Fellowship Objectives

Breast Imaging

At the completion of the training period, the fellow should be able to:

  1. Discuss current and evolving breast imaging technologies and possible future implications in the management of malignant and benign breast disease.
  2. Understand the techniques, interpretation and implications of mammography, ultrasound and MRI of the breast in the managements of both malignant and benign breast disease. 
  3. Demonstrate the understanding of BI-RADS nomenclature, the techniques of diagnostic mammography and recommendations for additional views. 
  4. Demonstrate the ability to select breast intervention procedures, including but not limited to, ductograms, stereotactic biopsy, and ultrasound and MRI-guided procedures such as cyst aspiration, large core and fine needle biopsies, and vacuum assisted biopsies. 
  5. Perform breast sonography and distinguish normal sonographic anatomy versus characteristics of simple & complex cysts, well-circumscribed probably benign mass, and solid mass of suspicious nature.
  6. Select, recommend, and interpret the techniques of breast lymphoscintigraphy.
  7. Discuss the complexities, advantages and disadvantages of breast screening trials in women at different age groups.

Breast Surgery

At the completion of the training period, the breast fellow should be able to:

  1. Assess and manage common benign and malignant breast conditions.
  2. Consider the indications and contraindications for, and demonstrate experience in the performance and interpretation of the results of common in-office procedures, including but not limited to cyst aspiration, bone marrow biopsy, fine needle aspiration, percutaneous core biopsy with and without image guidance, punch biopsy of skin.
  3. Assess the indications for techniques to optimize cosmetic outcome, minimize surgical trauma, and achieve best oncologic outcome for cancer operations for all major breast procedures, including but not limited to breast biopsy, wire localization biopsy, duct excision, lumpectomy, simple mastectomy, and modified radical mastectomy with or without skin sparing, chest wall resection, axillary lymph node dissection, and sentinel lymph node mapping. The surgical breast fellow must demonstrate proficiency in the performance of these procedures.
  4. Demonstrate proficiency in interdisciplinary evaluation and pre-surgical treatment planning with multiple disciplines, including but not limited to radiology, plastic and reconstructive surgery, medical oncology, radiation oncology, medical oncology and pathology.
  5. Identify the indications for and techniques of palliative surgical procedures for locoregional relapse as well as metastatic foci.
  6. Evaluate and manage side effects of breast cancer surgery including but not limited to lymphedema.
  7. Explain evolving surgical technologies such as percutaneous ablation, core vacuum resection, focused ultrasound, ductal lavage and ductoscopy.

Community Service and Outreach

The fellow should:

  1. Identify and contact local patient advocate organizations, and participate in relevant activities.
  2. Identify ways to provide public service to the community.
  3. Promote the best standard of breast care and screening.

Genetics

At the completion of the training period, the fellow should be able to:

  1. Identify patients at high risk for developing breast cancer,  via detailed patient/family history, including risk factors such as pathologic, familial, genetic, and previous cancer inducing therapies (i.e., childhood radiation).
  2. Discuss the epidemiological evidence of the effect of environmental factors (broadly defined as nutrition, lifestyle, pollutants, chemicals, social economic status, etc.) on high-risk patients.
  3. Advise patients regarding estimations of risk by contemporary models and risk reduction by screening, medication, and surgery and the option of available clinical trials for breast cancer risk reduction.
  4. Advise patients regarding indications, usefulness, costs, complications and privacy issues of genetic testing.
  5. Interpret the various pathology findings as they influence risk.
  6. Describe and evaluate options for breast conserving therapy in patients suspected of an inherited susceptibility.
  7. Identify resources available for genetic testing and counseling and facilitate referral when appropriate.

Medical Oncology

At the completion of the training period, the fellow should be able to:

  1. Describe the most commonly prescribed chemotherapy and hormonal agents and their associated acute and chronic toxicities.
  2. Assess the indications and contradictions, techniques and interdisciplinary coordination required for; adjuvant systemic chemotherapy, hormonal therapies and neoadjuvant chemotherapy.
  3. Describe the mechanism of action; risks, benefits and indications of existing and developing targeted therapies.
  4. Describe the prominent molecular pathways in the development and progression of breast cancer.
  5. Demonstrate experience in the interdisciplinary management of recurrent and metastatic disease including treatment benefits, side effects, associated costs and palliative care.
  6. Balance the use, benefits, side effects and cost of systemic chemotherapy and hormonal agents in the patient with metastatic disease.
  7. Manage the patient and familial needs for psychosocial support, intervention, hospice, and crisis management.

Pathology

At the completion of the training period, the fellow should be able to:

  1. Explain and evaluate the benign and malignant pathological aspects of breast disease.
  2. Understand optimal techniques for marking, processing and assessing the pathology specimen.
  3. Identify special pathology issues pertinent to the treatment of breast cancer.
  4. Explain and evaluate immunohistochemical stains, cytology, and tumor markers and other indicators of prognosis and their relevance to treatment.
  5. Discuss evolving pathology technology.
  6. Stage breast cancer clinically and pathologically.

Plastic and Reconstructive Surgery

At the completion of the training period, the fellow should be able to demonstrate an understanding of reconstructive and surgical procedures such as:

  1. General breast plastic procedures such as augmentation and reduction as they relate to total management of women with benign and malignant breast disease.
  2. Tissue expander, implant, and a variety of flap reconstruction techniques for immediate and delayed reconstruction in the setting of post mastectomy reconstructive surgery.
  3. The onco-plastic techniques of breast conservation.
  4. Explain and evaluate the interrelationship of adjuvant therapies on planning and timing of plastic and reconstructive surgery.

Psycho-Oncology

At the completion of the training period, the fellow should be able to:

  1. Communicate effectively with patients in a wide variety of age groups, and ethnic and educational backgrounds.
  2. Demonstrate effective verbal and listening skills; explain and discuss all aspects of treatment and care in terms understandable to the patient and caregivers.
  3. Utilize effective verbal and non-verbal techniques to communicate empathy and help educate the patient.
  4. Identify changing needs for social support systems for patients and their families throughout diagnosis, treatment, and transition to surveillance, and relapse.
  5. Recognize cultural diversity and the different needs of patients and their families with regard to illness and treatment.
  6. Recognize patients at psychosocial high risk and identify resources for referral, including complementary therapies/integrated care.
  7. Participate in and refer interested patients to existing support groups.

Radiation Oncology

At the completion of the training period, the fellow should be able to:

  1. Describe the following with the patient being evaluated for radiation therapy to the breast, including: simulation, treatment planning, treatment delivery, and acute and chronic effects of therapy.
  2. Identify the indications and contraindications for and complications of:
    1. Post breast conservation radiation therapy in both ductal carcinoma in situ and invasive carcinomas.
    2. Post mastectomy radiation therapy.
    3. The management of chest wall recurrences.
    4. Inclusion or exclusion of supraclavicular or internal mammary fields.
    5. Radiation therapy on various surgical options for reconstruction.
  3. Describe the common DCIS scoring systems and issues pertaining to the use of radiation therapy for DCIS.
  4. Describe and evaluate the considerations in combining systemic and radiation therapy.
  5. Identify the indications for and techniques of palliative radiation procedures for locoregional relapse as well as metastatic foci and the role of interdisciplinary management in this setting.
  6. Discuss the evolving technologies of more localized radiation techniques and the role of clinical trials in radiation oncology.

Research

At the completion of the training period, the fellow should be able to participate in:

  1. Participate in the design and conduct of clinical trials as well as prospective and retrospective clinical research.
  2. Present to and enroll patients in available local and national protocols.
  3. Participate in the conduct and critical review of research studies.
  4. Prepare manuscripts suitable for publication in lay or professional journals.