Monica Morrow

Memorial Sloan-Kettering Cancer Center, New York, New York, United States

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Publications (299)2933.34 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The relative contribution of biologic subtype to locoregional recurrence (LRR) in patients treated with neoadjuvant chemotherapy (NAC), mastectomy, and postmastectomy radiotherapy (PMRT) is not clearly defined. 233 patients with stages 2 and 3 breast cancer who received NAC, mastectomy, and PMRT between 2000 and 2009 were included: 53 % (n = 123) had HR+ (ER or PR+/HER2-), 23 % (n = 53) had HER2+ (HER2+/HR+ or HR-), and 24 % (n = 57) had triple-negative (TN) disease (HR-/HER2-). The 5-year LRR rates were estimated by Kaplan-Meier methods. Cox regression analysis was performed to evaluate covariates associated with LRR. The median follow-up period was 62 months. A pathologic complete response (pCR) was seen in 14 % of the patients. The 5-year LRR rate was 8 % for the entire cohort. The LRR rate was 0 % for the patients with a pCR versus 9 % for the patients without a pCR (p = 0.05). TN disease [Hazard ratio (HR) 4.4; p = 0.003] and pathologic node positivity (HR 9.8; p = 0.03) were associated with LRR. Patients with TN disease had a higher LRR rate than patients with HER2+ or HR+ disease (20 vs. 6 and 4 %; p = 0.005). Among patients without a pCR, TN subtype was associated with increased LRR risk (26 versus 7 % HER+ and 4 % HR+; p < 0.001). Patients with TN breast cancer had the highest LRR rate after NAC, mastectomy and PMRT. Whereas no LRR was observed among TN patients with a pCR, TN patients with residual disease had a significantly higher LRR risk. Patients with HR+ and HER2+ breast cancer had favorable LRR rates regardless of NAC response, likely due to receipt of adjuvant systemic targeted therapies.
    Annals of Surgical Oncology 08/2015; DOI:10.1245/s10434-015-4697-7 · 3.94 Impact Factor
  • Andrea V. Barrio, Monica Morrow
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    ABSTRACT: Axillary lymph node dissection (ALND), once considered standard of care for all patients with invasive breast cancer, is now obsolete in patients with histologically negative sentinel lymph nodes (SLNs). Alternatives to ALND in patients with histologically positive SLNs are available after the ACOSOG Z0011 and AMAROS trials demonstrated no difference in locoregional recurrence, disease-free survival, or overall survival between SLN biopsy alone (ACOSOG Z0011) or with axillary radiotherapy (AMAROS) and ALND in women with clinical T1-2 invasive breast cancer and 1–2 positive SLNs treated with multimodality therapy, offering the opportunity to reduce the morbidity of treatment. In contrast, the MA.20 and EORTC 22922-10925 studies suggest that similar patient populations benefit from ALND and comprehensive nodal irradiation. Here, we will discuss the contemporary surgical management of clinically node-negative breast cancer patients with metastases in the SLNs.
    07/2015; 3(7). DOI:10.1007/s40137-015-0095-0
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    ABSTRACT: Although breast-conserving surgery is oncologically safe for women with early-stage breast cancer, mastectomy rates are increasing. The objective of this study was to examine the role of breast reconstruction in the surgical management of unilateral early-stage breast cancer. A retrospective cohort study of women diagnosed with unilateral early-stage breast cancer (1998 to 2011) identified in the National Cancer Data Base was conducted. Rates of breast-conserving surgery, unilateral and bilateral mastectomy with contralateral prophylactic procedures (per 1000 early-stage breast cancer cases) were measured in relation to breast reconstruction. The association between breast reconstruction and surgical treatment was evaluated using a multinomial logistic regression, controlling for patient and disease characteristics. A total of 1,856,702 patients were included. Mastectomy rates decreased from 459 to 360 per 1000 from 1998 to 2005 (p < 0.01), increasing to 403 per 1000 in 2011 (p < 0.01). The mastectomy rates rise after 2005 reflects a 14 percent annual increase in contralateral prophylactic mastectomies (p < 0.01), as unilateral mastectomy rates did not change significantly. Each percentage point of increase in reconstruction rates was associated with a 7 percent increase in the probability of contralateral prophylactic mastectomies, with the greatest variation explained by young age(32 percent), breast reconstruction (29 percent), and stage 0 (5 percent). Since 2005, an increasing proportion of early-stage breast cancer patients have chosen mastectomy instead of breast-conserving surgery. This trend reflects a shift toward bilateral mastectomy with contralateral prophylactic procedures that may be facilitated by breast reconstruction availability.
    Plastic and Reconstructive Surgery 06/2015; 135(6):1518-26. DOI:10.1097/PRS.0000000000001276 · 3.33 Impact Factor
  • Senologie - Zeitschrift für Mammadiagnostik und -therapie 05/2015; 12(02). DOI:10.1055/s-0035-1550558
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    ABSTRACT: To determine if the histology of a breast malignancy influences the appearance of untreated osseous metastases on FDG PET/CT. This retrospective study was performed under IRB waiver. Our Hospital Information System was screened for breast cancer patients who presented with osseous metastases, who underwent FDG PET/CT prior to systemic therapy or radiotherapy from 2009 to 2012. Patients with invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), or mixed ductal/lobular (MDL) histology were included. Patients with a history of other malignancies were excluded. PET/CT was evaluated, blinded to histology, to classify osseous metastases on a per-patient basis as sclerotic, lytic, mixed lytic/sclerotic, or occult on CT, and to record SUVmax for osseous metastases on PET. Following screening, 95 patients who met the inclusion criteria (74 IDC, 13 ILC, and 8 MDL) were included. ILC osseous metastases were more commonly sclerotic and demonstrated lower SUVmax than IDC metastases. In all IDC and MDL patients with osseous metastases, at least one was FDG-avid. For ILC, all patients with lytic or mixed osseous metastases demonstrated at least one FDG-avid metastasis; however, in only three of seven patients were sclerotic osseous metastases apparent on FDG PET. The histologic subtype of breast cancer affects the appearance of untreated osseous metastases on FDG PET/CT. In particular, non-FDG-avid sclerotic osseous metastases were more common in patients with ILC than in patients with IDC. Breast cancer histology should be considered when interpreting non-FDG-avid sclerotic osseous lesions on PET/CT, which may be more suspicious for metastases (rather than benign lesions) in patients with ILC.
    European Journal of Nuclear Medicine 05/2015; DOI:10.1007/s00259-015-3080-z · 5.22 Impact Factor
  • Cancer Research 05/2015; 75(9 Supplement):P2-15-01-P2-15-01. DOI:10.1158/1538-7445.SABCS14-P2-15-01 · 9.28 Impact Factor
  • Cancer Research 05/2015; 75(9 Supplement):P4-04-12-P4-04-12. DOI:10.1158/1538-7445.SABCS14-P4-04-12 · 9.28 Impact Factor
  • Tari A. King, Monica Morrow
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    ABSTRACT: Early randomized trials of the addition of neoadjuvant chemotherapy (NACT) to the treatment regimen of patients with breast cancer failed to demonstrate an improvement in overall survival compared with conventional adjuvant therapy; nevertheless, the increased opportunities for breast conservation, owing to downstaging of the primary tumour, and enthusiasm regarding the potential to tailor systemic therapy based on responses observed in the neoadjuvant setting, resulted in the adoption of this approach as a useful clinical tool. That the effectiveness of NACT varies by molecular subtype is becoming increasingly clear, and although the potential of tailoring adjuvant systemic therapy based on treatment response before surgery remains to be realized, the increasing rates of pathological complete response following NACT have had a considerable impact on locoregional treatment considerations. For example, NACT reduces the need for mastectomy and axillary lymph-node dissection, thus decreasing the morbidity of surgery, without compromising outcomes. However, selection of the ideal candidates for preoperative chemotherapy remains critical, and personalizing local therapy based on the degree of response is the subject of ongoing clinical trials. This article reviews the current issues surrounding surgery of the breast and axilla in patients with breast cancer receiving NACT.
    Nature Reviews Clinical Oncology 04/2015; DOI:10.1038/nrclinonc.2015.63 · 15.70 Impact Factor
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    ABSTRACT: To evaluate preferences for and experiences with genetic testing in a diverse cohort of patients with breast cancer identified through population-based registries, with attention to differences by race/ethnicity. We surveyed women diagnosed with nonmetastatic breast cancer from 2005 to 2007, as reported to the SEER registries of metropolitan Los Angeles and Detroit, about experiences with hereditary risk evaluation. Multivariable models evaluated correlates of a strong desire for genetic testing, unmet need for discussion with a health care professional, and receipt of testing. Among 1,536 patients who completed the survey, 35% expressed strong desire for genetic testing, 28% reported discussing testing with a health care professional, and 19% reported test receipt. Strong desire for testing was more common in younger women, Latinas, and those with family history. Minority patients were significantly more likely to have unmet need for discussion (failure to discuss genetic testing with a health professional when they had a strong desire for testing): odds ratios of 1.68, 2.44, and 7.39 for blacks, English-speaking Latinas, and Spanish-speaking Latinas compared with whites, respectively. Worry in the long-term survivorship period was higher among those with unmet need for discussion (48.7% v 24.9%; P <.001). Patients who received genetic testing were younger, less likely to be black, and more likely to have a family cancer history. Many patients, especially minorities, express a strong desire for genetic testing and may benefit from discussion to clarify risks. Clinicians should discuss genetic risk even with patients they perceive to be at low risk, as this may reduce worry. © 2015 by American Society of Clinical Oncology.
    Journal of Clinical Oncology 04/2015; 33(14). DOI:10.1200/JCO.2014.58.5885 · 17.88 Impact Factor
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    ABSTRACT: Neoadjuvant chemotherapy (NAC) may allow breast-conserving therapy (BCT) in patients who require mastectomy at presentation. Breast MRI is more accurate than mammography in assessing treatment response, but combined test reliability in identifying BCT candidates after NAC is not well described. We evaluated whether post-NAC breast MRI alone and with mammography accurately identifies BCT candidates. In this retrospective study of 111 consecutive breast cancer patients receiving NAC, all had pre- and postchemotherapy MRI, followed by surgery. Posttreatment MRI and mammography results were correlated with surgical outcomes and pathologic response. Fifty-one of 111 (46 %) patients presented with multicentric or inflammatory breast cancer and were not BCT candidates. The remaining 60 (54 %) were considered BCT candidates after downstaging (mean age: 47 years). All 60 had at least a partial response to NAC and were suitable for BCT on MRI after NAC. Forty-five of 60 (75 %) underwent lumpectomy; 15 of 60 (25 %) chose mastectomy. Forty-one of 45 (91 %) of lumpectomies were successful; 4 of 45 (9 %) required mastectomy. Twelve of 15 (80 %) patients choosing mastectomy could have undergone BCT based on pathology; 3 of 15 (20 %) did require mastectomy. Two of these three patients had extensive microcalcifications on mammogram, indicating the need for mastectomy despite MRI suitability for BCS. MRI alone correctly predicted BCS in 53 of 60 (88 %) patients. MRI plus mammography was correct in 55 of 60 (92 %), although only 9 of 45 (20 %) BCT patients and 4 of 15 (27 %) potentially conservable mastectomy patients had complete pathologic responses. Posttreatment MRI plus mammography is an accurate method to determine whether BCT is possible after NAC is given to downstage disease.
    Annals of Surgical Oncology 03/2015; 22(5). DOI:10.1245/s10434-015-4502-7 · 3.94 Impact Factor
  • The Breast 03/2015; 24:S31. DOI:10.1016/S0960-9776(15)70066-4 · 2.58 Impact Factor
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    ABSTRACT: Chronic inflammation is recognized as a risk factor for the development of several malignancies. Local white adipose tissue (WAT) inflammation, defined by the presence of dead or dying adipocytes encircled by macrophages which form crown-like structures (CLS), occurs in the breasts (CLS-B) of most overweight and obese women. Previously, we showed that the presence of CLS-B is associated with elevated tissue levels of proinflammatory mediators and aromatase, the rate-limiting enzyme for estrogen biosynthesis. The associated increased levels of aromatase in the breast provide a plausible mechanistic link between WAT inflammation and estrogen-dependent breast cancers. Thus, breast WAT inflammation could be relevant for explaining the high incidence of estrogen-dependent tumors with aging despite diminished circulating estrogen levels after menopause. To explore this possibility, we determined whether menopause in addition to body mass index (BMI) is associated with breast WAT inflammation among 237 prospectively enrolled women. The presence of CLS-B and its severity (CLS-B/cm2) as indicators of WAT inflammation correlated with menopausal status (P=0.008 and P<0.001) and BMI (P<0.001 for both). In multivariable analyses adjusted for BMI, the postmenopausal state was independently associated with the presence (P=0.03) and severity of breast WAT inflammation (P=0.01). Mean adipocyte size increased in association with CLS-B (P<0.001). Our findings demonstrate that breast WAT inflammation, which is associated with elevated aromatase levels, is increased in association with the postmenopausal state independent of BMI. Breast WAT inflammation, a process that can potentially be targeted, may help to explain the high incidence of estrogen-dependent tumors in postmenopausal women. Copyright © 2015, American Association for Cancer Research.
    Cancer Prevention Research 02/2015; 8(5). DOI:10.1158/1940-6207.CAPR-14-0243 · 5.27 Impact Factor
  • Monica Morrow, Stuart J Schnitt, Larry Norton
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    ABSTRACT: High-risk breast lesions, which comprise benign lesions and in situ carcinomas (lobular carcinoma in situ and ductal carcinoma in situ), are clinically, morphologically, and biologically heterogeneous and are associated with an increased risk of invasive breast cancer development, albeit to varying degrees. Recognition and proactive management of such lesions can help to prevent progression to invasive disease, and might, therefore, reduce breast cancer incidence, morbidity, and mortality. However, this opportunity comes with the possibility of overdiagnosis and overtreatment, necessitating risk-based intervention. Notably, despite the progress in defining the molecular changes associated with carcinogenesis, alterations identifying the individuals with high-risk lesions that will progress to invasive carcinoma remain to be identified. Thus, until reproducible clinicopathological or molecular features predicting an individual's risk of breast cancer are found, management strategies must be defined by population-level risks as determined by models such as the Gail or IBIS models, as well as patient attitudes toward the risks and benefits of interventions. Herein, we review the contemporary approaches to diagnosis and management of high-risk breast lesions. Progress in this area will ultimately be dependent on the ability to individualize risk prediction through better definition of the key drivers in the carcinogenic process.
    Nature Reviews Clinical Oncology 01/2015; DOI:10.1038/nrclinonc.2015.8 · 15.70 Impact Factor
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    ABSTRACT: Although breast conservation is therapeutically equivalent to mastectomy for most patients with early-stage breast cancer, an increasing number of patients are pursuing mastectomy, which may be followed by breast reconstruction. We sought to evaluate long-term quality of life and cosmetic outcomes after different locoregional management approaches, as perceived by patients themselves. We surveyed women with a diagnosis of nonmetastatic breast cancer from 2005 to 2007, as reported to the Los Angeles and Detroit population-based Surveillance, Epidemiology, and End Results registries. We received responses from 2290 women approximately 9 months after diagnosis (73% response rate) and from 1536 of these 4 years later. We evaluated quality of life and patterns and correlates of satisfaction with cosmetic outcomes overall and, more specifically, within the subgroup undergoing mastectomy with reconstruction, using multivariable linear regression. Of the 1450 patients who responded to both surveys and experienced no recurrence, 963 underwent breast-conserving surgery, 263 mastectomy without reconstruction, and 222 mastectomy with reconstruction. Cosmetic satisfaction was similar between those receiving breast conservation therapy and those receiving mastectomy with reconstruction. Among patients receiving mastectomy with reconstruction, reconstruction type and radiation receipt were associated with satisfaction (P < 0.001), with an adjusted scaled satisfaction score of 4.7 for patients receiving autologous reconstruction without radiation, 4.4 for patients receiving autologous reconstruction and radiation therapy, 4.1 for patients receiving implant reconstruction without radiation therapy, and 2.8 for patients receiving implant reconstruction and radiation therapy. Patient-reported cosmetic satisfaction was similar after breast conservation and after mastectomy with reconstruction. In patients undergoing postmastectomy radiation, the use of autologous reconstruction may mitigate the deleterious impact of radiation on cosmetic outcomes.
    Annals of Surgery 01/2015; 261(6). DOI:10.1097/SLA.0000000000000908 · 7.19 Impact Factor
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    ABSTRACT: Background Human epidermal growth factor receptor 2 (HER2) overexpression was associated with locoregional recurrence (LRR) in the preadjuvant trastuzumab era. This study aimed to examine the effect of trastuzumab on LRR in mastectomy patients and whether it varied with postmastectomy radiation (PMRT). Methods From the authors’ institutional database, 501 women with stages I–III HER2-positive breast cancer who underwent mastectomy from 1998 to 2007 were identified. A landmark analysis was performed to compare two cohorts: 170 women who received trastuzumab and 281 who did not. Kaplan–Meier methods were used to estimate locoregional recurrence-free survival (LRRFS). A propensity score analysis was used to balance the treatment groups with respect to multiple covariates. Analogous methods were used to study the effect of PMRT. Results The women in the trastuzumab group were more likely to be node positive and to receive systemic therapy or PMRT (p –1.09; p = 0.07]. After adjustment for multiple covariates, including receipt of chemotherapy and PMRT, trastuzumab decreased LRR rates (HR 0.21; 95 % CI 0.04–0.94; p = 0.04). Among the women who received PMRT, trastuzumab reduced the 5-year LRR rate (0 vs 5 %; p = 0.06). Among those who did not receive PMRT, trastuzumab did not significantly decrease LRR (3 vs 6 %; p = 0.26). Conclusion High rates of locoregional control (5-year rate, 98 %) were observed among patients who received trastuzumab and mastectomy ± PMRT. Trastuzumab decreased LRR in HER2-positive women who received mastectomy and PMRT, suggesting that the largest benefit is seen in a higher-risk subset of patients.
    Annals of Surgical Oncology 01/2015; DOI:10.1245/s10434-014-4321-2 · 3.94 Impact Factor
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    ABSTRACT: Lobular carcinoma in situ (LCIS) is both a risk indicator and non-obligate precursor of invasive lobular carcinoma (ILC). We sought to characterize the transcriptomic features of LCIS and ILC, with a focus on the identification of intrinsic molecular subtypes of LCIS and the changes involved in the progression from normal breast epithelium to LCIS and ILC. Fresh-frozen classic LCIS, classic ILC, and normal breast epithelium (N) from women undergoing prophylactic or therapeutic mastectomy were prospectively collected, laser-capture microdissected, and subjected to gene expression profiling using Affymetrix HG-U133A 2.0 microarrays. Unsupervised hierarchical clustering of 40 LCIS samples identified 2 clusters of LCIS distinguished by 6431 probe sets (p < 0.001). Genes identifying the clusters included proliferation genes and other genes related to cancer canonical pathways such as TGF beta signaling, p53 signaling, actin cytoskeleton, apoptosis and Wnt-Signaling pathway. A supervised analysis to identify differentially expressed genes (p < 0.001) between normal epithelium, LCIS, and ILC, using 23 patient-matched triplets of N, LCIS, and ILC, identified 169 candidate precursor genes, which likely play a role in LCIS progression, including PIK3R1, GOLM1, and GPR137B. These potential precursor genes map significantly more frequently to 1q and 16q, regions frequently targeted by gene copy number alterations in LCIS and ILC. Here we demonstrate that classic LCIS is a heterogeneous disease at the transcriptomic level and identify potential precursor genes in lobular carcinogenesis. Understanding the molecular heterogeneity of LCIS and the potential role of these potential precursor genes may help personalize the therapy of patients with LCIS. Copyright © 2014 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.
    Molecular Oncology 12/2014; 9(4). DOI:10.1016/j.molonc.2014.12.005 · 5.94 Impact Factor
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    ABSTRACT: Triple-negative breast cancer (TNBC) is an operational term that refers to a heterogeneous collection of breast cancers lacking expression of estrogen receptor (ER), progesterone receptor, and HER2. These tumors account for 12–17 % of all breast cancers, preferentially affect young women, are more frequent in women of African and Hispanic descent, and are enriched in the population of patients diagnosed with “interval cancers.” TNBCs account for the majority of breast cancers arising in BRCA1 germline mutation carriers (approximately 80 %), and approximately 11–16 % of all TNBCs harbor BRCA1 or BRCA2 germline mutations. Well-known risk factors for ER-positive cancers, such as reproductive history and hormonal factors, do not appear to have the same correlations for TNBC, and histologic risk factors for TNBC have not been identified. Patients with TNBC have a higher risk of both local and distant recurrence, but this is not mitigated by bigger surgery, and standard criteria should be used to select the approach to local therapy in these patients. Although platinum drugs have shown promise in the treatment of TNBC, standard chemotherapy remains the standard of care outside of a clinical trial.
    Annals of Surgical Oncology 12/2014; 22(3). DOI:10.1245/s10434-014-4279-0 · 3.94 Impact Factor
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    ABSTRACT: National Comprehensive Cancer Network guidelines consider (18)F-FDG PET/CT for only clinical stage III breast cancer patients. However, there is debate whether TNM staging should be the only factor in considering if PET/CT is warranted. Patient age may be an additional consideration, because young breast cancer patients often have more aggressive tumors with potential for earlier metastases. This study assessed PET/CT for staging of asymptomatic breast cancer patients younger than 40 y.
    Journal of Nuclear Medicine 09/2014; 55(10). DOI:10.2967/jnumed.114.143297 · 5.56 Impact Factor
  • Archives of pathology & laboratory medicine 08/2014; 139(5). DOI:10.5858/arpa.2014-0384-ED · 2.88 Impact Factor
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    ABSTRACT: Most women undergoing mastectomy for breast cancer do not undergo breast reconstruction.
    08/2014; 149(10). DOI:10.1001/jamasurg.2014.548

Publication Stats

10k Citations
2,933.34 Total Impact Points

Institutions

  • 2008–2015
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Surgery
      • • Breast Service
      New York, New York, United States
  • 2012–2014
    • Cornell University
      • Department of Surgery
      Итак, New York, United States
  • 2010
    • Dana-Farber Cancer Institute
      • Department of Radiation Oncology
      Boston, MA, United States
    • Treatment Research Institute, Philadelphia PA
      Philadelphia, Pennsylvania, United States
  • 2009–2010
    • University of Michigan
      • Division of General Medicine
      Ann Arbor, Michigan, United States
    • Harvard University
      Cambridge, Massachusetts, United States
  • 2005–2006
    • Fox Chase Cancer Center
      • • Department of Radiation Oncology
      • • Department of Surgery
      Filadelfia, Pennsylvania, United States
    • Duke University Medical Center
      • Department of Surgery
      Durham, NC, United States
  • 2002–2005
    • Northwestern Memorial Hospital
      • Department of Surgery
      Chicago, Illinois, United States
  • 1998–2005
    • Northwestern University
      • • Department of Obstetrics and Gynecology
      • • Department of Surgery
      Evanston, IL, United States
  • 1993–2005
    • University of Illinois at Chicago
      • Department of Biopharmaceutical Sciences
      Chicago, Illinois, United States
    • University of Chicago
      • Department of Surgery
      Chicago, IL, United States
  • 2000–2002
    • American College of Surgeons
      Chicago, Illinois, United States
  • 1999–2001
    • Ann & Robert H. Lurie Children's Hospital of Chicago
      Chicago, Illinois, United States
    • American College of Radiology
      Philadelphia, Pennsylvania, United States
  • 1997
    • Roswell Park Cancer Institute
      • Department of Cancer Control and Epidemiology
      Buffalo, New York, United States