A prospective study was made of workers exposed to silica (7631869) or heavy inert dust to determine specific causes of death, particularly respiratory diseases and cancer. A group of 1625 exposed male workers born before 1911 was compared with a matched group of nonexposed workers. The study was initiated between 1950 and 1960 at time of first chest x-ray. Cohorts were exposed to nonfibrous dusts metal, glass, ceramics, stone, construction, cleaning agent and several other industries. Of 1621 workers in each group traced up to 1986, 1442 exposed and 1384 nonexposed workers had died. Relative risks in cohorts were significantly increased for lung cancer, stomach cancer, chronic obstructive lung disease and lung silicosis/fibrosis/tuberculosis. Increased rates of gastrointestinal diseases, mainly liver cirrhosis, were noted in cohorts. For secondary causes of death and additional diagnoses, cohorts revealed increased rates of respiratory diseases. Standardized mortality ratios (SMRs) of cohort and comparison groups against the general male Viennese population were calculated. Increased SMRs were noted in cohorts for overall mortality, lung cancer, stomach cancer, chronic obstructive lung disease, silicosis/fibrosis/tuberculosis and acute/infectious respiratory diseases. In comparisons, SMRs were decreased for silicosis/fibrosis/tuberculosis, cardiovascular diseases and accidents and increased slightly for lung cancer. Lung cancer SMRs in cohort subgroups were increased for 775 foundry workers, 475 grinders and other metal workers, 191 glass and ceramic workers and 65 others; highest SMRs occurred in stone and glass and ceramic workers. Stomach cancer SMRs were increased for all subgroups but were significant only for foundry and other metal industry workers. Survival rate of cohorts versus comparisons was not reduced before 7 years of observation and 58 years of age. The median survival difference was 3 years. The authors conclude that primary and secondary prevention should not be focused only on pneumoconiosis, and screening for workers with heavy dust exposure should be continued after retirement.