For clinical progress to occur in lung cancer, advances must be made in many inter-related areas. Advances in chemoprevention will be most useful if testing is able to identify those at greatest risk of developing lung cancer. Advances in surgical and ablative therapies will be most useful if testing is able to identify lung cancer at the earliest possible stage. Advances in systemic, targeted and individualised therapies will be most useful if testing is able to predict the nature of a patient’s lung cancer and the response to specific treatment choices.

A new test can improve on currently used tests by being more accurate, less invasive, less expensive and/or novel in its intent. To have a clinical impact, the result of the test must affect a decision to the benefit of the patient. The most recently developed tests that have had this sort of impact in lung cancer are positron emission tomographic imaging,1 advances in diagnostic bronchoscopy (electromagnetic navigation,2 endobronchial ultrasound3) and perhaps epidermal growth factor receptor analysis.4

Progress is occurring on many fronts …