Objective: To compare the incidence of cancer among women with and without a history of pre-eclampsia. Design: Cohort study. Setting: Jerusalem perinatal study of women who delivered in three large hospitals in West Jerusalem during 1964-76. Participants: 37 033 women. Main outcome measures: Age adjusted and multivariable adjusted hazard ratios for cancer incidence for the entire cohort and for women who were primiparous at study entry. Results: Cancer developed in 91 women who had pre-eclampsia and 2204 who did not (hazard ratio 1.27, 95% confidence interval 1.03 to 1.57). The risk of site specific cancers was increased, particularly of the stomach, ovary epithelium, breast, and lung or larynx. The incidence of cancer of the stomach, breast, ovary, kidney, and lung or larynx was increased in primiparous women at study entry who had a history of pre-eclampsia. Conclusions: A history of pre-eclampsia is associated with increases in overall risk of cancer and incidence at several sites. This may be explained by environmental and genetic factors common to the development of pre-eclampsia and cancer in this population.