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Mesothelioma is a rare malignancy, primarily caused by exposure to asbestos. The incidence rate of mesothelioma in Taiwan increased steadily in the previous two decades. However, very few of the mesothelioma patients received compensation due to their asbestos-related work. This study aims to examine the status of reported and unreported asbestos-related lung cancer, particularly mesothelioma in Taiwan, and to provide recommendations for improving the surveillance system.The reporting system of occupational diseases initiated by Department of Labours was used to retrieve the cases of occupational lung cancer from 2008 to 2014. Descriptive analysis was conducted including identification of exposure to asbestos. We further compared the data with Taiwan Cancer Registry. A review for international comparison of mesothelioma surveillance system was performed.73 cases of occupational lung cancer were reported, and 42 were suspected to be asbestos-related. 31 cases were confirmed as malignant mesothelioma. Only one of the 42 asbestos-related lung cancer cases was female. Their occupations and industries included construction (36%), work concerning installation and repair of boilers (24%), and shipyard and ship breaking (19%). The year of age at the time of diagnosis is 60.5, while the induction time was 35.2 years. In the same period, 349 mesothelioma cases were identified in the Taiwan Cancer Registry.This study showed that very few mesothelioma patients seek compensation in Taiwan. Further review showed that mesothelioma surveillance system was established in many countries to provide information of mesothelioma epidemic and investigate in asbestos exposure. Some have a specific registry and rely on medical doctor, particularly pathologists, to report. Some directly link the data from the pre-existing cancer registry. In Taiwan, all hospitals were mandated to submit cancer data to the central cancer registry. Improving linkage between mesothelioma surveillance and cancer registry should be considered.