Concentrations of 23 elements in lung, liver and kidney from deceased smelter workers are compared with those from rural and urban controls. The analyses were made by neutron activation analysis and atomic absorption spectrophotometry. Significantly higher levels of antimony, arsenic, cadmium, chromium, cobalt, lanthanum, lead and selenium were found in the smelter workers lungs (n = 85) compared with the rural controls (n = 15). Significantly higher concentrations of antimony, arsenic and lead were observed among all smelter workers compared with urban controls (n = 10). The highest increase, about 11-fold, was found for antimony in smelter workers compared with non-exposed controls. A six-fold increase was noted for arsenic. Workers who died from lung cancer (n = 7) had the lowest lung selenium content relative to concentrations of other metals, both compared with other disease categories among the workers (GI-cancer, other cancers, cardiovascular diseases, cerebrovascular diseases, other causes) and with the two control groups. The low lung selenium concentrations may have influenced the development of lung cancer. The highest lung tissue levels of cadmium were found in the lung cancer group. Smokers and ex-smokers were over-represented in this group and tobacco is a known cadmium source. The highest, or one of the highest, lung values for some of the other metals (antimony, arsenic, cadmium, lanthanum and lead) were observed in one or several of the lung cancer cases. Metal concentrations in liver (metabolism) and kidney (excretion) reflect the systemic distribution. The highest cadmium levels in the liver and the lowest selenium content in the kidney were found among the lung cancer cases. A multifactorial genesis for the development of lung cancer is concluded from this study, which visualizes the need for systematic health surveillance and follow-ups both in active and retired workers.