The poor prognosis of lung cancer has barely changed in the last decades, but the prognosis is better when the disease is detected earlier. Lung cancer screening by chest radiography did not lead to a decrease in lung cancer mortality, presumably because the chest radiograph is a poor screening tool with low sensitivity.With the advent of the low-dose spiral computed tomography (CT) scan it has become feasible to detect early invasive stage I lung cancer in 80-90% of cases. This technique could possibly decrease lung cancer mortality, but the extent of this effect is as yet unknown, and whether lung cancer screening will be cost-effective is yet to be determined. These questions can only be resolved in a randomized controlled trial with lung cancer mortality as an unbiased end-point.In this review, the initiatives to evaluate low dose spiral CT screening for lung cancer in Japan, USA and Europe are presented. In the USA and Japan, evaluation is in onearmed studies, whereas in many European countries randomized trials are now being planned and several one-armed studies have been initiated. A formal collaboration among these countries has now been set up.It is strongly recommended that lung cancer screening be evaluated in randomized trials in order to allow evidence-based health policy decisions to be made on this subject.

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