Is screening for lung cancer a panacea or a Pandora’s box? For the first time since the guidelines were initially published in 2003, screening those at high risk for lung cancer using a low-dose CT scan is recommended. This is based on a 20% reduction in lung cancer mortality found in the National Lung Screening Trial (NLST) for patients screened with a low-dose CT scan compared with a chest radiograph. However, the authors cautiously state that only patients meeting the same criteria as those in the NLST and who have access to medical centers delivering the same comprehensive care received by the NLST participants should be screened.2,3 The essence of a screening test is to reduce the chance of dying from a disease without causing harm in the process. The authors stress this fundamental point, as there is a frequent lack of understanding of screening among physicians, and there is potential harm involved.4,5 Questions remain as to how CT scans, biopsies, PET scans, and surgeries will be funded in light of decreasing Medicare dollars and a skyrocketing national deficit. Thus far, the US Preventive Services Task Force has not weighed in on the subject, and a cost-efficacy analysis by the NLST investigators is expected, but not yet published.