TAMPA — Richard Macdonnell started smoking when he was a teen. When he heard about low-dose CT scans to detect lung cancer, he knew he was a candidate.
"It was always in the back of my mind," said the 59-year-old, who smoked a pack a day for 40 years. "I knew I should do it, but I always put it off."
Last month, he summoned the courage, went to Moffitt Cancer Center and handed over $150 for the test, no prescription required.
The news was bad and yet good, too.
He did have lung cancer — but the tumor was only the size of his thumbnail and had not spread.
Just a few years ago, it could have been a much different story.
"Most of the time lung cancer isn't picked up until someone has symptoms and when tumors are the size of an orange or have spread to other organs in the body," said Dr. Jacques Fontaine, the thoracic surgeon at Moffitt who treated Macdonnell.
"Screening has changed that. Now we can catch cancers earlier when they are operable with robotic surgery and small incisions, and patients can get back to work and normal activities much faster."
Though breast cancer gets much more attention, lung cancer is actually the nation's top cancer killer. In 2010, 201,000 Americans were diagnosed with lung cancer, and 158,000 died from it.
Last year, a landmark study came out that confirmed that routine CT scans could help save the lives of people like Macdonnell whose long-term heavy smoking put them at high risk of lung cancer. Since then, medical groups have been recommending the scans, but they've been slow to catch on, possibly because they're not covered by most insurance plans yet.
"That will change as word gets out that these are curable cancers," Fontaine said. "Screening will change the lung cancer landscape."
If a lung cancer is found when it is less than a millimeter, or about the size of a blueberry, patients have an 80 percent chance for cure, Fontaine said. "If it's the size of a strawberry, there's a 70 percent cancer for cure."
So, why not screen everyone?
Like any medical test, lung CT scans have benefits and risks, notably exposure to radiation that itself can cause cancer. Researchers have shown the benefits outweigh the risks among people most likely to have lung cancer — those who smoke at least two packs a day for 15 years or one pack a day for at least 30 years.
"We don't know if screening someone who smoked a pack a day for 20 years, for example, is beneficial, because we didn't study that group," Fontaine said. "We will screen them, yes, but we require a prescription from your doctor."
Before CT screening, the only people diagnosed early were those who learned of it by accident when they had a CT scan for some other reason. For Virginia Costenbader of Gulfport, it was a fainting spell in 2011 that spurred her doctors to order a battery of tests. They found no reason for her fainting, but they did find a small speck on one of her lungs that was later found to be lung cancer.
"It was such a shock. I never would have thought I'd have lung cancer," said the 85-year-old, who has never smoked.
Costenbader and Macdonnell found their cancers in different ways, but both benefited from recent advances in surgical techniques. Today, early-stage lung cancers can be removed without cracking open the chest and spreading the ribs. Instead, less invasive robotic surgery, which involves making a few small incisions in the chest, is all the treatment patients such as Macdonnell and Costenbader need.
"No radiation, no chemotherapy and I'm clear as a bell," said Macdonnell, who works in construction and equipment maintenance at a Sarasota golf course.
Costenbader, who has always been physically fit and active, was home in two days and walking around her neighborhood within a week. Macdonnell is still recovering at home but expects to return to his physically demanding job in the next couple of weeks.
"I'm still fighting fatigue. But, if I worked in an office, I'd be there today," he said.
Irene Maher can be reached at firstname.lastname@example.org.