In a Swedish cohort of workers (n = 6,454) from seven aluminum foundries and three secondary aluminum (scrap) smelters there was no overall excess risk of cancer among male or female workers less than 85 years of age (males: 325 observed cases, standardized incidence ratio (SIR) 1.02, 95% confidence interval (CI) 0.91-1.13; females: 22 cases, SIR = 0.95, 95% CI = 0.60-1.44). In male workers, however, significantly elevated risk estimates were observed for cancer of the lung (51 cases; SIR = 1.49, 95% CI = 1.11-1.96), anorectal cancer (33 cases; SIR 2.13, 95% CI = 1.47-2.99), and sinonasal cancer (4 cases; SIR = 4.70, 95% CI = 1.28-12.01). There was no increase of urinary bladder or liver cancer. Lung cancer risks were highest in workers with a short duration of employment (< 5 years) suggesting determinants of risk related to socioeconomic factors rather than the occupational environment under study, but there were also indications of a lung cancer hazard from sand casting of aluminum for 10 years or more (SIR = 2.10, 95% CI = 1.01-3.87). The increase in anorectal cancer could not be etiologically related to occupational determinants of risk. Sand casting of aluminum aside, the cancer risk in secondary aluminum smelting seems to be lower than in primary aluminum smelting and in iron and steel founding, respectively.