In 2010, the National Lung Screening Trial (NLST) in the United States showed a 20% reduction in lung cancer mortality, screening heavy smokers age 55 to 80 with a 30 pack year history using low dose computed tomography (LDCT). This benefit, however, must be weighed against the possible harms of over-diagnosis (estimated at up to 18.5%) and possible over-treatment, anxiety associated with a positive result, discomfort and adverse effects of the screening test and follow-up investigations. Also there is uncertainty about the frequency and duration of screening; the costs must be compared to other measure to reduce lung cancer mortality and lack of definition of the optimal target population. Tools to evaluate population risk not only include age and smoking but socioeconomic state, body mass index, sex, ethnicity and presence of chronic obstructive airways disease. These need evaluation in Australian patients. Therefore the NLST results do not yet make a case for lung cancer screening by LDCT in Australia. In April 2010 the Australian Government announced both a tax increase on tobacco of 25% and the introduction of plain packaging designed to reduce the attraction of the packs to young people. Subsequently 2 of 4 annual tax increments of 12.5% have been introduced and there have been a series of anti-smoking advertising campaigns. This has seen the smoking rate in Australian adults fall from over 15% to 12.8%. It would seem with the current available data that the most cost effective strategy for reducing lung cancer in Australia remains the funding of tobacco control measures.