What You Need to Know About Cataract Surgery and Choosing the Right Replacement Lens

Updated on Jun 5, 2024 | Featured, Your Health

Cataracts result naturally as a part of the aging process.  Beginning at age 50, your ophthalmologist will monitor your cataracts and advise when the time is right for surgery. During cataract surgery, the cloudy natural lens is removed and replaced with an intraocular lens (IOL) that will enable you to see more clearly.

In this Q&A, Kira Manusis, MD, Co-Director, Cataract Services, at the New York Eye and Ear Infirmary of Mount Sinai (NYEE), explains some of the options available to patients that may reduce dependence on glasses after surgery.

What is a cataract?

A cataract develops over time and causes your eye’s natural lens to become cloudy, making it hard to see clearly. If you experience poor night vision, see halos around lights, or notice that your vision is not as sharp as you would like, it is time to schedule an eye exam.

If surgery is needed, your ophthalmologist will meet with you and discuss your eye health and lifestyle needs to prepare you for the upcoming surgery. Your natural lens will be removed and replaced with an artificial intraocular lens. Your physician will explain the IOL options available and help you decide which lens is best suited for your visual needs.

What happens during cataract surgery?

Cataract surgery is a routine outpatient procedure that involves removing the cloudy natural lens and replacing it with an artificial lens.  There are several procedures for cataract removal. Your doctor will recommend the best surgical option for your cataract. Each eye is operated on separately, a few weeks apart, and most patients recover quickly.

Kira Manusis, MD

What are the different types of intraocular lens options (IOLs) available? What are the benefits of choosing premium lenses?

An intraocular lens is a permanent replacement for your natural lens. Our ability to see can be broken into three main zones: far distance, intermediate, and near. Some intraocular lenses can correct for only one of these distances while others can correct for multiple distances. At NYEE, we offer patients standard intraocular lenses and premium lens that not only correct for different visual zones, but can also permanently correct astigmatism. After a thorough examination and evaluation, you and your surgeon will discuss the various lens options based on your eye health and your personal lifestyle needs and wants. Here are four options:

Monofocal lens implants: This basic lens provides great quality vision and allows you to see clearly at one distance, either near or far.  If you choose to see distance, you will need to wear eyeglasses for close up activities such as reading or working on an iPad. This lens is typically covered by insurance.

Premium Lens Options:

Multifocal lens implants: These lenses allow vision correction at multiple distances. Patients who want to reduce dependence on eyeglasses or contact lenses may benefit from this type of a lens. There are many multifocal lenses to choose from.  Each lens has its advantages and disadvantages, which will be discussed with your surgeon.  Premium lenses are not covered by insurance, and patients need to weigh the cost vs. value when choosing a lens. People with an active lifestyle can benefit from these glasses-free options.

Extended depth-of-field implants: An extended depth-of-field lens is a type of lens that enables clear distance and intermediate vision. For most patients, this advanced lens technology reduces your dependence on glasses for most activities except reading small print.

Toric lens: These implants can permanently correct astigmatism at the time of cataract surgery. The toric lens implant corrects the irregularity in the curvature of the cornea.  Patients with astigmatism can achieve good distance vision with significantly less dependence on glasses.

What else should I discuss with my doctor?

During your exam, you and your doctor can discuss your eye health, consider your lifestyle needs, answer any questions, and help you decide which lens will provide optimal vision. When considering which type of lens to choose, you should consider the following lifestyle preferences:

  • What do you spend most of your time doing at work? At home?
  • What are your hobbies?
  • How important is distance vision to you? (Driving, golf, skiing, theatre)
  • How important is mid-range vision to you? (Computers, cooking, grocery shopping,)
  • How important is near vision to you? (Reading, smartphones, sewing, crafts, puzzles)
  • After surgery, will you mind wearing glasses for distance, mid-range, or near vision?
Learn more about cataract surgery at NYEE
Learn more about options for intraocular lens (IOLs)

TelePrEP? PrEP on Demand? Here’s the Latest on Pre-Exposure Prophylaxis for HIV.

Updated on Jun 6, 2024 | Featured, Your Health

We’ve come a long way in HIV medicine since the 1980s—the height of the HIV/AIDS epidemic in the United States, when contracting the virus was considered a death sentence. Today, not only can we prevent HIV with pre-exposure prophylaxis (PrEP), we can also treat HIV and manage it to undetectable levels, in which virus counts are so low that they cannot be transmitted sexually.

For LGBTQ+ Pride Month in June, Richard Silvera, MD, MPH, Assistant Professor of Medicine (Infectious Diseases), and Medical Education, at the Icahn School of Medicine at Mount Sinai, provides the latest developments on PrEP and explains how these medications are more convenient to access than ever. 

“Pride Month is a great time where the LGBTQ+ community gathers and celebrates our achievements, as well as commiserates over our shared struggles,” says Dr. Silvera. “It is important to know that despite our breakthroughs, HIV is still out there, and that we have excellent tools to treat and prevent it.”

There are now different methods for accessing and delivering PrEP. “These different methods are really about trying to find a strategy that will fit into someone’s life most easily,” says Dr. Silvera. He discusses three recent developments with PrEP, and how you can find one that best suits your needs.

Richard Silvera, MD, MPH, Assistant Professor of Medicine (Infectious Diseases), and Medical Education, at the Icahn School of Medicine at Mount Sinai.

What is PrEP?

PrEP is a prescription medicine taken to prevent getting HIV. It reduces the risk of contracting HIV from sex by 99 percent, and from injection drug use by at least 74 percent, according to the Centers for Disease Control and Prevention (CDC).

PrEP is suitable not only for LGBTQ+ populations, but also cisgender straight men and women, especially if they have unprotected sex, have a partner with HIV, or have used injected drugs.

What is TelePrEP?

Usually, people go into a doctor’s office to get a prescription for PrEP, and get their blood work and sexually transmitted infection (STI) tests done there, says Dr. Silvera. But for some people who don’t want, or are unable, to make the trip to a clinic, there’s an online option for them known as telePrEP, he adds.

Here’s how telePrEP works:

  • An individual fills out a medical and insurance inquiry to ensure they are covered for telePrEP services. Once done, they can begin scheduling video calls with a provider.
  • During the video call, the provider walks the patient through what PrEP is, how and when to take it, and required tests.
  • For the required lab tests, which includes a blood draw and other routine STI tests, the patient can go to any commercial lab or testing center covered by their insurance network.
  • The patient can then pick up the medication at a pharmacy, or have it mailed.

“We have an excellent telePrEP program available through our Institute of Advanced Medicine, which specializes in care for the LGBTQ+ community, people living with HIV/AIDS, and people who experience domestic violence,” says Dr. Silvera. “For people whose lifestyle might not allow them to take time off to go into a clinic for PrEP visits, telePrEP can be a convenient option.”

Learn more about Mount Sinai’s telePrEP program

What is PrEP on Demand (PrEP 2-1-1)?

For people who might have concerns about taking PrEP medications daily—or are unable to for health reasons—there is a dosing schedule called “PreP on demand,” says Dr. Silvera. Also called “PrEP 2-1-1,” this is where someone who knows they might be at risk of HIV exposure takes two pills anywhere between two hours and 24 hours before sex, then one pill 24 hours after sex, and then another pill 24 hours after that.

This dosing schedule has been shown in studies to be effective in preventing HIV for gay and bisexual men who have sex without a condom, according to the CDC. This benefit may also extend to transgender women, or those who were assigned male at birth, notes Dr. Silvera. However, for heterosexual couples and those assigned female at birth, the evidence for this method of PrEP is not conclusive, he adds.

Accessing PrEP on demand works similar to daily PrEP: the patient makes an appointment with their provider, and lab tests will need to be done every three months.

[Sidebar: What have studies shown about the effectiveness of PreP on demand?](See below for full text)

Although the CDC has provided a guideline for this dosing schedule, it is not approved by the U.S. Food and Drug Administration (FDA).

What is Long-Acting PrEP?

Instead of taking a pill every day, there is now an injectable PrEP that lasts longer called Apretude® (cabotegravir). Currently the only long-acting PrEP approved by the FDA, Apretude is given first as two initiation injections administered one month apart, and then every two months thereafter.

“Apretude has the advantage of not being excreted through the kidneys, unlike oral PrEP,” says Dr. Silvera. “So if someone has kidney disease, Apretude might be suitable for them.”

What have studies shown about the effectiveness of PreP on demand?

PrEP on demand has been long studied for its effectiveness. In 2012, a randomized, placebo-controlled study named IPERGAY was one of the first studies on this dosing schedule. It enrolled 400 men and transgender women, with a median follow-up of 9.3 months. Findings were published in The New England Journal of Medicine in 2015. Here’s a summary of the findings:

  • Taking PrEP on demand reduced the risk of contracting HIV by 86 percent among participants.
  • The most common side effects of those who took the treatment were related to the digestive tract and kidneys.
  • There was no significant difference in how often people had unprotected sex before and after they had PrEP on demand.
  • The proportion of people who had STIs before and after they had PrEP on demand remained similar.

Studies have shown that the long-acting drug, injected once every eight weeks, is safe and more effective than daily oral PrEP at preventing HIV acquisition among both cisgender women and cisgender men and transgender women who have sex with men, according to HIV.gov, an official U.S. government site.

Accessing long-acting PrEP and its testing is slightly different: the patient has to go to the clinic every two months to receive the injection, as it cannot currently be self-administered. The patient would also do the required lab tests.

Discontinuing long-acting PrEP is also slightly more complicated than stopping daily oral PrEP, notes Dr. Silvera. “When someone wishes to stop long-acting PrEP, there will continue to be some amounts of medication in their body after stopping the injections.” The patient will be switched to daily oral PrEP until it is certain the long-acting medication has been cleared from the body, and then the oral PrEP can be stopped. “What we want to avoid is someone having enough medicine in their body such that if someone were exposed to HIV, the virus can learn to avoid that medicine, but also not having enough medicine in the body to prevent an infection,” he says.

Pride Month is a time for great joy and celebration, and LGBTQ+ people should keep themselves safe—and not just from HIV, says Dr. Silvera. Mpox (formerly known as monkeypox) cases have been increasing in New York City and other major cities in the United States, and other STIs are important too. “PrEP works great for protecting against HIV, but it does not protect against other things out there too,” he says.

Can Surgery Fix My Cleft Nasal Deformity?

Updated on May 30, 2024 | Your Health

Patients with cleft lip with or without cleft palate undergo reconstructive surgery early in life—but a majority will need further surgery to address the resultant functional and aesthetic deformity of the nose that becomes evident over time.

Cleft rhinoplasty can address these issues, resulting in a more symmetric, aesthetically balanced nose with improved breathing. Cleft rhinoplasty is similar to a traditional rhinoplasty in that it can improve the form and function of the nose. However, this is a much more complicated procedure due to the altered anatomy and scarring from prior interventions, which is why it is important to find a surgeon with the right experience.

Christopher R. Razavi, MD. Call 212-241-9410 or click here to make an appointment.

Christopher R. Razavi, MD, Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, explains what you should know before undergoing this complex surgery.

What is cleft rhinoplasty?

Cleft rhinoplasty is a nasal reshaping surgery that essentially addresses form and function issues with the nose resulting from a cleft lip—a congenital defect that occurs in approximately one out of every 1,000 births. This defect most commonly presents unilaterally (on one side of the nose), but it can also be bilateral.

When do patients typically undergo this surgery?

Patients with cleft lip with or without cleft palate generally undergo several surgical repairs during infancy, which start approximately 10 weeks after birth. Cleft rhinoplasty is typically the final procedure in the series of repairs, and it is typically performed between the ages of 15 and 17.

In what cases might someone decide not to get cleft rhinoplasty?

There are cases where the primary rhinoplasty—performed at the initial time of cleft lip repair—results in a nose that looks good enough and works well enough that patients decide not to undergo the definitive cleft rhinoplasty because they are happy with how things are.

How can cleft rhinoplasty help me?

Cleft rhinoplasty can address a wide range of issues related to a cleft lip with or without cleft palate, resulting in:

  • A more symmetrical nose
  • A more even, slim, and better defined nasal tip
  • Increased nasal tip projection
  • Increased nose length
  • A smoother, better shaped nose
  • Enhanced ability to breathe through the nose

Am I a candidate for cleft rhinoplasty?

An evaluation with an expert in facial plastic surgery is a good way to determine if you are a suitable candidate for cleft rhinoplasty. We typically look at physical, functional, and psychologic factors to assess the situation and determine how best to proceed.

There are some patients who have undergone multiple prior rhinoplasties that might make the procedure more challenging. But generally, the contraindications are the same as those for a conventional rhinoplasty, such as a medical comorbidity or instances where the patient’s goals are not realistic.

What happens during the cleft rhinoplasty?

You will undergo general anesthesia, so you will be fully asleep throughout the procedure. While there are several techniques than can lead to favorable outcomes, my team takes a specialized approach that involves using scarred skin from the prior cleft lip repair to enhance the shape and function of the nose. We reposition this scarred skin into the nose, which helps address the relative lack of internal nasal lining on the cleft lip side, and also allows us to revise the cleft lip scar. In this way, we simultaneously improve the appearance of both the nose and the lip scar, while also reducing the need to harvest as much grafting material from other areas of the body.  That said, additional grafting material from the rib is typically needed in these cases. This results in an additional incision on the chest.

Why is cleft rhinoplasty challenging?

The degree of scarring from the previous surgeries and the original congenital abnormality often lead to significant asymmetry in the nose. One of the biggest challenges of performing a cleft rhinoplasty is achieving perfect symmetry, particularly when viewing the nose from the base view, or looking up from below the nose. Although we are able to achieve a more natural and symmetrical look for patients using this unique approach, we also take care to set your expectations for outcomes.

Our goal is for improvement, not perfection, but these are things that are applicable to rhinoplasty in general. Ultimately, as much as our focus is on achieving the best possible outcomes for form, we also need to make sure the nose is functional and that the patient’s nasal breathing is optimized.

What should I expect following surgery?

Patients who have undergone cleft rhinoplasty are typically discharged the same day as surgery and advised to take a week off from work or school. To ensure the repair is protected and heals well, we use both external and internal nasal splints to support healing and aid in recovery. We will see you one week post-surgery to remove the splints and assess how well your nose is healing and functioning. Though most patients can return to regular activities two weeks post-surgery and contact sports after six weeks, we advise you to avoid activities that put your nose at risk.

How long will it take to heal?

It can take up to one year for swelling around the nose to completely subside, meaning that the overall improvements to the appearance of the nose may take time to fully appreciate. Despite that, patients who undergo cleft rhinoplasty from an experienced surgeon will likely be satisfied with the outcomes. Whether you want to breathe better, look better, or both, we are here to help make that happen for you.

What Is the Best Sunscreen and Skincare Routine for Me?

May 21, 2024 | Dermatology, Your Health

As spring turns into summer, people become more aware of protecting their skin from environmental factors like the sun and pollution. However, taking care of your skin and finding the right sunscreen is important to consider year round.

Helen He, MD. Click here to find a dermatology specialist at Mount Sinai.

In this Q&A, Helen He, MD, Assistant Professor of Dermatology at the Icahn School of Medicine at Mount Sinai, discusses how to build a solid skincare routine and the importance of sunscreen.

Should you change your skin routine as the weather changes?

The foundation for a good skin routine, which includes a cleanser, moisturizer, and sunscreen during the day, is constant year-round. However, there are adjustments you can make as the weather changes.

Because the cold air in the winter can dry out your skin, hydration is key, so you might want a rich, creamy cleanser and a thicker moisturizer rich with glycerin and ceramides to protect the skin barrier. In the summer, sweat and oils build up and cause the skin to be more prone to acne breakouts. To adjust, switch to a gel-based cleanser or even a cleansing oil to remove extra oils and a more lightweight moisturizer that won’t clog your pores.

What are the steps to a good daytime and nighttime skin routine?

The first step for both daytime and nighttime routines is to wash the face with a gentle hydrating cleanser to remove excess oils and dirt that may have accumulated during the day or night. Afterwards, some patients may opt for toners, serums, and eye creams. While this step is optional and should be kept simple, there are active ingredients that can be helpful.

For example, vitamin C serum during the day can brighten your complexion and has antioxidant benefits, while retinol/retinoids in the night can help with skin anti-aging, texture, pigmentation, and acne. If your skin is sensitive, add these ingredients to your routine gradually, and with guidance from a dermatologist.

The next step is to use a moisturizer to seal in the water content and keep the skin hydrated. During the daytime, sunscreen is also critical, and you can opt for a moisturizer that contains sunscreen to simplify your routine.

What is the most forgotten skincare step you see in patients?

Patients think sunscreen is only for the summer, but it is important to wear sunscreen year round. Also, many patients apply sunscreen diligently on their face but neglect other sun-exposed areas like the neck and the back of the hands. Equally important, sunscreen needs to be reapplied every two hours, and even more frequently after exercising and/or sweating.

How important is wearing sunscreen daily?

Daily sunscreen is very important. UV radiation has many harmful effects, from sunburns in the short-term to long-term consequences of cumulative exposure, such as increased risk of skin cancer, premature aging and wrinkles, and other issues with skin dyspigmentation and texture.

How do you choose the best sunscreen?

Use a broad-spectrum tinted sunscreen, which covers UVA, UVB, and visible light. For most patients, sun protection factor (SPF) of 30 or higher is recommended, but if you are particularly sensitive to the sun, have a history or high risk of skin cancer, or have skin concerns like rosacea or melanoma, SPF 50 may be better. While both mineral and chemical sunscreens are effective, mineral sunscreens tend to be broader spectrum and less sensitizing.

If you are active outdoors or swim, water-resistant sunscreen is best. Remember to reapply it frequently.

What cosmetic dermatology treatments do you recommend for aging?

As you age, consider incorporating anti-aging and antioxidant ingredients into your skincare regimen such as vitamin C, niacinamide, and retinoids. With consistent use, these ingredients can help to improve skin complexion and texture, reduce wrinkles, and promote collagen production. You can also explore elective procedures such as lasers and other energy-based devices that resurface and tighten skin, neurotoxins (e.g. Botox®), and soft tissue filler augmentation.

Do I need a complicated skincare routine?

Consistency and simplicity are key. The best cleanser, moisturizer, and sunscreen is the one you will use consistently. Having a complicated skincare regimen with many steps is not necessarily better and can do more harm than good. If you do introduce a new product to your skincare regimen, you should introduce it slowly, perhaps starting out with a few times a week and gradually increase the frequency to daily. Also, only introduce one new product at a time so that if you do get a reaction, you can more easily identify the culprit.

Learn more about Dermatology at Mount Sinai and Find a Doctor

Why It’s Important for AAPI Communities to Be Vigilant About Breast and Colon Cancer Screening

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

Want to learn more about mobile mammogram services from Mount Sinai? Click to learn more.

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.

What Is the Difference Between Hepatitis C and Hepatitis B?

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.

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