Occupational cancer is one of the most important topics in occupational health, because it can be avoided by using appropriate risk management strategies at work. However, due to the lack of suitable surveillance systems in Japan, it goes under-recognized. Burden of disease studies conducted elsewhere can be extrapolated to suggest thousands of deaths are attributable to occupational cancer in Japan. By law, about 20 kinds of cancer have been listed as occupational hazards; among those is asbestos related cancer. In fact, in recent years, thousands of asbestos related cancer cases have been compensated by the government run workers' compensation scheme for occupational accidents and diseases. On the other hand, for the other types of occupational cancer, only few cases are reported. To prevent re-emergence of occupational cancer, such as the recently publicized cholangiocarcinoma epidemics, employees, employers, medical institutions and competent authorities are strongly urged to establish better surveillance systems for occupational cancer.