Little is known about the relative importance of different causes of death in driving the evolution of senescence and longevity across species. Here we argue that cause-specific mortality may be shaped by physiological trade-offs between mortality components, challenging the theoretical view that physiologically independent processes should senesce at the same rate, or that interactions between causes of death will make selection blind to the effects of specific causes of death. We review the evidence that risk of cancers trades off with risks of mortality from other diseases, and investigate whether this might explain two of the most puzzling paradoxes in cancer evolution. First, among species, cancer prevalence is not a function of species’ size and longevity, despite the fact that cancer incidence is known to be a function of the number of cell divisions (and therefore of size) by unit of time (and therefore of longevity). Second, within species, despite the fact that genomic instability is thought to be the proximal cause of both cancer incidence and senescence, mortality rates rise with age while cancer incidence decelerates and declines at old ages. Building on a relatively novel theory from cellular biology, we construct a preliminary model to reveal the degree to which accumulation of senescent cells with age could explain this latter paradox. Diverting damaged stem cells towards a senescent-state reduces their risk of becoming tumorous; however, conversely, the accumulation of senescent cells in tissues compromises their rejuvenation capacity and functioning, leading to organismal senescence. Accumulation of senescent cells with age may then be optimal because it reduces cancer mortality at the cost of faster senescence from other causes. Evolution will drive species towards a balance between these two sources of mortality.