Strategies for the early detection of lung cancer are being investigated in an attempt to improve the poor prognosis associated with the disease. Such approaches, which include the identification of biomarkers for preclinical disease, must be integrated into multimodal cancer prevention strategies. Recent investigations have identified potential markers of early disease, including heterogeneous nuclear ribonucleoprotein, although the use of multiple markers may be required to provide the sensitivity and specificity necessary for mass screening. Early detection necessitates the development of effective chemoprevention strategies for the airway-confined phase of lung cancer. Current research efforts explore the utility of direct drug delivery, such as with the use of aerosolized delivery of retinoids, to maximize delivery of the active agent to the site of early lung cancer while avoiding systemic adverse effects.