Ex-Smoker Gets Lifesaving Lung Cancer Screening at Scripps
Active senior benefits from additional screening
Active senior benefits from additional screening
Dennis Higginbottom smoked cigarettes for nearly 50 years. “I started smoking when I was in primary school in England,” he says. “More people than not smoked at that time. It was a very common social thing.”
Now 76, Higginbottom’s smoking days are long behind him. Still, the decades-long habit did its damage, and last year, he received the dreaded diagnosis that he’d always known was possible. He had lung cancer.
Thankfully, Higginbottom had spent nearly eight years preparing for that possibility. In 2015, his primary care doctor, Gay Walker, MD, an internal medicine physician at Scripps Coastal Medical Center Encinitas, told him about a relatively new method of using CT scans to screen for lung cancer.
“Scripps’ electronic health record is designed to highlight patients who would benefit from additional screening, provided the necessary history has been entered into the chart,” Dr. Walker explains.
“In Mr. Higginbottom’s case, his chart had all the information needed to alert me to his need for screening, which is a huge timesaver, particularly for patients like Mr. Higginbottom, who hadn’t smoked for some time and who looked healthy,” she continues. “It would have been easy to overlook because he didn’t look like he had risk factors. Screening is critical for patients like him, though, because an early diagnosis can save their lives.”
Lung cancer usually caught late
Lung cancer usually caught late
While annual lung CT scans have been available for a number of years, Scripps Cancer Center’s coordinated program is unique in its multidisciplinary approach to screenings.
Early detection is important when it comes to cancer. With lung cancer it’s especially critical, as lung cancer is the leading cause of cancer deaths in the United States. In fact, each year more people die from lung cancer than from colon, breast and prostate cancers combined, according to the American Cancer Society.
“Lung cancer is usually caught late, and by that time, it has already metastasized to other parts of the body,” explains Nikunj Patel, MD, a radiologist at Scripps Cancer Center and Scripps Clinic. “We have now found that lung cancer screenings for people that fit the criteria for high risk do result in catching the disease at an earlier stage. This lessens the likelihood that it has metastasized and allows for better prognostics for curing.”
In 2022, Scripps Cancer Center launched a comprehensive multidisciplinary lung cancer screening program to address the need for early detection. The Jana Oliphant Hackett Lung Cancer Screening Program is open to anyone who meets the screening criteria outlined by the U.S. Preventive Services Task Force (USPSTF). In 2021, the USPSTF updated its guidelines, allowing more people to qualify.
“The new recommendations expand the criteria to include people ages 50 to 80 who have a 20-year smoking history — equal to one pack of cigarettes per day for 20 years. The American Cancer Society has also dropped the requirement regarding the number of years it has been since the person quit smoking,” Dr. Patel says. “This is a significant change to previous criteria, and it includes a lot more individuals. More data has come out to support screening as an effective way to detect lung cancer in its early stages, and it now has a greater ability to impact more people.”
While annual lung CT scans have been available for a number of years, Scripps Cancer Center’s coordinated program is unique in its multidisciplinary approach to screenings.
“What made our program unique at its inception was that there wasn’t really a dedicated program in the San Diego region,” Dr. Patel continues. “We identified lung cancer as an under-serviced area within cancer care in San Diego County and we made a concerted effort to start a program.”
The lung cancer screening program requires a referral from a primary care physician. Patients who are still smoking are encouraged to quit. They are offered pharmaceutical resources and support groups to help them achieve this goal, Dr. Patel explains.
“Once they are enrolled and undergo a shared decision-making visit, they receive annual lung CT scans, coordinated by the patient navigator,” he says. “Ultimately, the CT is what’s used to find the early cancer. If we see something of concern, the patient then gets referred to a pulmonary specialist for biopsies or other testing. If there’s nothing of concern, we’ll see them the following year for another CT screening.”
Early detection works
Higginbottom is a prime example of the importance of these annual screenings. Despite having a clear CT scan in 2022, just one year later something had changed.
“In October 2023, they discovered a nodule,” he recalls. “Because of its size and shape and the fact that it had not been there the year before, they deemed it highly suspicious.”
From there, Higginbottom was referred to Samir Makani, MD, an interventional pulmonologist with Scripps Cancer Center and the medical director of the lung cancer screening program, to develop a care plan.
“In general, lung cancers present late because they are relatively asymptomatic, which makes five-year survival low and treatment less likely,” he says. “The fact that screening can find cancers that are small makes a huge impact, and this case is a perfect example. Within one year, he went from having nothing to having something.
“When we find a spot like his, we have a few options,” he continues. “One is surveillance — waiting to see what happens over time. Two is more imaging, like a PET scan, to show what activity the nodule is having. And three is a biopsy. This can be either minimally invasive with a procedure called bronchoscopy or CT-guided biopsy. A final choice is an open lung biopsy or a wedge resection of the lung, if we feel the chance of cancer is extremely high. The results are something we find out in the operating room while the patient is asleep, and we proceed accordingly.”
Higginbottom was prepared for any of the three outcomes.
“I had done some research, and I knew that there was a high probability it was cancerous, so I opted to go straight to surgery,” he says.
Treatment with robotic surgery
Treatment with robotic surgery
“The fact that Dennis opted to participate in the screening program is very important. He was otherwise in great health, but he was at high risk because of his smoking history and his age. The screening and the resulting surgery have sustained his life.”
Samir Makani, MDOn Dec. 6, 2023, Higginbottom went into surgery with the understanding that he could wake up with part of his lung removed.
“They told me everything beforehand, so I was prepared,” he says. “I knew there was a reasonable chance I’d need to have the whole lobe removed.”
He underwent robotic-assisted, video-assisted thoracoscopic surgery — also known as robotic VATS surgery — which took approximately 90 minutes, during which time the team did a biopsy and determined the nodule was cancerous — stage 1 adenocarcinoma, to be precise. To achieve the best outcome, they removed a third of Higginbottom’s right lung.
“The fact that Dennis opted to participate in the screening program is very important,” Dr. Makani says. “He was otherwise in great health, but he was at high risk because of his smoking history and his age. The screening and the resulting surgery have sustained his life. If it would have presented late, it would have been life-altering. That he was able to access early screening and early treatment was lifesaving.”
Back to an active lifestyle
After his surgery, Higginbottom spent just a day and a half in the hospital before going home to recover.
“The whole experience was pretty amazing,” he says. “They used a special anesthetic that lasted for a few days, so I was in minimal discomfort. It was a pretty quick recovery — I had to spend a couple of weeks not doing much, no strenuous activity, no lifting or stretching. But less than three weeks later, on the day after Christmas — or Boxing Day to us Brits — my wife and I hosted a party for 25 people, and I barbecued for everyone!”
In January, Higginbottom was back to an active lifestyle, including playing tennis.
“Considering that on paper, 20% of my lung was removed, I certainly didn’t lose 20% of my capacity for activity. Although I think some of my tennis opponents would have hoped I did, I can still run around on the court!” he laughs.
Overall, Higginbottom is thrilled with the screening process and how quickly his cancer was detected, treated and he was back on his feet.
“Apart from the actual experience of discovering I had a cancerous tumor, of course,” he says.
He will have CT scans every six months for the next three years; then, he will gladly return to screening on an annual basis.
“I am certainly glad I was in the screening program. The CT is straightforward and non-invasive, why would you not do it? There’s no good reason to not do it and every reason to do it on an annual basis,” he says. “Everyone at Scripps was absolutely top notch. I couldn’t have asked for a better coordinator, pulmonologist and surgeon. Each team made it very straightforward and easy to go through the process. It was amazing to me how it all happened so quickly and efficiently.”
Scripps program has screened 1,000
In October 2024, Scripps Cancer Center screened its 1,000th patient in the program, exceeding expectations. Dr. Patel is thrilled to be able to offer this lifesaving screening to people who need it at any Scripps imaging site in San Diego County.
“It’s a great resource for the community,” he says. “There are many people like Dennis who were completely asymptomatic that we have been able to identify with cancer, treat and essentially cure them. You don’t have a lot of screenings that can have this impact. This is one that truly can prevent a much more complex health problem. It can catch disease early and let people continue to live a full, active life without any restrictions.”
Watch video on lung cancer screening
Watch the San Diego Health video with Dr. Samir Makani discussing the importance of early detection of lung cancer through screening.
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.