• idiopathic pulmonary fibrosis
• psychology

Screening programmes have transformed outcomes in a number of conditions such as diabetes, cardiovascular disease and cancer. For example, lung cancer screening has effectively reduced cancer-associated mortality1 by identifying premetastatic lesions amenable to curative or highly effective therapies. Therefore, it is natural to wonder if screening for a similarly morbid disease such as pulmonary fibrosis (PF) could yield comparable results. A decade ago, screening for PF would likely have had little impact on the natural history of these disorders. However, three recent discoveries have made PF screening potentially more consequential: (1) the identification of interstitial lung abnormalities (ILA) which are thought to be PF precursor lesions2 3; (2) the realisation that asymptomatic relatives of patients with PF represent a sizeable at-risk population that are enriched for ILAs4–6; and (3) the development of antifibrotic therapies that are effective even for individuals with preserved lung function.7 8 Thus, the stage is now set to determine if PF screening is a viable avenue for improving clinical outcomes.

In our zest to construct PF screening algorithms, we must acknowledge that such programmes may have unintended consequences. By definition, PF screening would aim to identify a potentially fatal disorder in individuals who do not yet have symptoms, a process which could cause excessive emotional or …