Using data on death certificates, we examined age-adjusted cancer mortality rates for West Virginia men and women from 1980-1994. The leading causes of cancer deaths among men in the state in 1994 were cancers of the lung, prostate, colon, and pancreas, and non-Hodgkin's lymphoma. Among West Virginia women in 1994, cancer deaths were most often due to cancers of the lung, breast, colon, pancreas, and ovary. Based on polynomial regression analyses, many of the leading cancer mortality rates significantly increased during 1980-1994. The most striking increase was a 76% rise in lung cancer mortality among West Virginia women. These mortality data underscore the continuing need for tobacco control and other cancer control practices. Even though barriers to medical care challenge the state's health care professionals, the burden of cancer in West Virginia can be reduced by prevention, early detection, and appropriate treatment.