In this article, there is a return to the beginning of the last century, retracing the evolution of the lung cancer epidemic. As lung cancer increased in frequency, the steps developed to investigate and treat the disease are recalled. At the beginning of the new millennium, the position of surgery in the management of lung cancer is summarized. The role of the surgeon in the investigation and treatment of lung cancer, whether with curative or palliative intent, is evaluated. The principles of surgical management are enunciated, how these principles are presently understood is discussed, and how the disease, its prevention, and treatment may develop in the new millennium is addressed.