Interest in the role of the insulin‐like growth factor (IGF) axis in growth control and carcinogenesis has recently been increased by the finding of elevated serum insulin‐like growth factor I (IGF‐I) levels in association with three of the most prevalent cancers in the United States: prostate cancer, colorectal cancer, and lung cancer. IGFs serve as endocrine, autocrine, and paracrine stimulators of mitogenesis, survival, and cellular transformation. These actions are mediated through the type 1 IGF‐receptor (IGF‐1R), a tyrosine kinase that resembles the insulin receptor. The availability of free IGF for interaction with the IGF‐1R is modulated by the insulin‐like growth factor‐binding proteins (IGFBPs). IGFBPs, especially IGFBP‐3, also have IGF‐independent effects on cell growth. IGF‐independent growth inhibition by IGFBP‐3 is believed to occur through IGFBP‐3‐specific cell surface association proteins or receptors and involves nuclear translocation. IGFBP‐3‐mediated apoptosis is controlled by numerous cell cycle regulators in both normal and disease processes. IGFBP activity is also regulated by IGFBP proteases, which affect the relative affinities of IGFBPs, IGFs and IGF‐1R. Perturbations in each level of the IGF axis have been implicated in cancer formation and progression in various cell types. J. Cell. Physiol. 183:1–9, 2000. © 2000 Wiley‐Liss, Inc.