Beryl Benacerraf, MD, has helped shape the field of obstetrical ultrasound from both within and beyond the Brigham. Benacerraf completed a fellowship in Ultrasound and Computerized Tomography at the Brigham and after a time spent in private practice, she came back to the Brigham in 1990, where she has helped to bring together the departments of Obstetrics and Gynecology (OB/GYN) and Radiology. Today, Benacerraf is a full professor in both departments and has achieved many accolades, including the Ian Donald Gold Medal Award from the International Society of Ultrasound in Obstetrics and Gynecology, and is an elected Fellow of both the American College of Radiology and the Society of Radiologists in Ultrasound. This month, Benacerraf was profiled in The American Journal of Obstetrics and Gynecology having been named the “Giant in Obstetrics and Gynecology” for 2021.

Benacerraf’s achievements have been hard won. Since childhood, she has faced many obstacles to a career in academic medicine, including dyslexia. Today, Benacerraf’s contributions to the field of obstetrical ultrasound, especially her insights that linked nuchal thickening directly to an increased risk for fetal Down syndrome, are lauded, but her original papers detailing her observations were sharply criticized. Benacerraf faced adversity with tenacity, and her clinical observations have led to important breakthroughs that have helped move the field of obstetrical ultrasound forward.

Benacerraf recently spoke to CRN about her early career experiences, advice for early-career physician-scientists and what’s next for the field.

Can you tell us more about the early days of your career?

BB: When I started out, ultrasound was a very new field. If you look at images from ultrasounds back in the ‘70s and ‘80s, you can see that the images were really hard to recognize. I like to think I ended up at the right place at the right time to make contributions.

In the private part of my practice, I scanned a very, very large volume of patients. And as I scanned those patients, I started making observations that I kept track of. And that’s really what clinical research is all about. I consider myself a clinical researcher. I don’t have a laboratory the way that investigators like my husband, Peter Libby, MD, (a cardiovascular medicine specialist at the Brigham) do. Instead, I make clinical observations. And one of the observations I made while I was scanning somebody that was about to have an amniocentesis was that the skin at the back of the neck of the fetus was a little thick, with some rolls of the back of their neck.

How did that clinical observation lead to a new way of diagnosing Down syndrome?

BB: I noted that and at first, I didn’t know what it was. I speculated on the wrong syndrome, actually. The patient was having an amniocentesis because of her age. When the patient got back positive test results for Down syndrome, I said, gee, that’s weird. And I set it aside. More than six months later, I saw the same thing on another scan. At first, I didn’t put two and two together. But when test results came back for Down syndrome again, all of a sudden, it rang a bell.

Not two weeks later, a woman came in for just a routine scan. She was 28 and I noticed the same thing. I suggested she have an amniocentesis and the test results were positive for Down syndrome.

Based on those three cases, I wrote up a paper and that’s how it started. But this paper and the subsequent papers that I wrote were very poorly received. People didn’t believe me and criticized me for thinking that measuring the back of the neck was related to Down syndrome.

How long did it take for the field to recognize that your findings were valid?

BB: I fought an uphill battle for a long time.

I fought my detractors in the literature. I could write very quickly because I dictate everything. I went to all the meetings. I sat there, and eventually, I wore them down. It took about five years before the field began to realize that I was right in these observations. And it was an isolating five years.

My father kept telling me that the more important that your discovery is, the more resistance it’s going to get because people wish it was theirs.

Fredrick Frigoletto, MD, believed in me and he was head of Obstetrics at the Brigham at the time. And it was an immensely busy time because there were so few people interested and well-practiced in obstetrical ultrasound. I would run home at night and keep writing until I just couldn’t keep my head up. I had a one-year-old and a newborn, but I knew I had to take the opportunities and make these clinical observations count.

What advice do you have for early-career physician-scientists who may be facing similar challenges in their careers?

BB: Many opportunities come along only once, I think. That’s important for women in particular to recognize. And I do talk about that to young women who ask me if you can have it all. My answer is that you can, but you just can’t have it all perfectly. Yes, you can have children and yes, you can have a successful marriage. Peter and I have been married for 46 years. You can have it all, but it takes a tremendous amount of effort and essentially no leisure. And you’ll have to admit that you’re not going to be the perfect mother, or the perfect anything.

How do you avoid falling into the trap of perfectionism?

BB:  I’m not really a perfectionist — I’ll set a goal and I’ll work tirelessly to achieve it, but I don’t allow perfectionism to halt me in my pursuits. I can usually make a very good judgment with about 80 to 90 percent of the information, because information is an asymptotic curve. You may never get to all the information, but you can get closer and closer to enough. So the trick is to know when you do have enough information. Otherwise, the train’s going to leave the station every time and leave you behind on the platform.

How did your childhood experiences as someone with dyslexia who was also bilingual inform who you are today?

BB: I’ve battled the stigma of dyslexia since I was a child. When I was growing up, people didn’t know much about learning disabilities so it was assumed you were either lazy or stupid. Everyone thought I was lazy because they figured I wasn’t stupid. It was a very hard-fought battle to show them otherwise. It made me a fighter. I think many people with dyslexia have a type of fighting instinct because they’ve had to fight these kinds of assumptions all their lives.

I was also very lucky and had many opportunities because of who my father (Dr. Baruj Benacerraf) was. There’s been two Nobel prize winners in my family in the last two generations. Seeing as I’m an only child, it’s not going to happen in my generation, but that was sort of a benchmark that was set. My first language is French, so when my family moved back to New York City when I was 7 years old, I was trying to learn a new language and was living in a family who had expectations that I couldn’t possibly meet. It was a struggle, but it was a good one, because I learned what was achievable through hard work.

What are you focused on today?

BB: The field of obstetrical ultrasound is very mature now. But the field of gynecology ultrasound is not.  There’s so much more that can be done in that area. Our European colleagues are very advanced in ways of detecting ovarian cancer, endometriosis and other gynecological conditions than we are here. And so I practice more like the Europeans and I do a lot of teaching over there. I’m working much more in gynecology now and I’m very interested in ovarian cancer, especially how to tell what a mass is when it gets discovered and how to tell if it’s malignant or benign.

There’s also a lot of work being done right now on pelvic pain and endometriosis. A lot of patients suffer from chronic pelvic pain, urinary tract infection and endometriosis that get sent to psychiatry instead of being treated properly. That’s where I’m engaged right now — using ultrasound to help our patients.

You’ve got to keep reinventing yourself if you’re going to stay in a field for 40 years because things mature. The field keeps moving all the time — so you have to keep moving too.

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