Approximately one in eight tobacco smokers develops bronchogenic carcinoma over a lifetime. The ability to identify a cancer-susceptible smoker would enable the physician and public health authorities to target intensive smoking-cessation efforts and chemoprevention interventions on the highly susceptible smoker. Additionally, early lung cancer screening techniques could be focused on those at highest risk for lung cancer. Recent developments in the understanding of the influence of genetics on the pathogenesis and susceptibility to lung cancer are outlined, and these developments, combined with demographic and clinical information, profile the high-risk individual. Reviewed in this article are currently available and clinically applicable lung cancer early-detection strategies, which include molecular, cyto-pathologic, and imaging techniques. In addition, the authors review other modalities likely to be instituted in the near future. Pending reevalution of these strategies, it is reasonable to use plain chest radiographs as an initial screening tool in high-risk smokers, such as those with preexisting lung disease, family history of lung cancer, and ongoing occupational and/or tobacco smoke exposure.