Lung cancer is the most common global cancer and a leading cause of cancer death. Lung cancer survival is poor, in part due to late diagnosis of the disease. Low-dose CT screening has been shown to reduce lung cancer specific mortality; however, screening must be targeted to those most at-risk to ensure efficiency and reduce harm to participants. Currently, selection for screening is performed using risk factors such as age and smoking history. In this review, we present the evidence for genetic risk factors playing a substantial role in mediating lung cancer risk. We discuss the potential for integrating these genetic factors into the tools used to select people for lung cancer screening and suggest which steps might be taken to bring such tools into clinical practice. (By Mikey Lebrett, https://jmg.bmj.com/content/early/2021/01/28/jmedgenet-2020-107399 )