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Medical Experts Separate Fact From Fiction at Dubin Breast Center’s Annual Luncheon and Symposium

Updated on Jun 30, 2022 | Featured, Your Health

From left: Elisa Port, MD, FACS; Isabel S. Blumberg, MD; Stafford R. Broumand, MD; Hanna Y. Irie, MD, PhD; Laurie Margolies, MD, Director of Breast Imaging, Dubin Breast Center; Jeffrey Mechanick, MD, Professor of Medicine (Cardiology, Endocrinology, Diabetes and Bone Disease); and Hank Schmidt, MD, PhD.

Are breast implants safe? Do oral contraceptives increase your risk for breast cancer? These were among the questions answered by a panel of physicians in May, at the seventh annual Dubin Breast Center Fact vs. Fiction Luncheon and Symposium that was held in Manhattan.

The sold-out event featured the latest information on breast cancer from six doctors at the Icahn School of Medicine at Mount Sinai and was moderated by Elisa Port, MD, FACS, Director of the Dubin Breast Center and Chief of Breast Surgery, Mount Sinai Health System. The goal of the annual luncheon is to clarify information about one of the most common cancers in women worldwide, so patients can keep up with advances and make informed decisions about their health.

“There is no one who gets a diagnosis of breast cancer who doesn’t think it’s the worst day of their life, the worst thing that’s happened to them, and the question of mortality always comes up,” Dr. Port said at the luncheon. “But let me be crystal clear that with a diagnosis of breast cancer there is so much room for optimism in 2019. For most cases, we are saying you have a 90 percent chance of survival. In some cases, a 98 percent or 99 percent chance of survival. This is success.”

Dr. Port said the development of “a few key drugs” over the past decade has led to increased survival rates. “What we need to work on are the outliers that don’t respond well. That continues to be the reason we get up every morning and sit in the lab and look for better treatments,” she added. “You will hear more from us, because we are on it.”

The following questions and answers were among those included at the luncheon.

Do birth control pills increase my risk for breast cancer?

Isabel S. Blumberg, MD, Clinical Instructor, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine: Yes. Even newer ones slightly increase the risk for breast cancer. The risk is very small. Someone who has had breast cancer is not a candidate for oral contraceptives. But there is a nonhormonal IUD that is really safe, lasts for 10 years, and works extremely well, so that may be the answer. A new diaphragm that is universally sized is coming to market, and condoms are always an option.

Are breast implants safe?

Stafford R. Broumand, MD, Associate Clinical Professor of Plastic Surgery, Icahn School of Medicine: Silicone implants are safe. But there are issues that need to be clarified. Different types of implants have different types of issues. Lately, anaplastic large cell lymphoma (ALCL) has been diagnosed in women with textured implants. We don’t really know why that is. We now use smooth implants because there is no incidence of ALCL. Women who have textured implants and those who are not sure whether they have them should discuss this with their physician.

Can a liquid biopsy detect cancer cells in the blood of someone who is not known to have breast cancer or determine if a patient’s cancer is returning? Can it also be used to track a patient’s response to treatment?

Hanna Y. Irie, MD, PhD, Associate Professor of Medicine (Hematology and Medical Oncology), and Oncological Sciences: A liquid biopsy is a blood test aimed at detecting small amounts of cancer cells circulating in the blood stream, as well as the footprint, or DNA, of these cancer cells. Most studies use the biopsy in the context of advanced cancers. However, because of the power of liquid biopsy in detecting small amounts of cancer, researchers at the Dubin Breast Center are trying to understand its utility in patients diagnosed with triple negative aggressive breast cancer. We are studying whether it can detect recurrences at an earlier stage than either CT scans or MRIs.

What is the right screening for me based on my family history?

Hank Schmidt, MD, PhD, Associate Professor of Surgery, Director, High-Risk Program at the Dubin Breast Center: The big question is ‘what is your risk?’ There are a lot of ways to risk stratify patients to find out where they lie on the spectrum of risk. Some patients have a strong family history of cancer but their genetic testing is negative. We look at a variety of risk factors. Then we define a plan for risk management. A big component of our surveillance is imaging. For women over age 40 mammography is the standard. We always begin with that. Then, based on personal risk, we decide whether to add ultrasound on a yearly basis, or for higher-risk patients or someone who wants to be more aggressive, we’ll consider adding annual breast MRI.

Urology Department Renovates Union Square Location

May 13, 2019 | Community, MSBI, Your Health

Faculty and staff of the Mount Sinai Health System’s Department of Urology recently celebrated the completion of a more than $3 million renovation project at Mount Sinai-Union Square. Upgrades to the 6,500-square-foot practice are being done in several phases, allowing the Sol & Margaret Berger Urology Department at Union Square to continually serve patients.

The project has doubled the Department’s capacity to perform in-office procedures and features new medical equipment. Wall outlets in the waiting room allow patients to charge their phones, and soon, patients will be able to check in for their appointments while seated on a couch rather than waiting at the front desk. Modern art, furniture with warm natural tones and finishes, special lighting, and a tank with 12 species of saltwater fish are designed to provide patients with a welcoming environment.

“All aspects of the renovation maximize the patient’s experience by reducing stress and making check-in and services more convenient and efficient,” says Ash Tewari, MBBC, MCh, Chair of the Department of Urology, Mount Sinai Health System. Plans also call for the Urology Department to launch a prostate cancer and men’s health program downtown and install a real-time location system that will enhance patient safety and improve clinical quality.

“We are excited to have this large, modern space in which to treat our patients and accommodate the more than 24,000 patient visits we receive each year,” says Michael A. Palese, MD, Chair of Mount Sinai-Union Square Urology. “World-class medicine with access to academic professionals and clinical trials in the setting of a brand new office space enhance the overall patient experience.”

Faculty and staff at the Department of Urology joined Michael Palese, MD, left, center, and Ash Tewari, MBBC, MCh, right, center, to celebrate the newly renovated facility at Mount Sinai-Union Square.

$3 Million Gift to Advance Study of Crohn’s Disease

Updated on Jun 30, 2022 | Featured, Research, Your Health

From left: Noam Harpaz, MD, Professor of Pathology, and Medicine (Gastroenterology); Sanford J. Grossman, PhD; Judy H. Cho, MD; and Asher A. Kornbluth, MD, Clinical Professor of Medicine (Gastroenterology).

The Sanford J. Grossman Charitable Trust has committed $3 million to a center at the Icahn School of Medicine at Mount Sinai that is focused on advancing the understanding of Crohn’s disease and creating personalized medicine for its treatment.

The trust donated $1 million to establish the Dr. Sanford J. Grossman Center for Integrative Studies in Inflammatory Bowel Disease in 2015. Now it will donate an additional $2 million—$400,000 a year for the next five years.

“Mount Sinai has a large and unique data set on patients: clinical symptoms, pathology reports, genomics, family history, and radiology,” says the founder of the trust, the economist Sanford J. Grossman. “My hope is that the integration and analysis of this data will enable a better understanding of Crohn’s disease, and with that knowledge, therapies will be developed to alter the natural course of the disease.”

Crohn’s is a chronic inflammatory bowel disease that affects nearly 700,000 people in the United States. Over time it can damage the bowel and create complications such as strictures, a narrowing section of the intestine that can lead to loss of function and reduce the quality of a patient’s life.

“Our main goal is to develop treatments that specifically deal with stricture in Crohn’s disease, and that aren’t the usual anti-inflammatory treatments,” says Judy H. Cho, MD, Director of the Center, and the Ward-Coleman Chair in Translational Genetics at the Icahn School of Medicine at Mount Sinai.

One new effort is a small clinical trial led by Robert Hirten, MD, Assistant Professor of Medicine (Gastroenterology) at the Icahn School of Medicine, that is exploring whether steroids are beneficial for Crohn’s patients hospitalized with a bowel obstruction caused by stricturing. Dr. Cho is conducting genetic and molecular projects involving pluripotent stem cells that might someday be engineered to repair the defects that cause Crohn’s disease. She says, “We are very grateful for Dr. Grossman’s donation, which will fund our unique, integrative team and catalyze new research.”

The Lowdown on Sexually Transmitted Infections

Updated on Jun 30, 2022 | Your Health

Sexually transmitted infections (STIs) can sometimes be a difficult topic to discuss. However, it is essential that sexually active people know about safe sex practices and be aware of their exposure risk. Dinaz Irani, MD, answers questions about STIs that will help keep you and your partners safe. Mount Sinai Urgent Care offers STI testing, if needed.

How do I know when to get tested for an STI?

It is important to get tested if you have had unprotected sex, sex with a new partner, sex with multiple partners, or sex with a partner who you know has an infection. Additionally, it is important to get tested if you have any symptoms of an STI. Anyone at increased risk for STIs should be screened even if they do not have symptoms.

Who is at increased risk for STIs?

The U.S. Centers for Disease Control and Prevention (CDC) recommends that all sexually active women under the age of 25 be tested for both chlamydia and gonorrhea annually. Chlamydia is the most frequently reported STI in the United States and is seen mostly in people between the ages of 15 and 24. Women 25 or older should be tested if they have a higher risk of having chlamydia or gonorrhea; this includes having new or multiple partners, having a partner with a known STI, or being pregnant. Routine screening for the infection is not recommended for men.

The CDC also recommends syphilis testing for anyone with symptoms of syphilis or who is sexually active with a partner who has syphilis. Syphilis is becoming more common and rates are increasing among men who have sex with men as well as heterosexual men and women. Pregnant women should be tested, as syphilis can be transmitted to an unborn baby. According to the CDC, men who have sex with men and sexually active men living with HIV should be screened for syphilis regularly. The CDC also recommends that anyone taking pre-exposure prophylaxis (PrEP), daily medication taken to lower the risk of becoming infected with HIV, also be tested routinely for syphilis.

What are the symptoms of an STI and how are the infections diagnosed?

Common symptoms of an STI include genital or rectal discomfort, abnormal discharge, pain with urination, or genital or rectal sores. See a physician if you are experiencing any of those symptoms. However, many STIs do not cause symptoms so you will not know if you are infected unless you get tested. STIs can be diagnosed from urine tests, swabs, or bloodwork. Chlamydia, gonorrhea, and trichomoniasis can be detected via a urine test or swab. Herpes can be diagnosed by swabbing the sores themselves or through blood tests. Syphilis, HIV, and hepatitis can all be diagnosed via bloodwork.

Genital warts, molluscum contagiosium, and scabies can be diagnosed based on their appearance and typically do not require testing. Bacterial vaginosis and vaginal yeast infections can be diagnosed with swabs but are often easy to diagnose on a physical exam; although these are not considered STIs, their symptoms may be more noticeable after sexual intercourse.

What happens if I have an STI and do not get treated?

Left untreated, STIs can cause very serious health conditions, including pelvic inflammatory disease, infertility, organ damage, certain cancers, and even death. Even the thought of contracting an STI can make some people anxious. At Mount Sinai Urgent Care, we want your experience to be fast, easy, and as stress-free as possible. To get tested, you can walk in without an appointment during our convenient daytime, evening, and weekend hours. We are even open on holidays.

Our physicians will discuss your concerns, perform a physical exam if needed, and treat you right away if appropriate. Most test results are complete within a few days. We will call you with your results as soon as they are available. If needed, a physician will discuss your results as well as how to prevent your partners from becoming infected and how to prevent infections in the future.

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Mount Sinai Urgent Care offers fast and easy STI testing and diagnosis in a safe and nonjudgmental environment. Services are always confidential and respectful of patient privacy. We test for HIV, gonorrhea, chlamydia, herpes, syphilis, trichomoniasis, hepatitis A, B and C as well as genital warts, molluscum contagiosum and scabies. We also provide testing for bacterial vaginosis and vaginal yeast infections.

View Mount Sinai Urgent Care Locations

A Novel Approach to Making Organ Transplants Successful

Updated on Jun 30, 2022 | Featured, Research, Your Health

Study co-authors, from left: Zahi Fayad, PhD, Director of the Translational and Molecular Imaging Institute; and Willem J.M. Mulder, PhD, Professor of Radiology, and Oncological Sciences.

The nearly 35,000 individuals who receive organ transplants each year in the United States face a harsh reality: the immunosuppressive drugs they must take to maintain organ survival also weaken the immune system, breaking down the body’s critical defenses against cancer, infection, and more. Researchers at the Icahn School of Medicine at Mount Sinai recently developed an innovative type of immunotherapy based on nanotechnology that they hope will address this conundrum. Their findings, published in the November 6, 2018, issue of Immunity, have demonstrated the technology’s feasibility of long-term organ acceptance in mice.

“This is a whole new approach to programming the immune system, not just another small molecule drug that’s going to help with organ transplantation,” says Zahi Fayad, PhD, Director of the Icahn School of Medicine at Mount Sinai’s Translational and Molecular Imaging Institute, which conducted the work. Dr. Fayad is also Professor of Diagnostic, Molecular, and Interventional Radiology, and Medicine (Cardiology). “Because of the many problems this approach addresses—the risk of rejection, the shortage of organs for transplant, the cost of these procedures—we believe it can be transformative for the organ transplant field.”

Jordi Ochando, PhD

The immunotherapy works by regulating innate immune memory, or trained immunity, which the investigators found to play a central role in organ rejection. In trained immunity, immune cells known as myeloid cells initiate the body’s immune system response by activating T cells, which then attack the transplanted organ.

“By inhibiting trained immunity, we prevent activation of the myeloid cells and their subsequent activation of T cells,” says Jordi Ochando, PhD, the study’s co-senior author, who is Assistant Professor of Medicine (Nephrology), Oncological Sciences, and Pathology at the Icahn School of Medicine. “This novel technology preserves the normal function of the T cells, which is to protect the body against cancer and infections.”

Identifying trained immunity as a target enabled the Mount Sinai scientists to focus on a signaling pathway known as mammalian target of rapamycin (mTOR), which regulates immune cell metabolism. The team developed an injectable nanoimmunotherapy based on high-density lipoprotein (HDL) nanomaterials and the existing mTOR inhibitor rapamycin.

“These nanomaterials essentially deliver the rapamycin to the myeloid cells, and that changes the metabolic state of the cells and prevents their activation,” says co-senior author Willem J.M. Mulder, PhD, Professor of Radiology, and Oncological Sciences at Icahn School of Medicine, and Director of the Nanomedicine Program. The absence of myeloid cell and T cell activation, Dr. Mulder points out, could drastically reduce the need for transplant patients to take lifelong immunosuppressive medicines to prevent graft rejection.

A Rare Bladder Condition, and in Need of a Kidney Transplant: Little Lexi’s Extraordinary Medical Journey

Updated on Jun 30, 2022 | Featured, Patient Stories, Your Health

Lexi Isler got a kiss from her father, Luther, before the kidney transplant surgery in January.

In 2009, when a prenatal ultrasound showed an abnormal kidney, Luther and Ashley Isler knew that their daughter, Lexi, would be born with a urinary problem. What they did not expect, however, was that Lexi would also be born without a bladder, a condition known as bladder agenesis that has only 20 known survivors worldwide.

Today, 8-year-old Lexi is among those remarkable survivors as she continues an extraordinary medical journey supported by her loving family and an interdisciplinary team of Mount Sinai physicians that has included pediatric urologists and nephrologists, and transplant surgeons, along with nurses and countless other caring staff over the years.

When Lexi was 2 years old, doctors at Mount Sinai Kravis Children’s Hospital confirmed by magnetic resonance imaging that urine had been backing up into her kidney—because she did not have a bladder. While she was in diapers, not having a bladder was not immediately obvious, but as she grew older, Lexi would need a way to both hold and pass urine. Meanwhile, her kidneys—damaged by her urinary outflow anatomy—had been steadily deteriorating and doctors realized that she would eventually need a kidney transplant.

Lexi’s urology and pediatric doctors formed a close team to strategize about her case from the earliest stages. “Long before a transplant, our team first had to think about how to make a bladder and how to get it to work,” says Jeffrey M. Saland, MD, Chief of Pediatric Nephrology and Hypertension at Mount Sinai Kravis Children’s Hospital and Medical Director of the Pediatric Kidney Transplant Service.

When Lexi was 5 years old, Jeffrey A. Stock, MD, Associate Professor of Urology, and Pediatrics, Icahn School of Medicine at Mount Sinai, and Chief of the Division of Pediatric Urology at Mount Sinai Kravis Children’s Hospital, performed the complex, six-hour surgery to create an artificial bladder.

“We removed part of her colon and connected the ends to create a bowel pouch that functioned as a bladder,” says Dr. Stock. “Then, we used her appendix to create a urethra to drain urine from the neobladder.” The neobladder can store, but not empty, urine so Lexi has learned to use a catheter in the bathroom to empty her new bladder. The neobladder procedure is rare. Dr. Stock, who specializes in the surgical reconstruction of genitourinary birth defects, has done only four such procedures in his 25 years of practice.

By January 2018, Lexi’s kidney function was so compromised that at one point, she was unresponsive for days. The situation remained critical all year with very little improvement, and in December 2018, the need for a kidney transplant could not be deferred. Fortunately for Lexi, when she was 3, her father had been identified as a match for her. “It was an easy decision,” says Mr. Isler. “I felt blessed that I was a match.”

Victoria Caselnova, RN, BSN, left, and Stacey Brooks, RN, BSN, with a smiling Lexi Isler on the day she was discharged from the hospital.

In January 2019, as Lexi was about to go into kidney failure, surgeons from the Recanati/Miller Transplantation Institute at Mount Sinai performed the transplant using her dad’s kidney. “We had all of our firepower available,” says Ron Shapiro, MD, Professor of Surgery, and Surgical Director of the Kidney and Pancreas Transplant Program, referring to the expert team of surgeons involved with the transplant and the bladder creation. A smiling Lexi was discharged after spending nine days in the hospital for the transplant surgery.

Still, says Dr. Saland, “This is a work in progress. Lexi remains at higher risk for urinary tract infections and we’ll need to make ongoing adjustments for drainage as well as in her anti-rejection medications. But at Mount Sinai, we believe we have all the expertise and resources we need to treat all aspects of Lexi’s condition.”

“I have the utmost respect for the doctors and nurses at Mount Sinai,” says Ms. Isler. “They all treated Lexi with so much respect and love. The nurses even came to her bedside when their shifts were over to paint with her.”

Despite periodic hospital stays, Lexi is happy and back at school, facing her health challenges with grace and an amazingly positive attitude for a girl her age, says Ms. Isler. Lexi recently found the courage to stand before her classmates and tell them about the condition she was born with and how it was treated. “Her classmates have been very supportive, and they don’t treat her like she’s different,” says Ms. Isler.

At home, the child who had been taking dance classes since the age of 2 has newfound energy and dances around the house with a lack of inhibition, Mr. Isler says. “With a lot of support, our goal is to enable Lexi to live a long, happy, and healthy life,” says Dr. Stock.

To learn more about organ donation, visit www.LiveOnNY.org.

Learn more about organ donation at LiveOnNY.org

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