Background. Cigarette smoking is variably associated with the various histological cell types of lung cancer. The primary aim of this study was to analyse various strengths of association between the common histological cell types of lung cancer and smoking in a Western Cape population. The secondary aim examined whether an association exists between scar carcinoma and smoking. Methods. We retrospectively analysed the records from 386 patients over a 2-year period. Both smokers and non-smokers were subdivided and analysed as two groups, which included those with non-small cell and small cell lung cancer. Smokers and non-smokers were also analysed separately according to the presence or absence of lung scarring. Results. In total, 94.3% of all patients with lung cancer were current or past smokers. There was a disproportionately higher number of patients with adenocarcinoma who were non-smokers compared with all the other cell types (p=0.01), whereas patients with squamous cell carcinoma were more likely to be smokers (p=0.05). Although the vast majority of patients with and without lung scars were found to be smokers (96.4% v. 93.7% respectively), there was no statistically significant difference found between these two groups (p=0.43). Conclusion. In a Western Cape population, patients with adenocarcinoma were more likely to be non-smokers, while those with squamous cell carcinoma were relatively more likely to be smokers. No clear association between scar carcinoma and smoking status was found.