Medical Breast Fellowship

Overview

Medical Breast Fellowship
Non-ACGME accredited
Duration: One year, beginning July 2022

The goal of Cleveland Clinic’s Medical Breast Fellowship is to train a Board Eligible or Board Certified Internist, Family Practitioner, General Surgeon or Obstetrician-Gynecologist to evaluate and manage patients with breast issues, increased risk for breast cancer or with a history of breast cancer with compassion and excellence. At the completion of training, the fellow should be able to apply an integrated interdisciplinary approach to the management of patients with benign and malignant breast diseases in accordance with NCCN (National Comprehensive Cancer Network) guidelines, with a focus on patient experience, value and outcomes. 

It is a unique program; promotion of graduates would further the reach of Academic Benign Breast Disease and High Risk Care. Cleveland Clinic currently has one of the largest Medical Breast departments in the country, developed in 1997 by Dr. Holly Pederson, the Program Director, who has already trained 16 medical breast professionals. The fellowship training would enable the graduate to seek employment/leadership positions in high volume breast practices in any setting, but multi-disciplinary accredited centers of excellence in particular would welcome a trained leader in this field.

Specifically, the fellow will have core educational experiences in Medical Breast Care, Breast Imaging, Breast Surgery, Plastic and Reconstructive Surgery, Genetics, Medical Oncology, Pathology, Radiation Oncology, Psycho-Oncology and Community Outreach. The fellow will also have opportunities and expectations for participation in Clinical Research.

Specific objectives include:

• Management of benign breast disease.
• Diagnostic evaluation of the symptomatic patient.
• Personalized risk assessment and management.
• Identification of those at hereditary risk (genetic and genomic).
• Expertise in nuances surrounding enhanced surveillance, chemoprevention and risk-reducing surgery.
• Pre-surgical treatment planning in cancer patients.
• Previvor and Survivorship care – cardiovascular risk reduction, bone health, weight management, menopause management, sexuality, and anxiety and depression.

Dr. Pederson has also established a hereditary high risk clinic following over 1,000 carriers. Overall, the breast program screens 120,000 women annually, treats over 2,000 with breast cancer and the Medical Breast providers see 60% of the 20,000 outpatient E&M’s annually, including 50% of the 5,000 New Patient visits. The training program will be rich and diverse, with a dedicated multidisciplinary team and unique focus on the subtleties of hereditary risk.

Teaching and Research Faculty

Holly J. Pederson, MD, NCMP
Director, Medical Breast Services

Zahraa Al Hilli, MD
Breast Surgeon

Shazia Goraya, MD
Medical Breast Services

Debra Pratt, MD
Director, Fairview Breast Program

 
Diane Radford, MD
Director, Hillcrest Breast Program

Stephanie Valente, DO
Director, Breast Surgery Fellowship Program

Clinical Rotations

Breast Imaging: The fellow will shadow sub-specialty trained Breast Imagers, learning about mammography, ultrasound and MRI.

Breast Medical Oncology: The fellow will shadow medical oncologists in dedicated breast clinic for 1.5 months out of the year and will observe multidisciplinary discussions and work up in newly diagnosed cancer patients, learning about treatment options, including neoadjuvant as well as adjuvant chemotherapy, and the fellow will learn the current recommended chemotherapeutic protocols, alternative regimens, expected benefits and sequelae. There will be an emphasis on appropriate selection and enrollment in clinical trials. Part of the rotation includes visiting the infusion center and work with clinicians who care for end stage and hospice patients. The fellow will also become familiar with discussions around adjuvant and neoadjuvant endocrine therapy, choice of agent, duration of therapy, side effects and their management.

Breast Psychology: The fellow will shadow our hereditary psychology team in clinic for two weeks out of the year.

Breast Radiation Oncology: The fellow will shadow Radiation Oncology for a two week period.

Breast Rehab: The fellow will shadow physical therapists and occupational therapists for two weeks.

Breast Surgery: The fellow will spend 2.5 months on the Breast Surgery service to learn about breast surgery (excisional biopsies for benign disease, partial mastectomy and mastectomy for malignant disease and risk reducing surgery. The fellow needs to appreciate what his or her patients will experience, and the rotation will allow for observation of different surgeons who may offer slightly different approaches and innovative techniques.

Genetics: The fellow will spend a total of a month with the genetics team (2 weeks early and 2 weeks later) learning about hereditary cancer (identification of carriers, associated risks and risk management) and will solidify this knowledge base in Medical Breast Clinic and Hereditary High Risk Clinic. This part of the fellowship will focus on the genetic counseling process, informed consent, understanding of results and new genetic tests (i.e. polygenic risk scores).

Pathology: The fellow will spend two weeks in Pathology and will observe Breast Pathology sign out learning about the different breast histologies of concern, receptors, and pathologic staging of breast cancers. The fellow will also become familiar with benign and benign high risk pathologic markers, and know which core biopsy findings require surgical excision.

Plastic Surgery: The fellow will shadow Plastic surgeons in clinic and in the operating room for two weeks.

Women’s Health: The fellow will shadow Women’s Health Practitioners in clinic and in shared medical visits for two weeks.

Educational Conferences

Schedule of conferences that trainees will attend includes:

Repeating meeting expectations:

• Quarterly medical breast meetings.
• Monthly case conferences (bring one case).
• Weekly Tumor Board.
• Weekly Family Review.
• Medical Breast Section Staff meeting every other month.
• Monthly Research Meeting.
• Didactic Sessions with Dr. Pederson.
• Monthly Somatic Tumor Board.
• Monthly Surgical Journal Club.

Local annual conferences:

• San Antonio / Major Breast Cancer Conference Update – February.
• Breast Cancer Summit – Fall.

National conferences relevant to the field – abstracts encouraged:

• Lynn Sage – Chicago.
• Miami Breast Cancer Conference.
• National Consortium of Breast Centers.
• American Society of Breast Centers.
• American Society of Clinical Oncology.
• San Antonio Breast Cancer Symposium.
• Montreal BRCA conference every other year.

Application Information

Interested candidates should submit applications to: MBfellowship@ccf.org

Please include a CV, cover letter, and two letters of recommendation with your application. Your cover letter can be addressed to:

Holly Pederson, MD
Chair, Medical Breast

For questions about applying, please contact Cleveland Clinic Physician Recruiter: Janine Keough, keoughj@ccf.org

Cleveland Clinic is pleased to be an equal employment/affirmative action employer: Women/Minorities/Veterans/Individuals with Disabilities. Smoke/drug free environment.