Objective: To carry out a systematic review of the evidence relating asbestos exposure to the risk of laryngeal cancer. Method: All identi®ed studies of asbestos workers providing data on laryngeal disease were reviewed, together with studies of laryngeal cancers giving epidemiological or experimental evidence of associated exposures. Results: Confounding due to smoking and alcohol intake, and to a lesser extent diet and socioeconomic factors, creates a major diculty over the identi®cation of any asbestos or other occupational eect. Not only are smoking and alcohol independently associated with large increases in relative risk (RR) of laryngeal cancer, but also have a synergistic eect with each other. Few of the studies provide details of either habit. Among 24 prospective studies for which a standardized mortality ratio (SMR) was available, nine had an SMR at or below unity, and among a further 11 without an SMR for comparison, in only one was there a clear excess risk. In 17 retrospective studies, only two showed a signi®cantly increased RR. Evidence from animal experiments, studies of associations with pleural plaques, and autopsy ®ndings also appear negative or inconclusive. Conclusion: The evidence does not indicate that asbestos exposure increases the RR of laryngeal cancer.