Refining strategies to identify populations to be screened for lung cancer

The selection of populations to be screened for lung cancer must be further optimized before translation to large population. A 3-step refinement should be integrated into forthcoming lung cancer trials, namely, calculation of risk based on (1) demographics, (2) biological factors, and (3) radiologic inputs. Biological sampling should be implemented up-front to reduce the use of low-dose computed tomography scanning in patients with lower risk of aggressive disease and, notably, to improve detection of aggressive disease that is overlooked by current screening strategies.