We believe that it is important to be clear about the business model. For example, are the costs covered by an institutional grant or a social fund to support disadvantaged patients? Currently, the most common institutional business model is to make up the discrepancy between what is collected for screening and what it actually costs from profits arising from interventions done for screen-detected nodules. It is important to recognize that this represents an inherent conflict: Optimal patient management calls for limited, judicious further intervention, whereas optimal financial management calls for maximizing the number of additional interventions performed. This conflict is particularly poignant because the rate of finding a nodule is high (10%-50% of those screened), the level of anxiety of those with a nodule is high, yet the proportion of inconsequential nodules is high (about 96%). The issue is further magnified when screening is extended beyond the National Lung Screening Trial criteria (currently unsupported by data or modeling studies of efficacy), which increases manyfold those being screened and needing further interventions with a much lower impact on actually preventing deaths from lung cancer.1 It is certainly possible for this conflict to be managed appropriately, but this business model increases the potential for intended or unintended overuse of subsequent interventions.