James J. Toth, Sr. Lung Screening Program at Providence, Saint John’s Health Center Prevents Stage 1 Lung Cancer from Advancing.

15 days after a CT scan showed an anomaly in his lung, Gary Bethel woke up in the hospital to discover not only was his biopsy positive for stage 1 cancer, but it was completely removed, and he would not need further treatments, such as radiation or chemotherapy.

I have never heard of having lung cancer and it not requiring chemotherapy or radiation.

Laura Bethel

The James J. Toth, Sr. Lung Screening Program at Providence, Saint John’s Health Center is still in its infancy–less than a year old– and is already proving to be an invaluable resource for early cancer detection and improved outcomes. The program director is none other than Dr. Robert McKenna, Director of Minimally Invasive Chest Surgery and Thoracic Surgical Oncology, and Professor of Surgical Oncology at Saint John’s Cancer Institute.

The lung screening program’s aim is to prevent advanced lung cancers in smokers since their risk of developing lung cancer is extremely high, about 80 to 90 percent.1 Symptoms of lung cancer usually don’t appear until it is in an advanced stage, making screening programs like this one at Saint John’s highly advantageous for longtime smokers.

Gary’s primary physician, based on certain prerequisites, such as age and smoking duration, recommended Gary have a lung screening CT scan, which led to a surgical biopsy.

Gary’s CT scan showed a finding that was concerning…and with Dr. McKenna’s 30-40 years of expertise, said the best course of action was surgery.

Sara Belton, Ph. D, RN

What is “Shattered Glass” on a Lung CT scan

A cluster of cells that have changed into a unique spattered pattern on a CT scan is called shattered glass. The name is based on how lung cancer cells appear on a CT scan. They can grow over time and should be watched closely. After comparing Gary’s last year’s scan with this year’s CT scan, it was determined the cells had grown slightly and should be biopsied to determine malignancy.

Another term for shattered glass is “ground glass opacity.” According to Sara Belton, Ph. D, RN, “these tumors are more ‘fuzzy’ or nebulous; they look like cotton candy. The less clearly defined a nodule or tumor is, the more tissue surrounding it you want to remove.”

Gary, while on the operating table, had no idea he had lung cancer, and that Dr. Robert McKenna was curing him of it.

He went in at 7:30, I expected a call at 9:30, I got the call at one o’clock; so I was very concerned.

Laura Bethel

Listen to Laura and Gary Bethel Comment on their Unexpected Cancer Journey

How Does the Pathologist and Surgeon Support a Better Outcome?

While in the operating room, a surgical pathologist tests each biopsy under a microscope for cancer, and if it is positive, Dr. McKenna will continue to remove additional portions of tissue around the tumor site until a biopsy from the pathologist comes back negative. This allows the surgeon to adjust the perimeter of the surgery until the cancer is completely removed, which reduces the need for future surgical treatments and the likelihood of metastasis (cancer spread).

Since the biopsy was positive for adenocarcinoma stage 1A2, a certain type of cancer that showed no lymph node involvement, Dr. McKenna removed the nodule using the Ion Robotic-assisted Bronchoscopy platform, then performed a segmentectomy to remove additional tissue. According to the journal General Thoracic and Cardiovascular Surgery, “The standard of care for surgical treatment of early lung cancer is still lobectomy with systematic lymph node dissection. However, recent research has shown that some ground-glass nodules may be treated with sublobar resections or non-surgical treatment.”2

Dr. McKenna removed Gary’s entire upper left lobe because ground glass opacity nodules are not well-defined.

What is Ion Robotic-Assisted Bronchoscopy for Minimally Invasive Peripheral Lung Biopsy?

According to Sara Belton, Ph. D, RN, the Ion system is a robot-assisted, minimally invasive surgical tool that allows surgeons to biopsy or even remove nodules from deep within the lungs less-invasively than what traditional, open surgical techniques allow. A nodule is a group of abnormal cells that have fused together, which may become cancerous.

Also known as the minimally invasive Ion endoluminal system, the Ion device is a small, thin, flexible catheter that can be inserted down a bronchoscope while the patient is intubated for surgery. Its tip can move 180 degrees, which allows it to easily navigate all areas of the lungs without the need for additional incisions.

Dr. McKenna used the Ion to locate and remove the nodule in Gary for biopsy, before going back in to take a segment of the lung.

The faster they catch it, the better. So, early is better.

Laura Bethel

Charting a New Chapter

With cancer behind him, Gary has given up smoking completely, which has ultimately afforded him the ability to chart a new chapter on life. After his surgery, Gary returned his last, and unopened pack of cigarettes to the local corner store and bought a cup of coffee and scratch-off lotto instead, according to his testimonial. Gary went home and told Laura he won $200 from the scratch off. Elated he beat cancer, no longer smokes, and won $200; Gary told Saint John’s Cancer Institute he spends most of his time now fishing. He has caught huge swordfish, and yellowfin tuna, to name a few. He’s been a fisherman most of his life and hopefully will be able to fish for a while yet.

Advice to Smokers on Screening from Gary

Gary, a man of few words, leaned on his wife, Laura, during his health journey. Laura, a huge proponent of his health, was a voice of reason to him during this time. She advocated for a biopsy, and to not wait, and she advocated for screening. When asked what advice he would give, resoundingly he remarked:

Just do it, don’t waste any time.

Gary Bethel

Additional Readings

To read how non-smokers or never-smokers develop lung cancer click here.

To listen to Dr. Robert McKenna in a podcast discuss lung cancer prevention with Kim Douglas, click here.


  1. Harms of Cigarette Smoking and Health Benefits of Quitting – NCI (cancer.gov)
  2. The diagnosis and treatment of lung cancer presented as ground-glass nodule – PubMed (nih.gov)

About the Author

Eleanor Zeri