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Columbia University Medical Center's Comprehensive Breast Center has taken an important step in the battle against breast cancer by establishing the Women At Risk Breast Surgery Fellowship. Women At Risk (WAR) is an 11-year-old organization at Columbia University Medical Center that mobilizes breast cancer patients and others to support research, education, and special events for fighting breast cancer. The WAR Breast Surgery Fellowship will enable the fellow to acquire advanced knowledge and a high level of skill in the evaluation and treatment of patients with breast disease or those who are at high risk for breast cancer. Through this fellowship, Columbia University Medical Center hopes to identify and train future leaders in breast cancer surgery.

The WAR Breast Surgery Fellowship is a one-year appointment for a general surgical trainee who has already completed a five-year accredited general surgery program. Each fellow will perform rotations with breast surgeons, assisting with lumpectomies, excisional biopsies, modified radical mastectomies, sentinel node dissections, and terminal duct excisions.

The fellow will spend eight-and-a-half months in the breast surgery service, one month in mammography, one month in the medical oncology outpatient clinics, one month in pathology, and two weeks in radiation oncology and genetic counseling. The fellow is expected to complete at least one scholarly project suitable for publication in a peer-reviewed journal, give at least one oral presentation, and participate in teaching medical students and residents. While Women At Risk is proud to have established this initial fellowship, efforts continue to ensure future funding for the program.

"We are proud to offer advanced training to surgeons in the area of breast diseases," said Dr. Freya Schnabel, chief of Breast Service and medical director of Women At Risk at the Columbia University Medical Center of NewYork-Presbyterian Hospital, and associate professor of clinical surgery at Columbia University College of Physicians & Surgeons. "Over the years, we have accumulated knowledge and expertise in this field, and we are eager to help train a new generation of breast surgeons who can assimilate that knowledge and build upon it. The fellowship program also enables us to begin an exciting basic science research endeavor in breast disease, which we anticipate will add to our understanding of the mechanisms of breast cancer development and lead to novel approaches to treatment."

The first fellowship is being awarded to Kathie-Ann Joseph, M.D., M.P.H, for the 2002-2003 year. Born in Spanish Town, Jamaica, and raised in Brooklyn, New York, Dr. Joseph attended Harvard University, where her thesis "Triple Jeopardy: Elderly, Poor, African-American Women and Their Barriers to Health Care and Screening for Breast and Cervical Cancer" won the Hoopes Prize for Excellence in Undergraduate Research.

After graduating from Harvard, Dr. Joseph earned a joint M.D.-M.P.H. from Columbia University College of Physicians & Surgeons and the Columbia University Mailman School of Public Health. After completing seven years in a general surgical residency program, which included two years conducting surgical-oncology research at NYU, Dr. Joseph has now returned to Columbia University Medical Center to be the first WAR Fellow.

Dr. Schnabel said, "Dr. Joseph is the future of academic breast surgery. With her background and her training, she will be able to offer superb clinical care and participate in research at the highest level. We are proud to contribute to her training."

Dr. Joseph is working in the breast clinic, caring for underserved women and supervising the house staff. She recently presented an abstract on the differences in tumor size and breast cancer stage in patients seen in private offices versus clinic settings at the Lynn Sage Breast Cancer Symposium, an international conference sponsored by the Robert H. Laurie Comprehensive Cancer Center of Northwestern University. In addition, she is collaborating with Dr. Ann Marie Schmidt, division chief of the surgical science division at Columbia University Medical Center and associate professor of surgery at Columbia University College of Physicians & Surgeons, in a basic science project examining the role of a factor called sRAGE in reducing tumor size and metastasis in mice that spontaneously develops breast cancer.

"I plan to focus my career on the management and treatment of breast cancer, as well as clinical and basic science research dedicated to breast cancer," said Dr. Joseph. "It is also important to me to help educate women and improve access to screening in underserved communities—particularly in New York City, my hometown."