Yankelevitz et al. reviewed whether chest radiograph screening for lung cancer offers benefit given historical randomized trials, contemporary low-dose CT data, and advances such as digital tomosynthesis and artificial intelligence. They summarize U.S. and international guidelines that generally advise against CXR screening, with Japan as a notable exception maintaining a national program. Historically, three NCI trials and a Czechoslovak randomized trial did not show a mortality reduction with CXR, shaping guidance for decades. The later PLCO trial of more than 140,000 participants also reported no mortality benefit. The authors detail design factors that could have masked benefit, including control-arm contamination in the Mayo Lung Project, high competing cardiovascular mortality, inclusion of lower-risk participants in PLCO, and nonstandardized diagnostic work-ups. A reanalysis of the Mayo trial that adjusted for adherence and contamination estimated a potential mortality reduction up to 43 percent. On overdiagnosis, prior estimates in the Mayo trial reached 51 percent, yet tumor kinetics among stage I cases showed rapid growth and near-uniform 5-year fatality in patients who declined surgery, indicating aggressive disease rather than indolence. PLCO’s overdiagnosis was estimated at 6 percent, and NLST’s at 18 percent, falling to about 3 percent when nonsolid nodules were excluded. Linking NLST and NELSON findings, the authors emphasize size at detection. CT reduces mortality largely by finding more stage I tumors. By the same logic, CXR-detected cancers should be more curable than symptom-detected cancers. Newer tools may further raise CXR yield: tomosynthesis improved detection of 3–5 mm nodules to 53 percent versus 7 percent with conventional CXR, and AI systems approximately doubled nodule-detection sensitivity without reducing specificity.