Assuming that, in the first year, all 25 million persons are screened (a highly unlikely scenario) at $300 each, the maximal cost of the initial screening examination would be $7.5 billion. Because many of those screened will have nodules detected, there will be further expense for tests to confirm or exclude LC. The Early Lung Cancer Action Project study7found 23% of persons had nodules that required further workup (ie, 5,750,000 study subjects nationally). Such persons require follow-up with high-resolution, contrast CT scans (approximate cost, $500 per scan) on two to four occasions. A small percentage of persons will require transthoracic needle biopsies or surgical resection for diagnosis. Assuming that the average cost of this workup will be $2,000, the total cost of a subsequent workup would be $11.5 billion. The maximum total cost for the first year thus would be $19 billion. In subsequent years, fewer new nodules would be discovered, and old nodules would have been demonstrated to be benign.8 Thus, the downstream reduction in cost would be considerable. Treatment dollars would be spent on an intervention (ie, surgical resection) that can reasonably be expected to result in an increase in survival rate and a reduction in mortality rate in stage IA patients.