The cancer mortality experience of 2649 Swedish grain millers was followed during the period from 1961 to 1979. Although the overall cancer incidence was not elevated, the risk of primary liver cancer was significantly elevated for this group (standard incidence ratio ‐ 238). The Swedish data is compared to the cancer mortality experience of workers in the Netherlands and the United States who are also involved in the bulk handling and storage of agricultural foodstuffs (e.g., peanuts, grains). The varying occupational exposures in this international comparison help establish etiologic hypotheses in the absence of comprehensive exposure information. Agents of potential concern include metabolic products of fungal contaminants (e.g., aflatoxins) and pesticides used to protect grain from insect infestation.