Abstract <p>Incidental findings (IFs) are common in lung cancer screening (LCS). While the detection of some of these findings can lead to early diagnosis and treatment of clinically significant conditions, it also carries the risks of overdiagnosis and overtreatment, causing anxiety for patients and increased economic costs for health systems. Effective management of IFs requires a balanced approach guided by clear guidelines, standardized reporting, and participants-centered communication. As the field of LCS evolves, continued research and innovation will be essential in refining the strategies for managing IFs, ensuring that the benefits of screening are maximized while minimizing potential harm. Evidence-based guidelines on reporting and management of IFs, however, are still lacking. This narrative review explores the pros and cons of reporting IFs in LCS, focusing on key controversies.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p><i>Reporting and managing incidental findings in lung cancer screening is largely debated</i>.</p> </ItemContent> <ItemContent> <p><i>The detection of incidental findings can lead to early diagnosis of clinically significant conditions but carries the risks of overdiagnosis and overtreatment</i>.</p> </ItemContent> <ItemContent> <p><i>A balance must be found to have a positive impact on the population while not placing a burden on healthcare systems</i>.</p> </ItemContent> </UnorderedList></p>