Fellowship

Daniela Ochoa, M.D.

Daniela Ochoa, M.D.

University of Arkansas for Medical Sciences
Little Rock, Arkansas

Program Director: Daniela Ochoa, M.D.

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) is 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.

The specific aims of this program are to provide the Fellows with the opportunity to master Breast Surgery Oncology in a collegiate environment by:

  1. Providing post-graduate, state-of-the-art training and experience in multi-modality clinical aspects of breast cancer.
  2. Proving training and experience in basic, clinical, translational and outreach research regarding breast cancer.
  3. Providing training and experience in a major cancer center in academic and scholarly activities regarding breast cancer.

Program Design

Since 1996, the Division of Breast Surgical Oncology at UAMS has offered a one-year Multidisciplinary Breast Surgery Fellowship.  The clinical experience obtained 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 second year focusing on research.

The Breast Service consists of two surgical attending physicians, clinical and research nurses, and managers who have advanced some of the cutting-edge procedures today: intraoperative and subareolar injection, Hematoma-directed US-Guided 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 UAMS Breast Clinic. Fundamental knowledge of radiation therapy and its appropriate applications will be acquired. Rotations will alternate with two attending physicians in new and return clinics focusing 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 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 Breast Cancer Case 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 fellows also attend and present at multiple conferences per year as well as attend the SSO Fellow’s Institute, Dr. László Tabár’s Mammography Course, and the American Society of Breast Surgeons’ annual conference.