Lung cancer is the most common cause of cancer death worldwide. The overall 5-year survival rate remains disappointing at 14% or less. Several clinician- and community-based interventions show promise for reducing lung cancer incidence through prevention and smoking cessation. However, long-term heavy smokers retain a significant lung cancer risk despite smoking cessation. Half of newly diagnosed lung cancers are now found in former smokers. An additional strategy of lung cancer control through chemoprevention needs to be developed. Advances in optical imaging technologies and genome science will continue to improve our ability to identify individuals with the highest risk of lung cancer for chemoprevention. More accurate surrogate endpoint biomarkers are becoming available for phase II trials of new agents. A number of promising agents are currently being tested in phase II and III trials for prevention of lung cancer.