Breast Cancer Multidisciplinary Surgery Fellowship NYU Langone Medical Center/NYU School of Medicine

NYU Langone Medical Center (NYULMC) provides one year of training for a multidisciplinary breast surgery fellow. Studies have shown a 37 percent reduction in the risk of dying of breast cancer if the patient is treated by a surgeon with specialty training. These findings underscore the importance of specialty training in the management of breast disease.

The mission of this fellowship program is to train and mentor the next generation of bright, highly-motivated surgeons interested in specializing in breast cancer. NYULMC’s Department of Surgery provides its fellows with an outstanding education in the interdisciplinary management of breast cancer. Fellows are exposed to a wide spectrum of patients and technologies through the combined yet distinct resources of the Medical Center, including New York University, Tisch Hospital, the Clinical Cancer Center, Bellevue Hospital Center, and Gouverneur Clinic on the Lower East Side of Manhattan. The training program provides a creative clinical environment for fellows to develop critical skills and experience.

We are pleased to announce that our fellowship application for accreditation as an approved Breast Fellowship Program was submitted in September 2012, reviewed by the Society of Surgical Oncology Training Committee, and approved for participation in the SSO Breast Fellowship Match.

History

We are the oldest cancer hospital in the nation, founded in 1882 as the Tumor Service of the Skin and Cancer Hospital. Bellevue Hospital is the oldest continuously operating hospital in the United States, established in 1736.

The NYU Cancer Institute (CI) is a world leader in the care of patients with cancer. An NCI-designated cancer center since 1975, the CI is recognized for translating knowledge about the roots of cancer into innovative therapies. The mission of the CI is to discover the origins of human cancer and to use that knowledge to eradicate the personal and societal burden of cancer worldwide. The CI is a translational center; scientists and other researchers share the goal of understanding how cancer develops at the molecular level and how that knowledge can be harnessed to reduce the risk of cancer and to treat the disease. The faculty constantly seek and create new opportunities for collaboration between investigators at NYU Langone, those located elsewhere in the New York University network of campuses (such as the Washington Square campus in lower Manhattan), and researchers at other institutions.

Background

Breast cancer is the most common non-cutaneous cancer diagnosed in women in the United States, with an expected 230,000 new diagnoses this year. It is second only to lung cancer as the leading cause of cancer deaths.

Socioeconomic status strongly influences outcome and survival for breast cancer. While mortality rates continue to drop, substantial racial differences in outcome between African Americans and Caucasians persist. Current research indicates that both access and barriers to care, as well as tumor biology, help account for these disparities in the outcome, but more research is needed.

This fellowship provides exposure to the full spectrum of breast cancer care, from the specialized tertiary care provided at NYU Langone’s Clinical Cancer Center and the Cancer Institute to the ethnically diverse and economically challenged populations served by the Health and Hospitals Corporation facilities of Bellevue Hospital Center, Gouverneur Clinic on the Lower East Side. In total, NYULMC surgically manages over 1,000 breast cancers annually.

Thus, our fellowship is uniquely positioned both to provide state-of-the-art training in the management of breast cancer, while also offering our fellows the training and research opportunities that prepare them to continue the mission of providing the best breast cancer care to all patients.

Fellowship Program Description

The breast fellowship is a one-year, Society of Surgical Oncology approved, clinical training program specializing in the interdisciplinary management of breast cancer. It is accredited by the NYU School of Medicine Graduate Medical Education program and adheres to the Interdisciplinary Breast Fellowship Core Educational Objectives of the Society of Surgical Oncology Fellowship program. The fellows must have completed an Accreditation Council for Graduate Medical Education-approved general surgery training program and be eligible to sit for the American Board of Surgery examinations. The goal of the fellowship is to prepare the fellows for leadership roles in an academic setting.

The NYULMC program has 9 full-time dedicated breast surgeons. In addition to clinical responsibilities at NYU Langone’s Tisch Hospital and Clinical Cancer Center, the fellow is an integral part of the Breast Service at Bellevue Hospital Center and assists the full-time dedicated Breast Service faculty in providing cutting-edge care to an ethnically diverse, socioeconomically deprived population. The fellow’s clinical responsibilities at Bellevue include a weekly radiology-pathology conference, where new patients are presented, a weekly breast clinic, and one day a week in surgery.

The clinical experience of the breast fellow involves advanced technical training of breast surgical skills in the operating room, pre-operative evaluation of the patient, and follow-up care. The fellow is expected to be involved with an average of 200 major cases during the one-year training.

The fellow will also rotate through other breast cancer treatment specialties (pathology, radiology, medical oncology, radiation oncology, plastic surgery) in order to gain a deeper understanding of the diagnosis and multidisciplinary care that breast cancer patients receive.

General Schedule: 

Other information: 2 weeks of vacation, and a travel stipend for conferences

Clinical Research

The Clinical Research Fellowship Program within the Department of Breast Surgery is a training program that teaches the fellow on the processes related to the development and conduct of clinical research at an academic institution. This program provides the unique skill set that will allow the fellows to engage in leadership positions in the field of clinical research.

The main objectives of the program are:

1. To obtain knowledge and training of the regulations and regulatory bodies governing clinical research, including the Collaborative Institutional Training Initiative (CITI), The Institutional Review Board (IRB), and the Office of Clinical Trials (OCT).

2. To understand and participate in the scientific process from hypothesis development to analysis of results by utilizing the institutional resources including the Breast Cancer Database, the High Risk Breast Cancer Database, and the Biorepository Center.

3. To develop data presentation skills: poster development, manuscript preparation, and oral presentation skills.

4. To understand the clinical research track in academic medicine.The breast fellow has the opportunity to participate in research with any and all faculty members involved in the NYULMC Breast Program. The multi-disciplinary team of clinicians and researchers at our institution consist of surgeons, medical oncologists, radiation oncologists, radiologists, pathologists, nurses, genetic counselors, epidemiologists, biostatisticians, clinical researchers, social workers, psycho-oncologists and other cancer specialists. We anticipate that each fellow will have specific expressed interests, and we further anticipate that, given the breadth and diversity of our faculty, an appropriate faculty member and project will be available. As Program Director, Dr. Guth meets with the fellows regularly and will ensure that each fellow has appropriate mentorship from a Breast Surgery faculty member, ideally one who is active in the fellow’s area of interest. The Breast Surgery Division at NYULMC is committed to our ongoing registry projects: the Breast Cancer Database and the High Risk Breast Cancer Program and Registry. Under the direction of Jennifer Chun Kim, MPH, our Research Program Director and Shira Schwartz, MPH, Data Manager, the fellow will become familiar with the registries including the variables collected and the methodologies for ensuring follow up and data integrity. Under Dr. Schnabel’s direction (PI for these data bases), each fellow will design and complete a project utilizing data from one or both of these longitudinal databases. After developing the study IRB protocol, the fellow will have an opportunity to present this research to the Breast Disease Management Program Group, which consists of all the faculty and research leaders in the field of breast cancer at our institution. After obtaining approval from the Breast Disease Management Program Group, the fellow will present the study to the Protocol Review and Monitoring Committee (PRMC). The PRMC is responsible for evaluating the scientific merit of all cancer-related translational and clinical research studies that take place on the NYU Medical Center campus and those of its affiliates. Once the PRMC approves the protocol, it is submitted to the NYU Institutional Review Board (IRB).

The fellows will also attend the weekly Multi-disciplinary Breast Cancer Conference at the Clinical Cancer Center, where they will be responsible for case presentations and literature reviews.

Additionally, fellows will be expected to attend the following meetings during the fellowship year: The San Antonio Breast Cancer Symposium (December), the Society of Surgical Oncology (March), the American Society of Breast Surgeons (April), and the American Society of Clinical Oncology Fellows Program (May), which has specific symposia on grant writing and clinical trial design. Further, they will be expected to submit abstracts to the SABCS, SSO, and ASBS, as well as at least two papers for publication during their fellowship. One month will be allotted for completion of one or more clinical research projects.

Community Outreach, Genetics, Supportive Services

During all of their rotations, fellows are expected to be involved with and attend all NYULMC community outreach programs pertaining to breast cancer, to interact with the Human Genetics Program as their patients are referred for genetic counseling/testing, and to work with other ancillary services (PT, nutrition, social work, etc.) to provide optimal multidisciplinary care for patients.

Teaching Responsibilities

As the senior trainee on surgical rotations, the fellow will be expected to interact with residents and NYU School of Medicine students, maximizing their educational experience through teaching both in and out of the operating room.

It is our goal to continue to train leaders in breast cancer care. Because of the socioeconomic and ethnic diversity of our patient populations, we offer a unique opportunity that is not widely available through other fellowship programs. This enables us to train our fellows to provide cutting-edge breast cancer care to a broad group of patients and to provide research opportunities in both the surgery and biology of breast cancer and diversity and access to care.

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