Current US guidelines for the management of latent tuberculosis infection in cancer patients are based on studies from 1970s, yet much about cancer care has changed in the interim. In a review of our experience during the past 25 years, we found that incidence of tuberculosis varied significantly according to country of birth and cancer type. Foreign-born patients with underlying hematologic neoplasm had a tuberculosis rate 50-100 times higher than US-born patients, whereas US-born patients with an underlying solid tumor had the same tuberculosis rate as US-born persons without cancer. These findings may help guide the management of latent tuberculosis infection in persons with cancer.