In a controlled psychological autopsy study of suicide in late life, eight cases in which the victim's belief that he had cancer played a major role in the decision to end his life were examined. All victims were men. The majority had diagnosable major affective disorders, but none had been seen in mental health care settings. Other common characteristics were an active relationship with a primary physician, numerous losses, prior experience with cancer or debilitating disease, and a rigid, self-sufficient personality style. The cases illustrate the complex determinants of suicidal behavior in the elderly and suggest preventive strategies for the primary care setting.