Wildland firefighters are exposed to wood smoke, which contains hazardous air pollutants, by suppressing thousands of wildfires across the U. S. each year. We estimated the relative risk of lung cancer and cardiovascular disease mortality from existing PM2.5 exposure-response relationships using measured PM4 concentrations from smoke and breathing rates from wildland firefighter field studies across different exposure scenarios. To estimate the relative risk of lung cancer (LC) and cardiovascular disease (CVD) mortality from exposure to PM2.5 from smoke, we used an existing exposure-response (ER) relationship. We estimated the daily dose of wildfire smoke PM2.5 from measured concentrations of PM4, estimated wildland firefighter breathing rates, daily shift duration (hours per day) and frequency of exposure (fire days per year and career duration). Firefighters who worked 49 days per year were exposed to a daily dose of PM4 that ranged from 0.15 mg to 0.74 mg for a 5- and 25-year career, respectively. The daily dose for firefighters working 98 days per year of PM4 ranged from 0.30 mg to 1.49 mg. Across all exposure scenarios (49 and 98 fire days per year) and career durations (5–25 years), we estimated that wildland firefighters were at an increased risk of LC (8 percent to 43 percent) and CVD (16 percent to 30 percent) mortality. This unique approach assessed long term health risks for wildland firefighters and demonstrated that wildland firefighters have an increased risk of lung cancer and cardiovascular disease mortality.