Winthrop P. Rockefeller Cancer Institute at University of Arkansas for Medical Sciences

Little Rock, Arkansas

Training Program Director:  Daniela A. Ochoa, MD

The Fellowship on Diseases of the Breast is housed within the Division of Breast Surgical Oncology in the Winthrop P. Rockefeller Cancer Institute that is a part of the University of Arkansas for Medical Sciences (UAMS).

Objectives

The overall goal of the Fellowship in Diseases of the Breast at the Winthrop P. Rockefeller Cancer Institute of the University of Arkansas for Medical Sciences (UAMS) will be to further the experience of recently trained surgeons who wish to pursue careers in the multi-modality clinical care specific to the breast patient and who want additional training in breast cancer research.

Program Design

The Division of Breast Surgical Oncology at University of Arkansas for Medical Sciences offers a one-year Interdisciplinary Breast Surgery Fellowship supported by the Arkansas Breast Cancer Research Program. The clinical experience will be accomplished over the course of one year. Additional experiences will be identified and provided for the special needs of individual fellows with an optional research year.

The Breast Service consists of three surgical attending physicians, clinical and research nurses, and data managers who have advanced some of the cutting-edge procedures today: intraoperative and subareolar injection, Hematoma-directed US-Guided (HUG) intraoperative localization (as an alternative to needle-localization), percutaneous excision and ablation of benign and malignant tumors, eRFA versus brachytherapy, total skin-sparing mastectomy and reconstruction, and axillary reverse mapping (ARM) to prevent lymphedema.

Physicians interested in breast disease must be educated in a multimodality fashion, developing knowledge of benign and malignant conditions. The breast specialist needs to have training in molecular epidemiology; genetics; screening and detection; breast imaging; benign breast disease and breast pain; behavioral, medical, surgical, pathological and radiation oncology; biostatistics, and clinical trial design and analysis. Unique to this fellowship is the emphasis on continuous versus fragmented care where the fellow will screen, diagnose, and provide both surgical, psycho-social and adjuvant therapy to the same patient.

Clinical Rotations

Basic surgical rotations include benign breast disease clinic and high-risk clinic in which the fellow evaluates patients with family history, prior diagnosis of a high-risk lesion, or genetic alterations. This clinic is coupled with a genetic counselor and a research nurse for accruing patients into clinical trials. The fellow will learn to discuss with patients contributing risk factors, calculate risk using various models, pros and cons of genetic testing, options including increased surveillance versus risk reduction, and accession onto clinical trials.

The fellow will learn the basic principles and techniques to gain proficiency in reading mammograms, MRIs, and PET on the same patients they see in the Breast Clinic. Fundamental knowledge of radiation therapy and its appropriate applications will be acquired. Rotations alternating with three different attending physicians in new and return clinics will focus on patients with palpable masses, abnormal mammograms, early diagnosis as well as advanced cancer.

The principal aim of these clinics is diagnosis and treatment. Using ongoing clinical research in minimally invasive treatment, patients can undergo diagnosis and removal or ablation of abnormalities on the same day. This is facilitated by one-on-one instruction by surgeons, radiologists, and pathologists on fine needle aspiration, stereotactic vacuum-assisted biopsy, and hand-held core and vacuum-assisted excisional biopsy. Unlike some fellowships, fellows do get to perform ultrasound and stereotactically-guided biopsies during this fellowship. Cancer patients seen by the fellow for surgical considerations will also be seen by the same fellow in the medical and radiation oncology clinics providing longitudinal continuity of care. 

These activities will culminate in a weekly multi-disciplinary conference, including all disciplines, in which both benign and malignant cases are reviewed. A special pathological tutorial will be given one-on-one weekly for basic background knowledge. Intensive one to two-week long courses will be completed in radiation oncology, mammography, ultrasound, and MRI (with Dr. Steve Harms). The fellow will also complete image-guided vacuum-assisted biopsy in clinic every day, a weekly tutorial with the radiologist, the ACS and/or the ASBS ultrasound (US) and stereotactic courses, SSO Fellow's Institute, and Dr. László Tabár's Mammography Course.

Contact Information

Training Program Directors: Daniela A. Ochoa, MD

Address: Division of Breast Surgical Oncology

University of Arkansas for Medical Sciences

4301 West Markham #725

Little Rock, AR 72205
Phone: 501-686-6504
Fax: 501-526-6191