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The past 20 years have seen an explosion in knowledge regarding the pathogenesis and treatment of breast cancer, and a natural outgrowth of this phenomenon is the emergence of multidisciplinary breast cancer subspecialties, including breast surgical oncology.1-4

A breast surgical oncologist is an oncologist who, although trained to utilize surgery as the primary mode of therapy, recognizes the essential need for multidisciplinary treatment for breast cancer as well. Thus, breast surgical oncologists must learn a broad range of skills beyond surgical skills. Breast surgical oncologists not only are aware of the results of the randomized clinical trials that have shaped our field, but also understand the need for such trials in establishing new treatment paradigms and understand the basic components of the design of such trials. With breast surgery, as with all surgery, the most critical component in delivering care is recognizing which patients do not need or will not benefit from therapy. In this regard, breast surgical oncologists must be highly trained in the differential diagnosis of benign breast entities, appreciate absolute and relative risk, understand genetic counseling and testing and identify resources available for genetic counseling and testing, and have a keen understanding of molecular diagnostics and therapeutics. Breast surgical oncologists must be able to keep up with technological advances in the field, such as image-guided breast interventions.

With the profusion of health information available on the Internet and from advocacy groups, patients, and their families have become increasingly savvy and are demanding specialized surgeons with focused practices in breast care. There are many paths to becoming an excellent breast surgical oncologist. In the past, the most common pathway in the United States was a 5-year general surgery residency. Another common pathway has been "on-the-job training": gradually increasing the numbers of patients with breast disease in one's practice over the course of a long career. Many of the current leaders in breast surgical oncology followed this path and were instrumental in developing the field of breast surgical oncology. More recently, the development of the field of surgical oncology and the establishment of general surgical oncology fellowships have added additional paths toward gaining breast surgical oncology experience.

This chapter discusses current breast surgical oncology fellowship training options in the United States and Europe, the role of breast surgical oncology within the multidisciplinary breast center model of care, the importance of work–life balance in maintaining career satisfaction and avoiding burnout, and the importance of mentorship.

About a decade ago, breast specialists in Europe and the United States recognized the need to provide additional training to physicians who wanted to specialize in the care of patients with breast disease and developed breast fellowship programs. The leadership of breast cancer funding and advocacy groups and specialty societies in the United States recognized the need for comprehensive multidisciplinary training to enable surgeons to become proficient breast surgical oncologists, funded some of these programs, and developed premier structured ...

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