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Although the profile of lung cancer has been raised recently, specifically1 and in the context of the general re-organisation of cancer services,2 concerns remain about the process of management3 and the delays in treatment which result.4 There is virtually uniform acceptance of the fact that, for patients with non-small cell lung cancer (NSCLC) at least, the best chance of cure is surgery5 and that successful surgery depends on diagnosis at an early stage in the disease process.6 Some evidence exists to suggest that, in Europe7 and the United States,8 almost 30% of patients with NSCLC undergo surgery. Although isolated reports from the UK quote operability rates of 20%,9 the overall resection rate is essentially static10 at 10% or less of the total number of new cases reported each year.11 Case selection and long term survival are, however, very similar in this and other countries.12 While it is …