Background We conducted a nested case-control study in a cohort of European asphalt workers in which we have previously reported an increase in lung cancer risk among workers exposed to airborne bitumen fume, although potential bias and confounding were not fully addressed. Objective To investigate the contribution of exposure to bitumen, other occupational agents, and tobacco smoking, to the lung cancer risk of asphalt workers. Methods Cases were cohort members in Denmark, Finland, France, Germany, the Netherlands, Norway, and Israel who died from lung cancer between 1980 and the end of follow-up (2002-2005). Controls were individually matched to cases (3:1) on year of birth and country. Exposure estimates were derived for bitumen fume and condensate, organic vapour, PAH, as well as for asbestos, crystalline silica, diesel motor exhaust and coal tar. Odds ratios (OR) were calculated for ever exposure, duration, average and cumulative exposure, after adjusting for tobacco smoking and exposure to coal tar. Results A total of 433 cases and 1253 controls were included in the analysis. The OR for inhalation exposure to bitumen fume was 1.12 (95% CI 0.84-1.49), and for dermal exposure to bitumen condensate 1.17 (95% CI 0.88-1.56). There was no significant trend between lung cancer risk and duration, average or cumulative exposure to bitumen fume or condensate. Conclusions We found no consistent evidence of an association between indicators of either inhalation or dermal exposure to bitumen and lung cancer risk. A sizable proportion of the excess mortality from lung cancer relative to the general population observed in the earlier cohort phase is likely attributable to high tobacco consumption, and possibly to coal tar exposure, while other occupational agents do not appear to play an important role.