Meeting report IV international conference on prevention and early detection of lung cancer, Reykjavik, Iceland, August 9 /12, 2001 Fred R. Hirsch a, *, P.A. Bunn, Jr a , E. Dmitrovsky b , J.K. Field c , W.A. Franklin a , R.E. Greenberg b , H.H. Hansen d , C.I. Henschke e , James R. Rigas b , R.A. Smith f , P. Toennesen g , J.L. Mulshine h a Department of Medical Oncology/Pathology, University of Colorado Cancer Center, 4200 E. Ninth Avenue, B 188, Denver, CO 80262, USA b Darthmouth Hitchcock Medical Center, Lebanon, NH, USA c Roy Castle International Lung Cancer Institute, Liverpool, UK d Department of Oncology, Finsen Center, National University Hospital, Copenhagen, Denmark e Department of Radiology, Cornell Medical School, New York, NY, USA f American Cancer Society, Atlanta, GA, USA g University Hospital Gentofte, Hellerup, Denmark h National Cancer Institute, Bethesda, MA, USA 1. Introduction The Fourth International Conference on Early Detec- tion and Chemoprevention of Lung Cancer was orga- nized by the International Association for the Study of Lung Cancer (IASLC) together with University of Colorado Cancer Center and Norris Cotton Cancer Center in USA. Since the previous IASLC conferences, which took place in Potomac, Virginia, USA in 1993 [1], Copenhagen, Denmark and Nancy, France, both in 1996 [2,3], significant advances have been obtained in molecular biology, radiology and diagnostic techniques. These advances have led to a better understanding of the nature of carcinogenesis leading to a shift in the diagnostic and therapeutic paradigm towards early detection and treatment of early lesions [4]. Thus, the aim of the conference was to bring together scientists working in different fields for an update on current research. In addition, a major focus was to formulate a strategy for international exchange and cooperation in the development of translational research for early lung cancer. As established in previous workshops, this type of research requires more and more interaction between different expert areas and a greater need for regular communication among participants. The conference had plenary sessions in order to update participants about the current state-of-the-art in relevant areas and break- out sessions for in-depth discussions in specific areas. These areas included lung cancer prevention */strategic considerations, epidemiology, risk assessment, primary prevention, molecular biology and field carcinogenesis, screening of lung cancer by spiral CT, management of screened detected lesions and chemoprevention. A summary from each workshops is reported below. 1.1. Lung cancer prevention */strategic considerations In spite of a tendency to a decrease in some western countries, lung cancer continues to be the leading cause of death from cancer due to a major rise in the eastern European countries, China and some of the developing countries. The main culprit for this increase is increased tobacco consumption. Tobacco is already the leading cause of premature deaths in the adults. In developed countries, tobacco causes a third of all male deaths in middle ages. For women, the tobacco epidemic is still growing. As the Director General of the World Health Organization, Dr Gro Harlem Brundtland, expressed it in 1998 to the World Health Assembly: ‘‘We need to address a major cause of premature death which is dramatically increasing-killing 4 million people this year-and if we let it go on without action-10 million people will die in 2030-half of them dying in middle age- not old age. The major focus of the epidemic is now shifting to the developing countries. I refer to tobacco’’. Since then, tobacco control has been on the top of the priority list of the WHO, and at the XI World Conference on Tobacco and Health in Chicago, 2000, Dr Brundtland presented the framework convention on * Corresponding author. Fax:  /1-303-315-1835 E-mail address: fred.hirsch@uchsc.edu (F.R. Hirsch). Lung Cancer 37 (2002) 325  /344 www.elsevier.com/locate/lungcan 0169-5002/02/$ - see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0169-5002(02)00141-1