A population-based case-control study was used to evaluate the relationship between cases of bladder cancer (n = 61), kidney cancer (n = 35), and leukemia (n = 34) and exposure to tetrachloroethylene from public drinking water. Subjects were exposed to tetrachloroethylene when it leached from the plastic lining of drinking water distribution pipes. Relative delivered dose of tetrachloroethylene was estimated, using an algorithm that accounted for (1) residential history and duration, (2) whether lined pipe served the neighborhood, (3) distribution system flow characteristics, and (4) pipe age and dimensions. Whether or not latency was considered, an elevated relative risk of leukemia was observed among ever exposed subjects (adjusted OR = 1.96, 95% CI = 0.71-5.37, with latency; adjusted OR = 2.13, 95% CI = 0.88-5.19, without latency) that increased further among subjects whose exposure level was over the 90th percentile (adjusted OR = 5.84, 95% CI = 1.37-24.91, with latency; adjusted OR = 8.33, 95% CI = 1.53-45.29, without latency). When latency was ignored, there was also an increased relative risk of bladder cancer among subjects whose exposure level was over the 90th percentile (adjusted OR = 4.03, 95% CI = 0.65-25.10). Given that tetrachloroethylene is a common environmental and workplace contaminant in the United States, its carcinogenic potential is a matter of public health concern.