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This paper describes a novel classification method for computer aided detection (CAD) that identifies structures of interest from medical images. CAD problems are challenging largely due to the following three characteristics. Typical CAD training data sets are large and extremely unbalanced between positive and negative classes. When searching for descriptive features, researchers often deploy a large set of experimental features, which consequently introduces irrelevant and redundant features. Finally, a CAD system has to satisfy stringent real-time requirements.This work is distinguished by three key contributions. The first is a cascade classification approach which is able to tackle all the above difficulties in a unified framework by employing an asymmetric cascade of sparse classifiers each trained to achieve high detection sensitivity and satisfactory false positive rates. The second is the incorporation of feature computational costs in a linear program formulation that allows the feature selection process to take into account different evaluation costs of various features. The third is a boosting algorithm derived from column generation optimization to effectively solve the proposed cascade linear programs.We apply the proposed approach to the problem of detecting lung nodules from helical multi-slice CT images. Our approach demonstrates superior performance in comparison against support vector machines, linear discriminant analysis and cascade AdaBoost. Especially, the resulting detection system is significantly sped up with our approach.