists of experienced gastroenterologists, dietitians, and health care professionals who can help support individuals through their celiac journey—from obtaining an accurate diagnosis to optimizing a gluten-free diet and improving their quality of life.

Find out more about celiac disease and what foods to eat

Some Success Stories From the Mount Sinai Alopecia Center

Sep 17, 2023 | Your Health

The emotional toll of alopecia areata can be devastating. But there are treatments that can help you remain positive, manage your symptoms, and thrive.

For Dan Kaplan, 43, who has been living with alopecia areata for a quarter century, Dupixent (dupilumab), a drug approved for the treatment of moderate-to-severe eczema, has been a game changer.

For years, he kept the condition under reasonable control with regular cortisone injections, but “it was like playing a game of whack-a-mole at the fair: We’d hit one bald patch and respond to it, then another one would crop up,” he recalls. His alopecia got dramatically worse during the COVID-19 pandemic, when he couldn’t get to his dermatologist’s office for his shots. By early 2022, he’d lost about half of the hair on his scalp.

Mr. Kaplan despaired, but his doctor had a solution: The doctor referred him to the Mount Sinai Alopecia Center. He met with the world-renowned expert in inflammatory skin diseases including alopecia, Emma Guttman, MD, PhD, Waldman Professor of Dermatology and Clinical Immunology, and System Chair of the Kimberly and Eric J. Waldman Department of Dermatology, at the Icahn School of Medicine at Mount Sinai. She examined him and noticed that he also had small patches of eczema. She recommended Dupixent to treat both the eczema and alopecia, and Mr. Kaplan began weekly injections of the drug in April 2022. The results were dramatic.

“After about two months, I noticed that areas of my scalp that had never responded to cortisone were beginning to grow hair again,” he says. Following the treatments, he has had about 95 percent hair regrowth.

“When you live with alopecia areata, you always wonder when the other shoe is going to drop and you’re going to lose more hair,” he says. “I’m so thankful now to be able to go about my day normally, without worrying about that.”

Stories like Mr. Kaplan’s are commonplace at the Alopecia Center, according to Dr. Guttman.

The Alopecia Center is also conducting studies in scarring alopecia, a type of alopecia in which the immune system destroys hair follicle cells completely, so that regrowth isn’t possible. One promising drug is ritlecitinib, a first-in-class drug that inhibits JAK3/TEC, an enzyme that interferes with the signals in your body thought to cause inflammation and implicated in alopecia areata.

A 2022 study done by Dr. Guttman and published in the Journal of Allergy and Clinical Immunology found that patients who took ritlecitinib for 24 weeks showed significant improvement in hair regrowth in patients with alopecia areata.

After showing increased JAK3 in scalp biopsies of patients with scarring alopecia, Dr. Guttman and her team are also translating these new developments in alopecia areata to scarring alopecia where she is studying ritlecitinib treatment. “We are so excited about this because up until recently, there were no treatments for scarring alopecia,” Dr. Guttman says. “It’s awful to have to give a beautiful woman the news that there’s nothing to offer her.”

Vicky Miller is one of those patients. The 54-year-old began to experience hair loss about two years ago and was referred to Dr. Guttman and to the Alopecia Center in 2022 by a neighbor who also had alopecia. She began a trial with a Janus kinase (JAK) inhibitor in May 2022.

“After about 12 weeks, all of a sudden the bald spots on the sides of my head began to fill in,” she recalls. “One day there was nothing there, and the next day peach fuzz. I went from 50 percent hair loss to full hair regrowth. I plan to be on this medication for the rest of my life.”

While there’s no cure yet for alopecia, these new treatment advances make it more manageable, according to Dr. Guttman. Other cutting-edge treatments for alopecia areata, for example, include Olumiant (baricitinib), a JAK inhibitor recently approved by the Food and Drug Administration. The Center plans to study Dupixent soon in children with alopecia areata and is investigating other treatment options as well.

“We’re able to offer our patients access to new, investigational therapies such as novel JAK inhibitors that aren’t available anywhere else,” says Dr. Guttman.

Learn more about the Alopecia Center of Excellence

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