Introduction. Tobacco use is associated with various types of cancer, as well as other noncommunicable diseases. The impact of tobacco on overall mortality and cause-specific mortality was analyzed in the European EPIC study (European Prospective Investigation into Cancer and Nutrition). Methods. Participants in the EPIC study, most of whom were aged 40 to 65 at enrollment, were recruited between 1993 and 2000 from ten European countries. Cox models were used to quantify the association between tobacco use and various risks of death: overall, from tobacco-related cancers, from cardiovascular disease (CVD), and from respiratory diseases, adjusting for major confounding factors, particularly alcohol consumption. Results. Among the 380,395 subjects included in this study, a total of 26,411 deaths were recorded. Heavy smokers (>26 cigarettes/day) had an overall mortality risk with a hazard ratio (HR) of 2.44 [95% CI: 2.12–2.82] for men and HR = 2.44 [2.06–2.88] for women, compared with non-smokers. Mortality from tobacco-related cancers, respiratory diseases, or CVD was similar. Subjects who had quit smoking had risks similar to those who had never smoked. Among women who consumed alcohol heavily, the risks of death associated with tobacco were significantly higher than among those who consumed little or no alcohol. Conclusion. The mortality rate among current smokers was 1.5 to 3 times higher than that of non-smokers. These results confirm those of previous studies. Benefits were observed among individuals who had quit smoking long ago. (R.A.)