The association between X-ray exposure in utero and child hood cancer was studied in a case-control study, nested in a national cohort of Swedish twin births. Records of the Swedish Twin Register for those born 1936-1967 (n = 83,316) were linked to the Swedish Cancer Register (1958-1983) and the Swedish Cause-of-Death Register (1952-1983). Ninety-five cases of childhood cancer before the age of 16 were identified. Two controls from the Twin Register were matched to each case by sex and year of birth. Maternal X-rays during preg nancy were documented for 41% of the cases and 36% of the controls. The crude relative risk of any childhood cancer associated with any prenatal X-ray was 1.2 (95% CI; 0.7-2.1). For the cases 64% of the X-rayed women had had abdominal X-rays, the numbers for the controls were 57%. Fifty-nine per cent of the X-rayed women had had abdominal X-rays, which were associated with a relative risk for all cancers of 1.4 (Cl; 0.8-2.5), leukemias I.7(CI; 0.7-4.1) and tumors of the central nervous system 1.5 (Cl; 0.5-4.2). There was no apparent confounding by mother's age, drug use, obstetric complications, previous miscarriages, social class or length of pregnancy. The observed relative risks of cancer following prenatal X-ray ex posure are consistent with previous studies, suggesting that the developing fetus may be more sensitive to the carcinogenic effects of ionizing radiation than are children irradiated post-natally.