In summary, the authors should be lauded for taking on such a challenging task. Clearly, there is a need for an Asian version of the CHEST pulmonary nodule evaluation guidelines that takes into consideration all the unique risk factors (genetic, cultural, environmental) that distinguish lung cancer in Asians from its western counterpart. However, in the absence of good data, many of the revisions are based largely on expert opinion, and only a limited number of thought leaders from pulmonary medicine and thoracic surgery were involved. Future revisions to this document may consider inclusion of a broader expert panel—regarding not only discipline (eg, medical oncology, radiation oncology, thoracic radiology, primary care, and patient advocates) but also the number of Asian countries represented, especially those of lower socioeconomic status. As with any high-quality guideline, the strength of recommendations should ideally consider the issue of affordability. The World Health Organization defines “cost-effectiveness” as anything less than three times the gross domestic product per capita per life-year saved. Thus, the inclusion of data demonstrating the solvency of these propositions in poorer countries would substantially bolster their validity.