Lung cancer screening program looks for cancer among rural South Carolina residents

November 16, 2022
a man in gray sweatshirt with sleeves pushed up and a camo baseball cap sits in a chair with a white blanket draped over him and hospital bracelets on
Steve Pettit is undergoing treatment for lung cancer. Photos by Clif Rhodes

Steve Pettit isn’t the kind of guy to sit around inside. He spent years working in home construction and then at home in Lancaster County, taking care of the family’s horses and tending to the yard. But treating his lung cancer has him sitting around a lot lately.

“I wouldn’t wish this on nobody,” he said, as he sat in an infusion suite in MUSC Hollings Cancer Center in Charleston, medication dripping through an IV into his veins. Despite how he feels, he and his wife, Tammy, are grateful for the lung cancer screening program that alerted him to the cancer, enabling him to get treated for it.

Steve Pettit is receiving a combination of chemotherapy and immunotherapy, with the possibility of surgery later, and Tammy Pettit hopes that he’ll be cancer free by the end of the year.

“That is a few short months … rough at times, yes, but had we not caught this as early as we did, his treatment plan could have been much longer,” she said.

Catching cancer early is the focus of Hollings’ lung cancer screening program, which started in Charleston but has since expanded to the MUSC Health-Lancaster Division, MUSC Health-Florence Division and MUSC Health-Midlands Division.

“You don't really have signs and symptoms of anything until it's at a much more advanced stage, and then it's harder to treat. So that's our goal – to catch these lung cancers very early so we can treat them.”

Alex Ingram, nurse practitioner

Nurse practitioner Alex Ingram handles the lung cancer screening and nodule management program in Lancaster and Chester. She works with people who are at high risk of lung cancer because of their smoking histories and encourages them to get annual lung scans.

She tells her patients that lung cancer grows quietly at first.

“You don't really have signs and symptoms of anything until it's at a much more advanced stage, and then it's harder to treat,” she said. “So that's our goal – to catch these lung cancers very early so we can treat them.”

The idea is to find lung cancer at Stage 1, when it’s small and hasn’t spread outside of the lungs. Steve Pettit’s was found a bit later than that, at Stage 3A, meaning it had spread to a lymph node on the same side of his chest as the tumor. But Tammy Pettit, who knows from sad personal experience the toll of lung cancer, focuses on the benefits of the screening program.

“My daddy had lung cancer and, unfortunately, when he found out it was too late – stage 4,” she said. “We caught it really early in Steve's situation. If it hadn’t been for the screening program, he probably never would have caught it this early.”

Pettit’s primary care doctor, Steve Culp, M.D., of Mackey Family Practice, referred him to Ingram because he was having trouble breathing and getting tired easily. But people don’t need to wait for symptoms to make an appointment with Ingram or any of the nurse practitioners in the screening program, and they don’t even need a doctor’s referral. People are eligible for lung cancer screening if they answer yes to all of the following:

  • Are between the ages of 50 and 77.

  • Are a current or former smoker who quit in the last 15 years.

  • Have at least a 20 pack-year history (one pack a day for 20 years, two packs a day for 10 years. etc.).

“It's nice when I get to say, ‘I'll see you next year,’ but lately that hasn't been the case very often,” she said. She’s had 10 people receive lung cancer diagnoses after their scans. “Those conversations are pretty hard, but just letting them know, ‘If you would have never come and done this, you would still be walking around right now with lung cancer and not know – and then I might not see you next year.’ That's, I think, a big ‘wow’ for them.”

a nurse adjusts an IV line while a man in a reclining chair and a woman in a visitor's chair look on 
A nurse adjusts Steve Pettit's medication while Tammy observes. She has come with him to all of his appointments in Charleston.

Edward McCutcheon, M.D., chief medical officer for the Lancaster Division, said the division has performed around 500 scans since the program was implemented in 2021.

“We don't want anybody to have cancer. But we do want to offer the screening opportunity for our patients,” he said. “The intention is to detect earlier.”

He praised Ingram’s efforts to reach more people who could benefit from the screening.

“Alex Ingram is local. She grew up in Lancaster County and became a nurse, did her training locally and eventually earned her nurse practitioner degree,” he said. “She is the perfect advanced practice provider to run this program.”

The Pettits praised her, too. Steve Pettit said that Ingram makes it a point to check up on him and see how he’s doing. Ingram has been wonderful, Tammy Pettit agreed.

“Anything that we have questions about, she’s been right there with us from day one,” she said. “You can tell she really has a love for her job and her patients.”

Like many of Ingram’s patients, the Pettits chose to go to Hollings in Charleston for treatment. Because it’s a three-hour drive from home, the Pettits typically head to Charleston the night before one of his appointments. A former employer who owns a home in Charleston lets them stay at his house. The Pettits are at Hollings first thing in the morning, where Steve Pettit sits for hours as the treatment is delivered, then they make the three-hour drive back home while Pettit is still sleepy from the Benadryl that he takes along with the chemotherapy and immunotherapy.

Tammy Pettit has been lucky that her employer has allowed her to work from home, enabling her to balance work and caregiving.

“Cancer is a journey that so many people go on. I, for one, never thought this would be a journey my husband and I would face,” she said. “Even with the treatments causing many rough days for my husband, I do believe with everything in me that this screening program saves lives.”