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Background: In 1978, asbestos-related occupational cancers were added to the Spanish list of
occupational diseases. However, there are no full accounts of compensated cases since their inclusion.
Objective: To analyze the cases of asbestos-related cancer recognized as occupational in Spain between
1978 and 2011.

Methods: Cases were obtained from the Spanish Employment Ministry. Specific incidence rates by year,
economic activity, and occupation were obtained. We compared mortality rates of mesothelioma and
bronchus and lung cancer mortality in Spain and the European Union.

Results: Between 1978 and 2011, 164 asbestos-related occupational cancers were recognized in Spain,
with a mean annual rate of 0.08 per 105 employees (0.13 in males, 0.002 in females). Under-recognition
rates were an estimated 93.6% (males) and 99.7% (females) for pleural mesothelioma and 98.8% (males)
and 100% (females) for bronchus and lung cancer. In Europe for the year 2000, asbestos-related
occupational cancer rates ranged from 0.04 per 105 employees in Spain to 7.32 per 105 employees in
Norway.

Conclusions: These findings provide evidence of gross under-recognition of asbestos-related occupational
cancers in Spain. Future work should investigate cases treated in the National Healthcare System to better
establish the impact of asbestos on health in Spain.