Lung cancer screening – Time for an update?

•Lung cancer screening can reduce mortality but can also be tailored to better address diverse populations and emerging risk factors such as air pollution.•Objective biomarkers promise to overcome some of the limitations of risk assessment but are not yet ready for implementation.•Primary prevention should continue alongside screening. Lung cancer screening can reduce the mortality of lung cancer, the leading cause of cancer death worldwide. Real world screening experience highlights areas for improvement in a complex and changing world, particularly ethnic disparity, and the potential for new and emerging risk factors, in addition to well known risk of smoking and asbestos exposure. Biomarkers offer the promise of objective risk assessment but are not yet ready for clinical practice. This review discusses some of the major issues faced by lung cancer screening and the potential role for biomarkers.