Like a lot of young people, D. David Dershaw wasn’t entirely certain what he wanted to do with his life. “My undergraduate experience at Trinity was wonderful,” he remembers. “I loved the academic world. It gave me time to really think about possible careers.” He toyed with the notion of foreign service but ultimately had to concede that languages were not his strongest suit. He gave strong consideration to teaching, but he was nagged by a growing suspicion that ultimately a life in academia wouldn’t satisfy the hunger he felt to somehow be engaged in a daily confrontation with gritty life-and death-affairs of the real world.

Only after rejecting those career options did he decide upon a career in medicine. It might have seemed an obvious choice for a young man whose father and uncle were physicians. But there was nothing predictable about how satisfied he would be as a doctor. As a 21-year-old Trinity undergraduate, he certainly could not have imagined the extraordinary impact he would have upon the lives of thousands and thousands of women.

Thirty years later, Dershaw is a professor of radiology at the Cornell University Medical College and the director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York. He sees a lot of women in his practice. Young women. Old women. Women of all faiths, creeds, and colors. All those variations aside, they have something in common, and it’s about as gritty and real-world as life ever gets.

They come to David Dershaw hoping, praying for good news. More and more, he is able to answer their prayers. And for many of them, the good news is that he is able to tell them they have cancer.

Right place, right time
After graduating from Trinity in 1970, Dershaw earned his M.D. at Jefferson Medical College in Philadelphia. He completed his residency in radiology at the New York Hospital–Cornell Medical Center in 1978 and then did a one-year fellowship in diagnostic radiology at Thomas Jefferson University Hospital in Philadelphia where he immersed himself in two emergent technologies that would, over the next few years, utterly revolutionize radiology—ultrasound and computerized tomography (CT).

In 1979, he moved to Chicago, where, over the next two years, he held positions as a staff radiologist at two area hospitals. The jobs were unsatisfying. So when, late in 1981, he learned that the radiology department at Memorial Sloan-Kettering wanted to establish an ultrasound program, he didn’t hesitate to return to New York.

And then something happened that changed his life irrevocably. When the department’s mammography expert retired, Dershaw was pushed into the role. Mammography, he remembers, was a small and decidedly low-profile part of Memorial Sloan-Kettering’s radiology practice at that point. Indeed, many physicians saw it as something of a novelty.

But that was about to change, and David Dershaw was about to be the beneficiary of being in the right place at the right time.

Early diagnosis saves lives
By the mid-1980s, mammography was routinely being used as a screening tool for women. And Dershaw, enjoying increasing success publishing articles about the rapidly evolving technology, was quickly positioning himself at the forefront of the field.

It was an ideal place for a young man who wanted a life in daily confrontation with the real world. His professional life revolved around daily interaction with women who had cancer. He came to know them and understand their special needs.

And he threw himself, with increasing devotion, into the quest for better ways to serve them. Since the mid-1980s, Dershaw has been intimately engaged in research that has led to better methods for interpreting mammograms, introduction of minimally invasive needle biopsies to replace surgical biopsies, significant advances in conservation of breasts after cancer surgery, and many other advances.

The results of that quest have been near-miraculous. “When I began my practice in mammography,” he recalls, “I would routinely see women with cancers large enough to feel. Today, diagnostic procedures have become so precise that a tumor is considered large if it is over two centimeters.”

Between 25 and 50 percent of all breast cancers detected today are discovered so early that have not yet become invasive. That means that the cure rate is now in the 50 to 75 percent range. And with that increasingly positive cure rate, which only promises to get better, cancer’s grip on the collective imagination has grown more and more tenuous.

“A generation ago, cancer was often thought of as a death sentence,” says Dershaw. “It was so scary that you just didn’t talk about it. But that has changed for the better. Improvements in radiology are part of a multidimensional attack on cancer that has had profound consequences. Because significant improvements in diagnosis mean cancers are often much smaller when they are discovered today, treatment has also improved significantly. At least 50 percent of women with breast cancer no longer require a mastectomy. And even when a mastectomy is required, reconstructive surgery has also improved strikingly.

“Because there is much less likelihood of mutilation than there was when I began practicing medicine, women are less afraid. They now seek diagnosis earlier.” And because that, in turn, means many more lives are saved, when David Dershaw tells one of his patients that she has cancer, there’s a really good chance that he is giving her good news.

Sometimes, at the end of a long day, Dershaw finds himself remembering a vibrant young woman he knew all too briefly when he was still a student at Trinity. She was the wife of one of his closest friends, and she developed breast cancer when she was still in her 20s. Despite the best treatment available at that time, she died.

“She died much too young,” he says, “and it was not an easy death. In the 1970s, cancer treatment was aggressive surgery and aggressive chemotherapy with all the horrors that went with it. When I think about how many women are spared that nightmare today because of the work we do, it’s a source of great satisfaction for me.”

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