Objective: The aim of the study was comparison of cancer incidence risk of lungs, stomach, colon, bladder and kidneys from ex-miners of black coal mines and the general male population of the Czech Republic. Materials and methods: The analysis was conducted in two cohorts of ex-miners according to the presence of coalworkers’ pneumoconiosis (CWP). The first cohort included the miners without CWP (N = 6705), and the second cohort included the miners who were compensated for CWP (N = 2158). Personal and occupational data was merged with the data in the National Population Register and the National Oncological Register for the period from 1992 to 2006. Cancer risk in miners in comparison to the general male population of the Czech Republic was evaluated by SIR (Standardized Incidence Ratio) and 95% confidence interval (CI). Results: About twice as high risk of lung cancer was found in miners with CWP (SIR = 2.21; 95% CI: 1.75–2.76). Lung cancer risk correlated with the severity of CWP (simple CWP SIR=1.96; 95% CI: 1.48–2.56, progressive massive fibrosis SIR = 4.29; 95% CI: 2.09–7.87). No increased risk of lung cancer was found in ex-miners without CWP. The risk of malignant neoplasm at the other selected sites was comparable with the risk in the general male population of the Czech Republic. Conclusions: This study found increased lung cancer risk in coal miners with CWP, but not in those without CWP, comparing with the general population. These results served as the basis for the inclusion of lung cancer in association with CWP into a new Czech list of occupational diseases.