Ottolenghi’s Roasted Chicken with Clementines and Arak

Chicken w/ Clementines & Arak

One of these days, I’m going to visit Israel, if only to taste in situ the foods that inspire Ottolenghi, whose Jerusalem cookbook has become one of the most used cooking tomes in our household. The hummus recipe alone is worth purchasing his book.

This recipe combines orange and anise flavors with a delightful roasted chicken. Don’t let the use of Arak, a licorice flavored liquor – worry you. The anise flavor is subtle, despite the use of both fennel and fennel seeds – and perfectly balanced by the clementines.

We served it with brown basmati rice and carrots, and I used the leftovers the next day to make a warm Flageolet salad.


Note – Ottolenghi’s US version of the recipe seems to have made an erroneous conversion of celsius to fahrenheit, and says to cook at 475 degrees. Cook instead at 425, or you’ll find yourself with little juice to serve it with.



  • 6 1/2 tbsp/100ml arak, ouzo or Pernod
  • 4 tbsp olive oil
  • 3 tbsp freshly squeezed orange juice
  • 3 tbsp lemon juice
  • 2 tbsp grain mustard
  • 3 tbsp light brown sugar
  • 2 1/2 tsp salt
  • 1 1/2 tsp pepper

Chicken and veggies

  • 2 medium fennel bulbs (500g in total)
  • 1 large organic or free range chicken, about 1.3kg, divided into 8 pieces, or the same weight in chicken thighs with the skin and on the bone
  • 4 clementines, unpeeled (400g in total), sliced horizontally into 0.5cm slices
  • 1 tbsp thyme leaves
  • 2½ tsp fennel seeds, slightly crushed
  • salt and black pepper
  • chopped flat-leaf parsley, to garnish


Make the marinade – Whisk together the arak, oil, orange juice, lemon juice, mustard, brown sugar and salt in a bowl large enough to hold the chicken.

Trim fennel and cut in half lengthwise, then cut each half into 4 wedges.

Add fennel, chicken, clementine slices, thyme and crushed fennel seeds to the marinade. . Turn several times to coat, then if tie allows, marinade in fridge for a few hours to overnight.

Preheat oven to 425 degrees. Transfer all ingredients, including marinade, to a roasting pan large enough to hold the ingredients in a single layer (12×14 1/2 inches); chicken should be skin side up. Roast until chicken is browned and cooked through, 35-45 minutes. Remove from the oven.

With tongs, Remove chicken, fennel and clementines to a serving plate; cover and keep warm. Pour cooking liquid into a small saucepan and over medium-high heat, bring to a boil, then simmer until sauce is reduced and you are left with about 1/3 cup. Pour heated sauce over chicken. Garnish with parsley and serve.


Other Ottolenghi recipes from TBTAM

Flageolet with Fennel and Feta

Flageolet beans w fennel and Feta

I send Mr TBTAM to the market for French Le Pay lentils yesterday, and he returned instead with French flageolet.

It’s partly my fault. After all, he did call me from the store to be sure he had the right brand. My mistake was assuming he knew what a lentil was, and instead focusing on making sure that what he was buying was actually imported from France. He said the word flageolet, and even spelled it out for me. I had no idea what flageolet meant, but it sure sounded French to me, and thinking it was a lentil brand name, I approved the purchase.

Only when he got them home did I discover that flageolet are not a lentil brand, but a type of bean. And not just any bean, but a small, buttery bush bean plucked from the pod while still young and delicate. Sort of the veal of the bean family, but without the force feeding or animal cruelty.

Flageolet beans

Flageolet have been called the “caviar of beans”. I’m not sure I’d go that far – a bean is after all just a bean. And truth be told, I still love the stronger flavor of a good lima bean more than any other legume. But flageolet are a really nice alternative to white beans, and the small size is just lovely.

How I cooked and served my flageolet

I eschewed the overnight soak, instead following Epicurious’s recommended method of bringing the beans and water to a quick boil, then letting them soak for just an hour. Then I added salt and a bay leaf, brought the beans to a boil again and simmered for one and a half hours, till a blow on a spoonful of beans loosened the skin and I knew they were done and ready to be drained. (I saved the bean water to be used as a chicken stock alternative).

While the beans were cooking, I sauteed a diced onion with diced carrots and celery and 4 cloves minced garlic in a few tbsp of olive oil. I had a large piece of chicken, some braised fennel and a few cooked clementine slices leftover from last nights dinner – Ottolenghi’s Chicken with arak and clementines.  I chopped that up and added it to the sauteed veggies, along with the now cooked and drained beans, and finished it all off with some low fat feta, lots of parsley and a drizzle of olive oil. A side of cucumber salad was the perfect accompaniment.

Perhaps a better approach

Ina Garten has a baked preparation for flageolet that I may try sometime soon. She uses the very same ingredients I used, but sautees her veggies in bacon (oh yeah…), adds rosemary and cooks her beans in the oven using beef stock instead of water and with the veggies and herbs, advising that the mild flavor of the flageolet requires them to be cooked with their accompaniments. She also advises not to add salt till the end of the cooking time, as it toughens the beans – which may explain why I did not find the flageolet to be the buttery consistency I’ve read so much about.

A fortuitous mistake

I’m so glad Mr TBTAM got it wrong at the market yesterday. Flageolet are a wonderful bean, a great alternative to white beans, and are now a staple in my pantry.

How do you serve your flageolet?


Some flageolet serving ideas from around the web

Foraged Delight – The Staghorn Sumac


This is staghorn sumac (rhus thphina), whose gorgeous red fruit berries I first encountered last summer atop High Knob in the Loyalsock. Isn’t it gorgeous?


The branches and berries of the staghorn sumac have a fuzzy feeling like the antlers of a deer (hence the name) and will NOT give you a rash. The stuff that gives you a rash is poison sumac.

Poison sumac has a red trunk. It grows in swamps and standing water, it’s berries are white and hang down, and the leaves look like this.


Got it? Good. Now stop being afraid and go get yourself some staghorn sumac.

What to do with Staghorn Sumac Berries


The sumac fruit is best harvested in late summer after a few days of dry weather. (Rain washes away the oils and lessens their already light flavor)  If you’re lucky and have found it at just the right time, it will feel slightly sticky, and when you lick your fingers after touching it, you’ll taste its slightly acidic, lemony flavor.

Bring along a paid of kitchen shears, and cut the fruits off at the base of their stems.  Handle them gently, and pack lightly into a paper bag for transport. (Or like me, tear them off and lay them across the hatchback floor for the ride home.)

Sumac fruit is high in Vitamin C and antioxidants. The berries can be used to make tea, or dried to make a fabulous spice.



Sumac iced tea is a refreshing, light summer tea.  It’s easy to make. Simply rinse the berries in cold water, then pull them off the cluster and into a french press.


Add cold water, 1-2 cup per tbsp of berries, stir and let steep until the flavor is to your liking. (If you go too long and too strong, and it may be bitter.)


Press. Pour the tea into your cup or pitcher, add a little sugar or honey and enjoy. Better yet, add some Campari, Pimms, simple syrup and a lemon twist for a refreshing cocktail.

You can dry the sumac and use it to make hot tea during the cooler months.



The sumac berry, dried (and if you want, ground) makes a wonderful spice.

Ground Sumac is widely used in Middle Eastern food. Israeli chef Ottolenghi loves sumac, and it is featured heavily in his cookbooks. He even serves a sumac martini in his restaurant.

Sumac is primarily used as part of a spice mixture call za’atar.

za’atar spice mix

There are as many recipes for zaatar as there are tribes in the Middle East, but most contain thyme, salt and sesame seeds. It’s commonly sprinkled atop pita bread brushed with olive oil, or used as a rub for meats.


Clip the sumac fruits off the stem and lay out to dry for a few days.


Pull the berries off the stems in clumps and place into the bowl of the food processor. Pulse for a few seconds to separate the seeds and stems from the fruit.

Transfer to a fine sieve, and using a pestle, strain the fruit from the stones and twigs.


The sumac spice is fine threads, with a consistency almost like pencil shavings.


This is what’s left behind. Toss it out.


This is the gold.


Store it in a jar in a cool place out of direct light. It should keep for a year.

Where to buy sumac

If you don’t want to forage your own sumac, you can buy it in New York City at Fairway or Kalustyans. Amazon and Penzys carry it as well.

If you’re ready to try sumac, here’s a recipe for you.



Melissa Clarks original recipe uses two whole chickens and is meant for a holiday dinner crowd. I cut it back and modified it to serve 4 using chicken thighs. You can use breasts or a small chicken instead of the parts if you prefer. If you use a whole chicken, omit the thyme from the rub and instead stuff a sprig or two into the chicken cavity, and place the chicken on a small roasting rack atop the plums. (Melissa has a wonderful video showing how she makes the dish using two whole chickens.)

For the chicken

  • 1 large lemon
  • 1 tablespoon ground sumac
  • 2 teaspoons kosher salt
  • 1/2 tablespoon black pepper
  • 1/2 teaspoon cinnamon
  • 1/2 teaspoon allspice
  • 1 tbsp finely chopped fresh thyme
  • 2 tablespoons extra-virgin olive oil
  • 2 garlic cloves, grated or minced
  • Enough chicken thighs and breasts to serve 4
  • Fresh Thyme

For the plums

  • 1 pounds plums, halved or quartered if large
  • 2 shallots, sliced into 1/4-inch-thick rounds
  • 1 tablespoons honey
  • 1/2 tablespoon extra-virgin olive oil
  • 1/4 teaspoon salt
  • 1/4 teaspoon cinnamon
  • 1/8 teaspoon allspice
  • 1/2 bay leaf
  1. Grate lemon zest and place in a small bowl. Set aside the zested lemon.
  2. Stir sumac, salt, pepper, cinnamon, thyme and allspice into the lemon zest. Stir in 1 1/2 tbsp of the olive oil and the garlic. The mixture should feel like wet sand. Rub it all over the chicken parts and place the chicken on a plate. Let marinate, uncovered, in the refrigerator for at least 1 hour or up to 24 hours.
  3. When ready to roast, let chickens come to room temperature for 30 minutes. Heat oven to 450 degrees.
  4. Heat 1 tbsp olive oil in a large saute pan that can go into the oven (We used a cast iron pan). Quickly sear and brown chicken thighs over high heat in a pan, then remove to a plate. Turn down heat and in the pan, toss together plums, shallots, honey, oil, salt, Place chickens over the plums in the pan. Roast for 15-20 minutes.
  5. Meanwhile, squeeze 1 tablespoon juice from the reserved lemon and mix it with remaining 1 tablespoon olive oil. Drizzle this over the chicken, then continue to roast until skin is golden and chicken is cooked through. (another 15-20 mins)
  6. Let chicken rest, covered lightly with foil, for 10 minutes. Serve with the plums and sprigs of thyme for garnish.


More about Sumac

Summer Fruit Cake

Summer Fruit Cake

Labor Day weekend at the cottage with good friends. A bittersweet end to summer.

Lake swimming, hiking, biking, reading, stargazing.

Shunpiking* to discover gorgeous vistas, plump red sumac berries ripe for the picking (and drying for spice – I”ll post on that later) and the best garage sale ever.

Making Irene’s summer fruit cake to bring to a wonderful outdoor dinner party (great conversation, great food, great people) on an evening cool enough to end inside around a burning wood stove. (Thanks Rick for leaving the stove door open so we could see the fire.)

We left a day early, warned that the impending hurricane would make return to the coast near impossible. False alarm, but a traffic-less return with great music and great conversation more than made up for the early leave.

Here’s to the end of summer in the Endless Mountains, made even better by this year’s strategy of taking off a bunch of Fridays in lieu of a vacation week. The good news is the mountains and the lake are even more beautiful in autumn, the wood stove beckons, and we’ve got a good 10 weeks before we need to close the cottage up for winter.

*Shunpiking: an avoidance of major highways (regardless of tolls) in preference for bucolic and scenic interludes along lightly traveled country roads.


This cake recipe is absolutely perfect and a delicious celebrating of the stone fruits of summer. My mother-in-law Irene makes it with small Italian plums – each slice has a single plum half nestled atop, making for a very pretty presentation. We used larger plums and white peaches from the Farm Market and sliced them before putting them on the cake – not as pretty a presentation but omg delicious. You can also make this cake using apples.

  • 6 oz. soft butter
  • 1 ½ cups sugar
  • 3 eggs separated
  • grated lemon peel from 1 lemon
  • 1 tsp. vanilla extract
  • 3 tbsps. rum
  • 2 cups flour
  • ½ tsp. baking powder
  • ¼ tsp. salt
  • 8 peeled and sliced apples tossed with lemon juice or any summer fruit* such as blueberries, apricots, peaches or small blue Italian plums. If using summer fruit, omit lemon juice. If using blueberries about 1 pint of berries will be needed. If using apricots, peaches or plums about 18 to 24 whole fruits will be needed, depending on size.
  • ¼ cup slivered or sliced almonds

Grease and flour a 9 x 13 inch baking pan. Preheat oven to375 degrees fahrenheit.

Halve the fruits, remove pits. If they are large (i.e. peaches), slice them thick. If they are small plums or fresh apricots, just leave them halved and don’t slice them.

Beat egg whites until stiff and fluffy. Reserve.

Cream butter and sugar. Add egg yolks one at a time beating thoroughly after each addition. Add rum and vanilla to butter mixture. Add lemon peel and mix well.

Mix flour, baking powder and salt together and add to batter, mixing only until incorporated. Do not over beat. Fold in beaten egg whites.

Pour batter into baking pan. Place fruit cut side down on top of batter. (If using apples, slice and arrange in rows on top of batter with a little sprinkled sugar and cinnamon, and ¼ cup currants or raisins if desired.) Sprinkle the top with the slivered almonds.

Bake in pre-heated 375 degree oven for 30 to 35 minutes until tester comes out dry and cake is lightly browned. Cool on rack. Cut in serving size squares and remove from pan.


On Balsamic Vinegar, Proscuitto and Why Foodie Friends are Just the Best

Giuseppe Giusti - Il Quarto Centenario

There’s what you think is Balsamic vinegar, and then there’s this stuff.

Quartro Centenario Aceto Basilica, a limited edition, 15 year old Balsamic made by the Giusti family in Modena, Italy to celebrate 4 centuries running the oldest balsamic vinegar house in the world.

OMG. Thick and rich, sweet but still vinegary, full of flavor and well, just heaven.

This balsamic is too special to use in a salad dressing. What you do is drizzle it on something special, in this case an open faced sandwich made with ever so lightly toasted baguette that you’ve brushed with olive oil, then topped with a slice of fresh Mozarella, tomato, basil leaf, and a fast grind of sea salt and pepper.  It’s a lunch of the gods.

Thanks forever to my foodie friend Chris Eden (in his other life an architectural photographer), who gifted me a bottle of this liquid gold that he bought at Di Palo’s food market in Little Italy. DiPalo’s is not just a food store – it’s a portal into Italy, lovingly maintained for four generations by the one special family.

Chris visits DiPalo’s whenever he’s in New York. The store is often very, very crowded (the lines can be up to 45 minutes long). So it was no small feat when one day, Chris managed to get Lou DiPalo’s individual attention when he asked for a half pound of unsliced Prosciutto. Previously on rapid autopilot, filling orders right and left, Lou stopped short.

“You slice the Prosciutto yourself?” he asked Chris.

Yep, he does. Paper thin and just right, using a vintage American slicer that he refurbished himself.

American Slicer VIntage

Pretty sweet, huh? Now look at it slicing the prosciutto


and the finished product, which Chris served as part of an antipasto spread in April when I visited him and his wife Trish. (Dinner at their house should be a tourist attraction for Seattle…)

Sliced Prosciutto

Yep, you gotta have the right slicer. That’s what DiPalo tells us in his book Di Palo’s Guide to the Essential Foods of Italy: 100 Years of Wisdom and Stories from Behind the Counter, which Chris gave me along with the vinegar of the gods –

You also want to ask for a taste so you can see how it is sliced. You can ruin an excellent prosciutto if you slice it too thick, or use a machine that heats it up or is used to slice other things, even if you don’t start slicing it at the right angle. … More important than the angle is that the slicer be belt-driven or even manual.Prosciutto is raw, remember – an ordinary slicer spins around really fast and creates heat, and that can cook a really thin slice.

That little moment of shared recognition and the discussion that followed between these two prosciutto-slicing aficionados was enough to seal Chris’s reputation with Lou as someone more than just a run of the mill tourist customer. Now, Lou actually recognizes him when Chris visits, though Chris makes a point of doing so only during the weekdays when there’s no line.

On his last visit there, Lou told Chris the back story on how his family chooses and buys olive oils. He even gave Chris an invite for me to attend one of his oil tastings (which one of these days I swear I will do…)

I’m doing my best to savor the vinegar, holding it for special occasions like that Sunday lunch up there. I do admit that sometimes I take the vinegar out of the cabinet and drizzle a little of that liquid heaven onto my fingertip to taste, just because I can. Maybe I’ll head down to Di Palo’s myself one of these days soon, pick me up some sliced Prosciutto and drizzle a little on that. Hmmm…….

Oh yeah. Chris also gave me a Cavitelli maker and taught me how to use it. (He had a spare one lying around the house…)

But that’s a post for another day.


Tahcheen-e Esfenaj (Baked Persian Rice Cake with Lamb, Spinach & Prunes)

Tahcheen-e esfanaj

I must apologize for the infrequency of my blog posts over the past year. My new position at the medical school has kept me much busier than I’d ever imagined. Now, a year later, things are finally settling in and I’m hoping to bring this blog thing back to life, if only because the act of writing truly grounds me.

One of the better parts of my new position has been getting to know our Qatar-based medical school faculty and staff, who sent me the most amazing Persian cookbook – Saraban: A Chef’s Journey through Persia by Greg and Lucy Malouf. (Thank you Shahrad and team!)

This is a cookbook that deserves more than just a look at the recipes (which are amazing), but demands a real sit-down read. Saraban introduces the reader to an Iran most Americans do not know – a complex and beautiful country of both desert and verdant mountains, with warm, friendly people whose culture is steeped in marvelous food, family, literature (especially poetry) and religion. The grief and impact of years of political unrest and conflict are acknowledged, but are not central to this portrait of a people and a cuisine.

If only one day there were peace within this region and between our nations. We have so much that is beautiful (and delicious) to share with one another.

Tahcheen-e esfanaj

TAHCHEEN-E ESFENAJ (Baked Persian Rice Cake w/ Lamb, Spinach & Prunes)

The authors tell us that Tahcheen means “spread over the bottom”, which describes the tahdig or crispy rice mixture that forms the base of this cake, which is then layered with richly spiced lamb, cooked spinach and prunes.

Getting the cake out with the tahdig intact can be tricky (note I failed at that). I suggest you watch this video to learn how. I used a square pyrex pan, but you can use a glass pan, cast iron skillet if large enough, or a La Cruset pan. Non-stick would be great if you have it.

In this recipe, the meat is stewed and removed from the broth. This leaves you with a lovely broth to be used in future dishes (Pilaf? Soup?) The meat is then marinated in the yogurt/saffron mix for 8-24 hours. That’s a huge make-ahead step. For a quicker version, after the meat is cooked, just cook the broth down into a nice thick gravy, and avoid the yogurt marinade step altogether.  It will mean that the rice yogurt part of the dish won’t have a lamb overtones, but I’m sure it will still be delicious. 

There are many versions of Tahcheen (also spelled Tah-Chin and Tahchin), the most popular being chicken. I could see this being delicious made without the lamb for a vegetarian version.

  • 3 tbsp olive oil
  • 2 large onions, very thinly sliced
  • 1 clove garlic, roughly chopped
  • Sea salt
  • 1 tsp freshly ground black pepper
  • 1/2 tsp ground turmeric
  • 1/2 tsp ground ginger
  • 1/2 tsp ground allspice
  • 1 pound lamb shoulder, trimmed of fat and cut into 2-3 cm cubes
  • Enough water of beef broth to cover meat for cooking
  • 200 gm thick natural yogurt
  • 2 egg yolks
  • 80 ml (5 tbsp) saffron liquid (See recipe below)
  • 200 gm spinach leaves (one standard bag of pre-washed)
  • 2 cups basmati rice
  • 12 prunes, pitted and roughly chopped
  • 2 oz butter, plus extra for greasing the pan

Heat 1.5 tbsp oil in medium saucepan over low heat. Add one of the sliced onions, along w/ garlic, 1 tsp sea salt, pepper and spices and fry gently for 4 minutes. Add meat and enough water or broth to cover, bring to simmer and simmer gently for an hour, or until meat is tender. Remove meat from broth and cool.  (Save that broth!  It’s gold, Jerry, gold…)

Beat yogurt with egg yolks and saffron liquid in a shallow dish. Drain the cooled meat well and add to yogurt mixture. Cover and refrigerate for at least 8 and up to 24 hours.

Heat the remaining oil in a large frying pan over a low heat. Add the remaining sliced onion and fry gently till soft and lightly colored. Add spinach and cook, tossing gently with tongs, till wilted. Cook over a medium heat to evaporate any excess liquid. When cool, squeeze the spinach to remove any remaining liquid and coarsely chop.

Parboil the rice: Wash/rinse the rice well, then soak in cold water for 30 mins. Drain and add to 8 cups boiling water in a large pot. Bring back to a rolling boil and boil for 5 mins. Rinse with warm water and drain well.

Preheat oven to 375 degrees Fahrenheit. Butter an ovenproof dish with an 8 cup capacity. Remove the lamb from the yogurt mixture. Mix half the parboiled rice with the marinade and spoon into the bottom and up the sides of the ovenproof dish. Arrange the lab on top of the rice, then cover with spinach and dot with the prunes. Spoon remaining rice to cover and smooth the surface. Cover tightly with a sheet of aluminum foil and bake for 1 1/2 hours

Remove the dish from the oven and dot with bits of butter. Replace foil and leave to rest for 10 minutes. Turn the rice cake out onto a platter and serve warm.

Saffron Liquid

  • About 60 saffron threads
  • 6 tbsp boiling water

Lightly toast the saffron threads in a small frying pan over medium heat for about 30 seconds or until totally dry. Be careful not to burn the saffron. Place saffron into aa mortar and let sit for a minute or two before grinding into a powder. (If the saffron is well dried, and like me, you don’t have a mortar and pestle, just crush the saffron threads with a spoon against the side of a small bowl and it will grind easily into a coarse powder.) Mix the ground saffron into the boiling water in a small cup or bowel and set aside to infuse for at least an hour before using. The color will continue to develop for at least 12 jours.

You’ll be using 5 tbsp of this liquid in this recipe.

More Tacheen

  • PersianMama makes one gorgeous Lamb Tahchin with black-eyed peas. (Great pics – Check out those sautéed onions…)
  • WorthyPause makes her Tahchin with ground lamb and barberries
  • Persian Fusion makes a vegetarian Tahcheen with mushrooms and aubergine
  • Fig and Quince shows how to make a beautiful Tacheen Morgh (Chicken Tacheen). (She also has great pics from her trips to Iran)
  • Azita of Turmeric & Saffron makes a particularly gorgeous Chicken Tah-Chin
  • PersianMama makes a pretty Tachin Morgh
  • A quick video shows how to make an easy stove-top Chicken Tacheen
  • Jamie Oliver makes a nice Chicken Tahchin

New York City Garden 2016

It’s been a long year or so without our balcony herb garden. Mandatory brickwork outside our apartment started in April 2015 with a Cristo-like gauze wrapping around the entire facade and taping shut our windows and balcony door. We lived like that for almost an entire year, until finally, in April, we were allowed access to the balcony again.

That’s the bad part.

The good part is that I got to start the balcony garden all over again. The building had removed our handmade deck floor, so I replaced it with a wonderful and inexpensive Ikea deck floor.


I also swapped out our rusting bistro set and rickety plant stand for a bistro table and Sophia Chairs (ridiculously cheap on Craigs list) and a couple of Ikea plant stands.


The window boxes and all the pots survived on the roof during the construction, although we lost all the herbs save the hardy chives that have come back every spring for almost 20 years. I planted the window boxes with a brown grass, coleus, Thai basil and asparagus fern that I found at my new favorite garden store – GardenWorks in Flushing.


After some searching around for them, I found some straggling hyacinth beans for a song at Chelsea Gardens in Red Hook. They had wilted in the heat and looked terrible, but the salesclerk promised me they’d be fine and she was right. They are rapidly lining the trellis and railing, keeping the eyes off the ugly white storage building across the street and focused instead on the garden and the skyline view.


Still left to do is hang a half moon lined planter or two from the brick wall (if the building will let me), and fill them with some colorful annuals. And get an umbrella. And maybe some pretty pillows for the chairs. And some little bistro lights for evening.

Drinks, anyone?…


NYC Gardening Resources

I would have killed for this list in my early days of gardening here in NYC. Sadly, many of the favorite places I used to frequent (like Dimitri’s and Liberty) are no longer in existence, but these are tried and true. I avoid the small, precious gardening stores, and tend to larger garden centers, which are cheaper. If you have a car, your options increase widely. 

Union Square Farmers Market. The place to go for organic lettuces and herb plants. I’ve got some gorgeous lettuce mixes over the years that have graced my salads well into summer. Also good for annuals.

Plant Shed. On 96th St near Broadway on the Upper West Side. They’ve been there for years, and a consistently reliable source for spring herbs and annuals. Perennials and shrubs more limited. Prices are not outrageous for NYC. They deliver.

Chelsea Gardens: Not cheap, but if you need something, they’ll have it (like the hyacinth beans I was looking for this year.) Staff is extremely knowledgable.  Great place to go to see what is possible in the city. Started in Chelsea, now also in Williamsburg and Red Hook.

Gowanus Nursery. The place to go for something special, and like Chelsea Gardens, see what is possible. If you’re visiting Red Hook, combine it with a trip to Chelsea Gardens.

Kings County Nursery: Very reasonably priced Garden Center deeper into Brooklyn. I like this place. A lot. Good source for trees, vines, grasses, shrubs, as well as garden supplies and annuals.

Garden World in Flushing. My new favorite place. Wonderful selection of healthy, gorgeous plants and trees.

Home Depot. The one on Northern Blvd in Long Island City. Where I go for potting soil, stones, and basic shribs and annuals. (The Home Depot in Manhattan does not have the really large bags of soil or stones.) Occasionally they surprise you with an unusual shrub or annual. Sales can be great. I picked up two crabapple trees for 10 bucks apiece there a few years back – both are thriving. The Spirea I got there for next to nothing have also lasted years.

Jamali Garden – in the flower district. Basic supplies, containers, plant food, lighting, you name it. Like a giant hardware store for your garden. Reasonable prices.

Hicks Nurseries – If you’re up for the schlep out to Long Island, Hicks is well worth the trip. They have everything. Not as cheap as you’d think. But great selection and quality.

IKEA – for containers and fun garden accessories such as funky solar lights, prices can’t be beat. I go to the one in Brooklyn.

For trees. Any of the garden centers in the city and near Long Island are way too expensive for my budget when it comes to buying trees. For these buys, I head out to New Jersey, where garden centers abound. Prices will be much more reasonable, but be careful. The help do not know urban gardening and could recommend the wrong species for your roof or balcony conditions. If they deliver, it may be pricey. So consider renting a truck and delivering to yourself.

What Women Want – How and When to Deliver the News of a Breast Cancer Diagnosis


If you’re going to have to tell a woman that she has breast cancer, she wants to hear the news as quickly as possible, preferably face to face, ideally within 1-2 days of the biopsy being done, and have an appointment set up to deal with the diagnosis either that day or the next.

That’s what Dr Deanna Attai and colleagues found out when they surveyed over 1000 women, including 784 breast cancer survivors, to find out how and how soon they wanted to get their breast biopsy results, and compared that to what actually happened when they got their results.

It’s no surprise that in almost all cases, when it comes to hearing results, what women got did not match what they wanted. For example, while 40% of women heard their diagnosis within 1-2 days of biopsy, 80% would have wanted their results within that time frame.  Fifty four percent heard their mammogram results within 2 days, but 84% wanted them the same or next day.

A few important nuances emerged from the data – given a choice between hearing results face-to-face and getting them faster over the phone, women opt for speed. If it’s a mammogram or blood test result rather than a biopsy, face-to-face is not as important.

Most interesting were the comments women made on their surveys, which should be required reading for anyone having to give bad news. Here are just a few –

  • “Use the same compassion and candor you would use if you had to give this info to your loved one”
  • “Nothing is worse than calling a patient and telling them to bring someone with them but not telling them why.”
  • “Please remember that a bad test result may throw a person off, so much so that they cannot really hear what you are saying. Be clear and be careful. Ask the person to reflect back what you have said, so you are sure they got it!”
  • “We were starving for reliable information when I was diagnosed. Wish there was information provided with the results that further explained everything.”
  • “Always present situation with hope.”
  • “My oncologist was exceptionally kind. He said ‘I’m sorry this is happening to you’. He was the only one of several doctors to do so’”

The study population by design sampled internet-saavy women, and Caucasian women were over-represented in the sample, so these results may not extrapolate to all women.

But the message is loud and clear – when it comes to breast cancer screening results, we are not meeting our patient’s desire for timeliness or preferred method of communication.

Rethinking Gonad Removal in Individuals w/ Complete Androgen Insensitivity Syndrome

Lauren in MTV's "Faking it" has AIS
Lauren in MTV’s “Faking it” has AIS
What if you were genetically male, but your body was blind to testosterone ?

I’ve just described XY Complete Androgen Insensitivity Syndrome, or CAIS, a genetic condition in which there is a defect in the androgen (testosterone) receptor gene – located, ironically, on the X-chromosome.*

Describing CAIS

XY (genetically male) individuals with CAIS have gonads (testes) that manufacture testosterone, but their body’s cells cannot see the testosterone. As a result, their internal and external genitalia develop as female, but the vagina is shortened and smaller than normal. The testes are either located in the groin or in the abdomen.

At puberty, individuals with AIS develop breasts due to the body’s conversion of testosterone to estrogen. Pubic and underarm hair is scant, since this hair growth requires androgen receptors. With dilation of the vagina, AIS individuals can have sexual intercourse, but they cannot bear children.

As to gender identity, although CAIS individuals are viewed as female and until now, treated that way, it may not be as simple as that. (Huge “Duh” from the AIS community on this one, I’m sure…) Some interesting brain imaging studies do suggest the brain sexual response in CAIS aligns to female, not male. But gender identity is too individual an issue to address here. It could be linked to specific gene defects, and I suspect will be teased out over time as the medical community wakes up to the psycho-sexual needs of this community.

One way in which we are already waking up is in how we are managing the risks of cancer of the gonads in individuals with CAIS.

Cancer Risks in the Gonads of XY individuals with CAIS

Until recently, based mostly on case reports and anecdotal evidence, it had been accepted that there was an increased risk of cancer in the testes of individuals with AIS – a risk as high as 22% in one early published series. Therefore, for many years, one of the tenets of caring for individuals with AIS has been removal of the gonads in childhood, followed by the induction of puberty with estrogen and lifelong estrogen replacement therapy.

All of this has changed over the past few decades. A growing scientific literature finds that the actual incidence of gonadal cancers in CAIS is as low as 5 to 10%, with few to no malignancies prior to puberty. This led to the current standard of care for AIS, which is to delay gonad removal till after puberty is complete – usually between ages 16-18. This allows for a smooth, natural pubertal transition (nature always does it better than pharma), and for the more mature patient to be involved in management decisions going forward.

Rethinking Gonad Removal for Cancer Prevention

Now, the needle is shifting even further, as genetic sequencing allows us to stratify cancer risks in individuals with AIS according to their genetic defect. For those with complete androgen insensitivity, at lowest risk of cancer, the chance of retaining the gonads indefinitely is now being considered, along with various surveillance regimens to help catch cancer if and when it develops in the retained gonads.  Proposed surveillance options include gonad biopsy, ultrasound and serum tumor markers in individuals whose testes can be easily seen on sonogram. For those whose gonads are hard to image, laparoscopic surgery called gonadopexy can move the testes closer to the abdominal wall to allow for biopsy and sonographic surveillance.

(Note that this option of surveillance is only appropriate for those with CAIS. Individuals with Partial Androgen Insensitivity Syndrome or PAIS have a cancer risk as high as 50%. For these individuals, standard of care is to remove the testes, usually before puberty.)

We don’t know yet just what, if any, advantage there is in retaining the gonads past puberty in CAIS, other than the obvious one of avoiding surgery and hormone replacement therapy. Proposed gonadal surveillance strategies have not yet been tested prospectively, and ideally would be done in an IRB-approved clinical trial, which may not be randomized for ethical reasons, but could certainly be matched to individuals choosing to have their gonads removed at puberty.

Paramount to moving forward on any path towards surveillance, research or otherwise, is a well-informed patient. The good news on that front is that there is a lot of information out there now for patients and their families to help them learn about and participate in management decisions around CAIS. And as we move forward, let’s never forget – Prima non nocere.



Patel V, Kastl Casey R, Gomez-Lobo, V. Timing of Gonadectomy in Patients with Complete Androgen Insensitivity Syndrome – Current Recommendations and Future Directions, J Pediatr Adol Gynecology 29 (2016) 320-325. This blog post was written in response to this well-written state of the art mini-review and its accompanying editorial by Joseph Sanfilippo, MD.


*Note – there are XX individuals with CAIS who carry a gene defect of the androgen receptor on both X chromosomes. These individuals are genetically female and develop as a female, but are minimally affected, though they may be tall, have scant pubic and underarm hair and delayed puberty. This blog post is not about them. 

Onion & Olive Tart

Onion & Olive Tart

This wonderful onion and olive tart is based on a recipe from Molly O’Neill.  Think if it as an Americanized version of the classic French Pissaladiere – a Nicoise savory tart made with anchovies, onions, olives and herbs.  The classic Pissalidiere is made with a thin pizza crust (though Julia Child made hers with puff pastry) and derives it name from its use of pisalla – a condiment speciality of the coastal area around Nice made from ground anchovies with olive oil, herbs and spices.

Today, I’ve made my mother-in-law Irene’s variation of the tart without anchovies. I plan to bring it to my brother-in-laws kick-ass Second Saturday Party, where it will accompany his amazing chicken wings and the best roast beef sandwiches in the world. Anchovies just don’t seem right, and I fear not everyone will like them.

But making this tart and learning about its origins has me itching to try my hand at a classic Pisalladiere.

Onion & Olive Tart

The original recipe by Molly O’Neill has instructions for making the crust by hand, if you prefer that over using the food processor.  Molly also hides the anchovies and olives between two layers of onions. Maybe she’s also worried about her audience…. I just made the variation without anchovies. 


  • 2 cups flour
  • ½ lb unsalted butter, sliced
  • ½ tsp kosher salt
  • 1 egg yolk
  • 3 tbsp ice water


  • 2 tbsps sweet butter
  • 3 lbs yellow onions, thinly sliced
  • Salt and freshly ground pepper
  • 12 anchovy fillets
  • 1 cup oil-cured black olives, pitted and halved
  • ¼ tsp each, basil and oregano

Make the crust:  In food processor, pulse flour and salt. Add butter, pulse. Add liquids. Pulse, then shape into ball on floured board. Wrap in plastic. Chill for one hour

Make the filling by melting the butter in a large skillet over high heat. Reduce the heat to low and add the onions. Cook, stirring frequently until the onions are light brown, about 15 minutes. Adjust the flame to avoid burning. Season with salt, pepper, oregano and basil. Set aside to cool to room temp.

Preheat the oven to 375 degrees. Roll the dough out on a lightly floured board and place in a large pie or tart pan. Press the dough into the pan and crimp the edges.

Lay in the onions using a fork. Arrange the anchovies in a starburst pattern from the center of the pie. Arrange the olives between the anchovies.

Bake the tart until the crust is golden and the onions are caramelized and brown, 40 to 50 minutes. YIELD: eight servings.

Pie Variations:

Omit anchovies. Sprinkle ¼ cup grated Parmesan cheese on crust before adding the onions. Dot with whole olives before baking.

To make ahead 

Cook up the onions, and refrigerate. Make the pie dough and refrigerate. On the day you are serving, roll out the pie dough, assemble the pie and bake.  Serve at room temperature or warm up before serving.

Bronx River Pathway Ride

Bronx RIver

Boy, is spring ever late coming this year. Last weekend found us more than eager to finally get out in the warmish weather. Figuring Central Park would be packed, we decided to take our bikes north of the city to the Bronx River Pathway.

This Greenway runs along the Bronx River in Westchester County, NY. The trail has three paved segments, which are not continuous. We chose to ride the uppermost section from Greenacres Road to Kensico Dam, about a 10 mile round trip. It’s not an entirely bucolic country ride, since the highway and civilization are never far away, but there are more than enough green spaces and points of interest that we barely noticed the the nearby traffic.

Bronx RIver 2

The trail takes you from north Scarsdale through White Plains to the Kensico Dam Park in Valhalla. You’ll be biking along babbling waters, past a tennis club, along a poorly paved section in the forest, then on a decently-paved path through White Plains, taking some steep and narrow stretches under the roadways (Get off and walk here – you risk hitting a biker coming the other way or worse, hitting your head on the low overhanging bridges).

Bronx River Greenway

You’ll cut across a parking lot and a road or two, including one short stint over a roadway bridge where the trail does not cut perfectly across the road. Just follow the bike signs.

Bronx River Greenway 2

Along the trail, there are numbered outposts of the Bronx River Walk App, a podcast narrated by Dan Rather, who tells the history of the Bronx River, and directs your attention to points of interest, both man-made and natural, along the way. Given that the trail has a slight uphill grade going north and a few steep (but mercifully short) uphill climbs, these little listening breaks were both enjoyable and restful.

Bronx River Greenway 3

Once you climb up the hill to the Valhalla Bridge, you’re almost at the north end of the trail and your ride’s halfway point.

Valhalla Bridge

Stop and look north – you’ll see the Kensico Dam, beckoning like a Mayan Temple in the distance.

Kensico Dam from Valhalla Bridge

The dam, built in the 1920’s, holds back the waters of the Kensico reservoir, which is a terminal collecting point for water from 6 other reservoirs in the Catskills ultimately destined to be delivered to New York City.

It is massively beautiful (my pictures do not do it justice)

Kensico Dam 2

and graced on its south side by a lovely public park.

Kensico Dam Park

You can ride (or in my case walk) your bike up the winding brick road on the right of the dam

Kensico Dam 4

all the way up, where a road allows you to ride right across the top of the dam!

Kensico Dam 7

It’s just so cool – seeing the water high on one side

Kensico dam 10

and the land way down below on the other.

Kensico Dam 8


The park has restrooms and food – if we’d planned the day better, we would have left earlier and planned to stop here for lunch. But we had dinner plans back in the city, so after a brief rest we headed back down the trail. The trail heading south is almost all downhill, and before I knew it we were back at the trailhead!

Bottom Line

The Bronx River Greenway is a great day trip from New York City. Leave early, plan to stop for lunch at the Kensico Dam and make a day of it.

One thing I would have also liked to have done would be to spend some time exploring Scarsdale’s downtown, perhaps having a late afternoon coffee there after the ride. Take Fox Meadow Road south from near the trailhead for about 2 miles, mostly flat according to google maps. If you’re not driving, you can get the train from the Scarsdale station back to the city.

Getting there

This is perhaps the most difficult aspect of this trip if, like me, you live in the city and don’t know West Chester. We drove, and took 87 to the Cross Bronx to the Bronx River Parkway. It’s probably easier to just take 278 to the Bronx River Parkway. The Bronx River Parkway becomes rather narrow and windy as it goes north, and may be closed if it’s a Sunday (See alternate route below). Follow your map carefully. Next time we may just take the train.

  • By train : Take Metro North from Grand Central to Hartsdale. Bike over Fenimore Road, then a left onto Greenacres to the trailhead. If you pass the church, you’ve gone too far.

From Train

  • By car (Enter Hitchcock Presbyterian Church in Scarsdale as your destination.): Head north to the Bronx River Parkway, taking the Fenimore Ave Exit. Turn right onto Fenmore, left onto Walworth ave, then another left on Greenacres Road. Park across from the church.

Bronx River Trail head Scarsdale

  • If it’s a Sunday morning in fair weather season, the Bronx River Parkway may be closed to cars, in which case take the Hutchinson Parkway to exit 22, then take Mamarineck Road to Fenmore and then Greenacres.

alternate route

Helpful links

Almond-Lemon Torte w/ Strawberries

Almond and Lemon torte with strawberries

The never ending search for the perfect Seder dessert continues. This one’s coming close.

Of course, my family would probably say the prefect Passover dessert has already been found in my mother in law Irene’s hazelnut strawberry shortcake. Problem is, delicious as it is, I couldn’t bring the shortcake to my kosher friends’ seder, since it is served with whipped cream and the Seder is a meat meal.

The fallen middle in this torte is a given. It’s what happens when you depend on eggs alone for your leavening, pouring an air filled light batter into your pan, then holding your breath as you place it into the oven. You have two choices at that point – either bake it till its hard and dry, with a crust sturdy enough to stand up as it cools, or keep it lightly browned and moist and just let it fall as it cools. I chose the latter, testing several times till the tester came out clean to be sure I wasn’t under-baking the center, and taking the cake out before the top started to split or got too brown. I was worried when it fell, till I compared my torte to the picture in Epicurious – their’s fell about the same amount as mine.

Despite the fall, this torte is quite delicious. The cake itself is incredibly moist, not too dense, not too sweet and really just plain lovely. The strawberry sauce, while thin, is not too sweet and a perfect accompaniment. Even better, this dessert can be made a day or two ahead, as I have done.

You know what? I think this may actually be the perfect Seder dessert.

Almond-Lemon Torte with Strawberries

Adapted from a recipe by chef Diane Rossen Worthington on Epicurious.  I found using my hand held beater easier than switching and cleaning bowls for the standup mixer. Plus I think it whips things lighter. 

Torte Ingredients:

  • 6 tbsp olive oil (plus a little more to brush the pan)
  • 4 tbsp matzo meal (2 tbsp for the pan, 2 tbsp for the torte)
  • 2 cups almond flour or almond meal
  • 1 cup sugar, divided into thirds
  • 6 large eggs (you’ll be separating them)
  • 2 tbsp fresh lemon juice
  • 1 tbsp orange juice
  • 2 tsp lemon zest, fine (I use this lemon zester)
  • 1/2 teaspoon salt
  • 1/2 cup slivered almonds

Sauce and berries:

  • 5 cups sliced and stemmed strawberries (about 2 pounds), 2 cups for sauce, 3 cups to serve
  • 2 tbsp sugar


Preheat oven to 350°F. Brush 10-inch-diameter springform pan with oil. Line bottom with parchment paper round or wax paper. Brush paper with oil. Place 2 tbsp matzo meal in pan and shake to coat; tap out excess.

Combine remaining 2 tbsp matzo meal, almond flour, and 1/3 cup sugar in medium bowl; whisk to blend.

Separate eggs – yolks to a largish bowl, whites to a medium bowl.

Add 1/3 cup sugar to egg yolks and beat until thick and fluffy. Beat in 6 tbsp olive oil, then lemon juice, orange juice, and lemon zest. Mix in dry ingredients. Clean your beaters and wipe them dry.

In the other bowl, add 1/2 teaspoon salt to egg whites; beat until soft peaks form. Gradually add 1/3 cup sugar and beat until stiff but not dry.

Fold whites into yolk mixture in 3 additions. Transfer batter to prepared pan. Sprinkle almonds over top.

Bake cake until golden brown and tester inserted into center comes out clean, about 40 – 50 minutes. (It took me 50 mins) Remove to rack and cool cake completely in pan.

Can be made 2 days ahead. Store in pan, covered with foil at room temp.

For sauce and berries:

Combine 2 cups sliced strawberries and 2 tbsp sugar in blender or food processor; blend until smooth. Can be made 1 day ahead. Cover and chill.

To serve:

Cut around cake; release pan sides. Cut cake into wedges. Serve with sauce and remaining sliced strawberries.

Prophylactic Mastectomies Increasing Despite No Survival Benefit

fight like a girlOne of the more concerning trends in breast cancer treatment is the growing use of bilateral mastectomy to treat breast cancer that is present in only one breast. We call this prophylactic contralateral mastectomy – or removal of a normal breast in order to prevent future breast cancer.

A new study of almost half a million women with breast cancer reports that in 2009, 12.7% chose to treat cancer in one breast by removing both breasts, a rate almost triple that in 2002. Unfortunately, the additional surgery added no benefit, as survival rates were no better among women who had bilateral mastectomy compared to those who chose to keep their healthy breast.

The trend towards prophylactic contralateral mastectomy (PCM) is most pronounced among women diagnosed with breast cancer prior to age 55. PCM Rates are highest among women with more advanced disease, the group it is least likely to benefit, but also increasing among those with stage 0 or 1 breast cancer. Other factors associated with use of prophylactic contralateral mastectomy are Caucasian race, higher income and education, larger tumor size, use of breast MRI, family history of breast cancer and increased anxiety and fear of recurrence.

While prophylactic mastectomy does decrease the chance of a new primary breast cancer in the unaffected breast, that risk is less than 1% to start with. The study did not address mastectomy of the affected breast, but in most cases, mastectomy does not improve survival when compared with lumpectomy and radiation therapy.


Why are so many women opting for bilateral mastectomy, when local treatment with lumpectomy and radiation therapy will in most cases be more than sufficient treatment, and allow for women to keep both their breasts?

Some are crediting Angelina Jolie, who famously underwent bilateral mastectomies for prevention of breast cancer due to a genetic mutation she carries in the BRCA gene.  Yet only about a third of the increase in PCM seen in this study occurred in genetic mutation carriers, so something else is at play here.

I think that something else is the desire for that elusive “peace of mind”, combined with mandatory insurance coverage of reconstructive surgery and the widespread acceptability of breast implants in the general population. Add in a really good nipple tattoo or nipple reconstruction and you’re set to move on from your diagnosis into a breast-cancer free future.

Because nothing says “I’m done” more than a set of new, cancer-free breasts.

Forget that the odds were already well in your favor before the procedure. Or that the procedure does nothing to improve those odds. Or that your peace of mind comes at quite a price – loss of breast sensation, inability to breast feed, and higher cost and complication rates.

I’m not sure what the right answer is to this obvious conundrum.

We’ve done so much to move away from aggressive treatment to allow for improved quality of life and breast preservation compared to the old days, when the Halsted Radical Mastectomy was standard over-aggressive treatment for what in most cases is a localized disease.  Now it seems we are going backwards, but this time at the behest of women themselves.

I suppose that all we can do it take it on a case by case basis, and try to be sure that women are making this important treatment choice with the best data we can give them. In that vein, studies like this provide important information.


More Reading 



Maple Cheesecake with Roasted Pears

maple cheesecake w roasted pears

She may have gone to prison for insider trading, but Martha Stewart does make one mean cheesecake. Maple syrup lightly sweetens the cheese filling and is brushed on pear slices as they roast before being layered atop the cheesecake, made here with a classic graham cracker crust. Not too heavy, not too sweet. Perfect.

Maple Cheesecake with Roasted Pears 

Martha uses a vanilla wafer crust, but I prefer the traditional graham cracker crust. She broils her pears, I simply roasted them. She sprays her roasting pan with cooking spray, I brush it with canola oil. I used an Epicurious recipe for the crust because it had less sugar – graham crackers are sweet enough – and a little more butter – because you can never have enough butter.


  • 2 – 8 ounces packages Philly cream cheese, room temperature
  • 3/4 cup pure maple syrup
  • 1 cup cold heavy cream
  • 2 tablespoons confectioners’ sugar
  • 1 Graham Cracker crust, made in a 9 inch springform pan (Recipe below)
  • 2 medium Bartlett pears, sliced lengthwise 1/8 inch thick


In a large electric mixer bowl, beat cream cheese on high until fluffy, about 3 minutes. Add 1/2 cup maple syrup; beat until smooth.

In another smaller bowl, beat cream and sugar on high until soft peaks form, about 3 minutes. With a rubber spatula, fold a third of the whipped cream into cream cheese mixture, then fold in remainder. Transfer to prepared crust and refrigerate until firm, 3 hours.

Preheat oven to 450 degrees. Lightly brush a parchment-lined rimmed baking sheet with canola oil. Arrange pear slices in a single layer on sheet and brush with 2 tablespoons maple syrup. Roast until pears are soft and browned in places, about 20 minutes. Let cool.

To serve, arrange pear slices, overlapping slightly, on cheesecake.

Graham Cracker Crust

If you find yourself running short while pressing this onto the sides of the pan (or eating too much while making it), just make a little more. I find how much I use depends on how thick I layer the crumbs, and it’s hard to do it uniformly every time. 


  • About 12 graham crackers to make around 1 3/4 cups graham cracker crumbs
  • 2 1/2 tablespoons sugar
  • 6 tablespoons (3/4 stick) unsalted butter, melted


Preheat oven to 350°F. Make the graham cracker crumbs by processing crackers in food processor till fine. Blend 1 3/4 cups graham cracker crumbs and sugar until combined. Gradually add butter and blwnd until moist clumps form. Press crumbs onto bottom and 1 1/2 inches up sides of 9-inch-diameter springform pan with removable bottom. Bake until set, about 12 minutes. Transfer to rack; cool completely before filling.

False Positive Mammograms & Subsequent Breast Cancer Risk

breast ca risk and false pos mammo
A recent study points to a higher risk of breast cancer in women with a history of a false positive mammogram.

Investigators examined the number of breast cancers occurring over 10 years with whose routine screening mammogram had resulted in either a “call back” normal mammogram or a benign breast biopsy (false positive mammograms), and compared it to the number of cancers in women whose mammogram was normal on the first go round (true negative mammogram.)

Women who had a false positive mammogram had a higher risk of breast cancer in the subsequent 10 years compared to women with a true negative mammogram. How much higher? As you can see in the graph above, for every 1/000 women with a true negative mammogram, 3.9 breast cancers occurred within the subsequent 10 years. This is in contrast to women with false positive mammograms who had 5.5 breast cancers for every 1,000 women, and women with a false positive biopsy who had 7 cancers per 1,000 women.

Thought the relative risks between groups is statistically significant, it’s extremely important to realize that ALL these risks are under 1%, so we are making distinctions between very small numbers.

Here’s what the study results looks like in an icon array, a useful tool for illustrating comparative risks that are under 1%. Among the 1,000 women pictured in each array below, the pink ladies are the ones who developed breast cancer within the 10 years, while the grey ladies remain cancer free.

true neg

False pos


Further stratifying results by breast density, the researchers found that 10 year subsequent breast cancer risk was highest in women with extremely dense breasts and a false positive biopsy (9.01 per 1,000 women), and lowest in women with fatty breasts and true negative mammograms (2.22 per 1,000 women), with the rest scattered in between according to density.

breast ca risk by density

The investigators uses data from the Breast Cancer Surveillance Consortium (BCSC) from 1994 to 2009, studying over 2 million mammograms done in over 1 million women. It’s a robust database that the US Preventive Services Task Force used to advise their recommendations for mammogram screening. They adjusted risk data for age, race/ethnicity, menopausal status, history of breast biopsy, and family history of breast cancer, all factors that are associated with breast cancer risk.  The study results are consistent with those of other studies, adding to a growing body of literature linking false positive mammograms with breast cancer risk.

Now What?

A history of a prior breast biopsy is a known risk factor for subsequent breast cancer, and is already incorporated into the Gale Model and other breast cancer risks assessment tools. It may be time to consider incorporating a history of a prior false positive mammogram into these tools. At this point, breast density has not been incorporated into these risks assessment tools, primarily because it is such a subjective measure with not great reproducibility, and because it changes over time.

How to Use This Information

Women and their doctors may want to use this information to help them decide how often to have mammograms, or whether or not to begin to incorporate sonograms into their breast cancer screening regimen.

That said, it’s important to understand that although the risks for breast cancer are increased by a false positive mammogram, the absolute increase in risk is modest – still less than 1% in even the highest risk group.