Smokers with a severe lung condition are to be tested to see if there is a way of detecting who is at greatest risk of cancer.
The trial of 1,300 people, funded by Cancer Research UK, will take place at six English hospitals.
Samples of phlegm will be tested twice a year, with further checks if abnormal cells are found.
If lung cancer is detected earlier, more treatments can be offered, and survival rates improved.
" It may be the first step towards an effective screening test for lung cancer in those at high-risk of the disease"
Currently, 38,000 people a year - over 100 a day - are diagnosed with lung cancer in the UK, and 33,000 people die from the condition annually.
Overall, just 7% of patients are still alive five years after diagnosis.
But if some types of lung cancer are detected at an early, operable stage, up to 80% of patients are alive five years later.
This study will look at screening long-term smokers with chronic obstructive pulmonary disorder (COPD).
COPD is a degenerative lung condition, largely caused by smoking, that includes chronic bronchitis and emphysema, and increases the chance of developing lung cancer.
Survival chances
Professor Stephen Spiro of University College London Hospitals (UCLH), who is leading the study, said: "Many of the tests that have been used to screen for lung cancer have not been able to pick up very early signs of the disease so we're using two new tests which we think could be better at picking up lung cancer earlier."
Around half the patients on the trial will be asked to give a sample of phlegm for analysis once a year.
If any abnormal cells are found, the patient will be asked to take two further tests - a spiral CT scan, which offers a 3D picture of the chest, and a fluorescence bronchoscopy.
In that test, a camera is put down the windpipe and uses blue and white light to examine the lining of the airways.
This involves inserting a narrow flexible tube with a camera down the windpipe to look into the lungs and collect a tissue sample.
If further indications of abnormalities are discovered, more investigations will be carried out. Otherwise, they will be re-tested annually.
The other half of the patients in the trial will receive standard COPD care, and be given a normal chest X-ray after five years.
Kate Law, director of clinical trials at Cancer Research UK, said: "We urgently need to find new ways of detecting lung cancer earlier, so that patients have a better chance of successful treatment.
"This is a very important trial and it may be the first step towards an effective screening test for lung cancer in those at high-risk of the disease."
The trial will take place at University College Hospital, London, Royal Brompton Hospital, London, Papworth Hospital, Cambridge, St James's Hospital, Leeds, Glenfield Hospital, Leicester and Chelsea and Westminster Hospital, London.
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