There is growing evidence that earlier diagnosis of lung cancer is an important factor in improving outcomes. There is an extensive literature spanning several decades on the concept of ‘diagnostic delay’ in cancer. This recognises that patient pathways to presentation to healthcare and initial management in primary care are key determinants of cancer patient outcomes. In this presentation I will discuss some of the evidence regarding the effect of time to diagnosis on lung cancer outcomes. I will present The Model of Pathways to Treatment, a theoretical model which underpins much of our research on time to cancer diagnosis. I will also discuss research we have conducted on symptom appraisal and help-seeking for lung cancer in rural Australia and the UK, and trials of interventions aimed at promoting earlier presentation to healthcare and prompt investigation of symptoms in primary care. While we await further consideration about the implementation of lung cancer screening, strategies are needed to ensure people recognise symptoms of lung cancer and, once they seek healthcare, are investigated and treated rapidly to maximise their chance of survival