Lung cancer is the leading cause of cancer death worldwide and the incidence is rising. The overall five year survival is 19% for all lung cancers and 4.5% for lung cancer with metastases[i]. The cancer mortality rate in South Africa was reported as 69/100 000 deaths in 2014, with lung cancer being the leading cause of cancer deaths[ii]. The true incidence of lung cancer in South Africa is unknown. The National Cancer Registry (NCR) reported Age Standardised Incidence Rate of 3.95/100 000 for women and 10.12 for men is likely to be underreporting the true incidence due to the late presentation of patients who do not receive a histological diagnosis. In-house Cancer registry data reveal that the mortality rate of 22 per 100,000 is double the pathology reported incidence of the NCR.