Based on evidence that coal miners have elevated gastric cancer mortality rates, a case-control study was developed to assess the gastric cancer risk of coal mine dust exposure. Forty-six cases of US white male gastric cancer deaths from NIOSH coal miner cohorts were individually matched by age to controls. From these data we show that a statistically elevated gastric cancer risk exists for miners who have prolonged exposure to coal mine dust and prolonged exposure to cigarette smoke. Coal workers' pneumoconiosis, a disease defined in terms of coal dust deposition in the lungs, was not found to be a gastric cancer risk.