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Focus on Barbara Monsees, MD

Barbara Monsees, MD, is the Ronald and Hanna Evens Professor of Women’s Health, Radiology.

Dr. Monsees sees patients at the Center for Advanced Medicine, in the Joanne Knight Breast Health Center, Mammography and Breast Imaging, 4921 Parkview Place, 5th floor, Suite D.


What happened in the course of schooling to influence you to choose your specialty?

Although I really enjoyed my radiology elective at Washington University medical school, I thought I wanted to be a clinician, so I went into pediatrics. I enjoyed my internship and residency, but I realized that what I liked best was visiting the radiology department to review imaging exams, and I decided to switch residencies. So, I took a circuitous path to where I am today. I think that happens to a lot of people in medicine – you don’t really know where you are going until you get there.

After my residency in radiology, I joined the musculoskeletal section at Mallinckrodt. We were general radiologists with expertise in bone, but we also covered the emergency room at Barnes Hospital, did most of the outpatient imaging, mammography and some angiography. At that time, breast imaging was not a field. Interpreting the few mammograms we did each day could not keep a person busy -- but the field was evolving and it interested me.

The reason I’m in the field today is a result of my post-education experience; I loved the problem-solving of breast imaging, the field was wide open, and I was drawn to helping women through the process.

What brought you to Washington University?

When I was considering medical schools, a friend of mine told me to look at Washington University. I was an east coast girl and didn’t know anything about the school. During my visit I realized this was the right place for me. I came here for medical school and I have never left.
Dr. Monsees with Gold Medal from the SBI

Which aspect of your practice is most interesting?

What I find most interesting is tailoring the imaging for the clinical question at hand - whether it’s routine screening or workup for women who have a sign or symptom of breast disease. The questions to consider are: What tests do you do, and in what order? How can we provide that service to our patients in the most considerate and efficient way, and how can we facilitate their getting a timely result?

Can you describe the field’s evolution over the years?

Breast imaging was very limited when I started in the field. It grew after screening was proven to save lives and when the American Cancer Society recommended routine screening for every woman of a certain age. In the early years, we worked on providing efficient high quality screening and diagnostic mammograms, to a large number of women. That involved educating the public and the medical profession
I was fortunate to be here when this all happened. Through the years the technology of mammography has improved, and new technology has been introduced. We now routinely use ultrasound as an adjunct to mammography, and magnetic resonance imaging (MRI) is a newer (but not new) addition to the field of breast imaging. In addition, we now perform biopsies of breast findings, using stereotactic mammography, ultrasound and MRI. These same technologies are used to help evaluate the extent of disease so that our surgical colleagues can know what treatment options can be offered to patients.

How has it improved?

There have been incremental advancements in the equipment, including the detector, and the way images are displayed. In the early years, we used film mammography and the earliest advances were in making more efficient film and accompanying image detection. This allowed us to provide images with more contrast, requiring less radiation exposure to the patient. The science of quality control and quality assurance activities became very important. Later, digital mammography was introduced, further improving image quality and reducing the variability in quality control.

Screening programs were among the first in medical practice where results were routinely tracked and outcomes could be evaluated. The American College of Radiology (ACR) began a voluntary accreditation program for mammography, and later, the Mammography Quality Standards Act was passed by Congress, and mammography became regulated by the Food and Drug Administration (FDA). I have been very active in working with both the ACR and FDA to improve mammography quality.

What other new developments are you excited about?

For many years, screening has been one-size-fits-all mammography. Now we can offer MRI to supplement screening mammography for certain groups of high risk women. I’ve been working with my colleagues and with Washington University epidemiologist, Graham Colditz, MD, DRPH, to launch a risk assessment program for every woman who comes to the breast center. Working with colleagues in other fields (medicine, genetic counseling, surgery) will help us provide another level of care for these high-risk women.

We’ve been doing research on digital tomosynthesis, which is an application of digital mammography. The technique involves taking multiple tiny exposures of the breast from a sequence of angles, and producing a composite set of images that can be viewed by paging through slices of the breast. I’ve also been working with Lihong Wang, PhD, in biomedical engineering on some projects to develop new promising technology to look at the breast.

What do you recommend for someone with a family history of breast cancer?

Women who have multiple family members with breast or ovarian cancer, family members who developed breast cancer at an early age or in both breasts, or if there is breast cancer in a male family member should be aware that in some families, there is an inherited predisposition to developing the disease. It is these women we hope to identify by doing routine risk assessment. We now have risk reduction strategies to help them. Those women should consider getting genetic counseling, seeing a specialist who can advise a woman at high risk, and screening with MRI in addition to mammography.
Where are you from?

I grew up in Sheepshead Bay, which is on the water in the southern part of Brooklyn, New York. When I was a kid, it was a quieter part of New York City -- cooler in the summer and warmer in the winter because we were near the ocean. We used to go down to the docks and get fresh fish, lobster and clams from the fishing boats
My husband and I are from the opposite ends of the country. He was West coast, I was East coast and now we’re both Midwesterners. Our two sons were born and raised here.

Is there a particular award or achievement that is most gratifying?

I just received the Gold Medal from the Society of Breast Imaging (SBI). I’ve worked for the SBI for many years – I’m also past president and on the executive committee. There are over 2,000 people in the SBI. The award is voted on by the Fellows of the Society and is given every other year at our national meeting. It’s a huge honor and I’m very thrilled to have it. The other honor I’m most proud of is the Washington University Distinguished Faculty Award for clinical fellow mentoring.

What is the best advice you’ve ever received?

My mother used to say “Be yourself.” I’m very comfortable with that.

If you weren’t a doctor what would you like to be doing?

I’m so inundated with work that it is hard to think about that right now. But when I was in college I took lots of classes in art history, and I loved that. I enjoy making jewelry to give to friends and family. When I’m retired, I will have more time for beading, ballroom dancing, sewing, quilting and hopefully, someday, being a grandmother.

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Copyright 2015 Washington University School of Medicine