Lung cancer screening is currently challenged by the dual dilemma of over-screening and under-screening. Over-screening is primarily manifested by low-dose computed tomography (LDCT) performed at frequencies exceeding clinical necessity, as well as overly intensive short-interval follow-up of indolent or clinically insignificant lesions, resulting in cumulative radiation exposure, patient anxiety, and waste of healthcare resources. Under-screening, in contrast, is reflected in the failure of high-risk populations to receive recommended LDCT screening, insufficient coverage of individuals with emerging non-traditional risk factors by current guidelines, and delayed identification or management of aggressive early-stage lesions, ultimately leading to late-stage diagnosis and substantial physical, psychological, and financial burdens on patients. Resolving this paradox requires a screening strategy deeply aligned with the biological heterogeneity of lung cancer. Available evidence suggests that lung cancer generally follows three evolutionary trajectories: occult primary tumors with early systemic metastasis, rapidly emerging and progressing solid nodules, and a slowly progressing course characterized by ground-glass opacity (GGO). GGO-type lung cancer may remain clinically indolent for a considerable period, but may ultimately transform into lethal invasive disease. Approximately 95% of persistent, slowly progressing GGOs harbor malignant pathology; nevertheless, to avoid overtreatment of stable lesions, intervention should be strictly reserved for lesions demonstrating radiological progression or continuous enlargement. This article proposes an exploratory "low-age, low-frequency" screening strategy aimed at harmonizing screening intervals with tumor biology and individualized risk. By emphasizing the capture of the "curative time window" and timely intervention for persistently progressing lesions, this strategy seeks to reduce the global burden of advanced lung cancer while maximizing curative benefit and cost-effectiveness.