Objectives: To investigate the effect of sex on the risk of silicosis and to explore any interaction between cigarette smoking and sex in the development of silicosis. Methods: The cohort was selected from eight Chinese pottery factories. Diagnoses of silicosis were based on 1986 Chinese pneumoconiosis Roentgen diagnostic criteria. Data on cigarette smoking were collected by face-to-face interviews in 1989 and 2003. Results: Eight thousand eight hundred and eighty seven dust-exposed workers were included. Men had a 77% higher incidence of silicosis than women. At lower pack-years of smoking, men were 72% more at risk than women. The latency period was found to be longest in female never-smokers and shortest in female ever-smokers. Conclusions: Men had a higher risk of developing silicosis than women. Cigarette smoking increased the risk in both sexes, more so in women.