More than half of all lung cancer cases are diagnosed in patients older than 65 years of age. Risk of death after thoracotomy also increases over the age of 65. As a result, surgical intervention for lung cancer is often considered too risky in elderly patients, leaving the caregiver with a treatment dilemma when confronted with an abnormal radiographic finding. Advances in preoperative risk assessment, surgical and anesthetic techniques, radiation oncology, and locally ablative techniques have resulted in improved survival with a significant decrease in post-procedure mortality and morbidity for the aged population. On this basis, we believe treatment options for incidental pulmonary nodules found on chest roentgenograms should be discussed with patients and interventional work up pursued. It is no longer reasonable to deny elderly patients the benefits of surgical intervention simply on the basis of age. Every effort should be made to assess risk and optimize treatment for this large and growing segment of the population.