Cancer prevention literacy in Europe: a cross-sectional study

This study aimed to assess cancer prevention literacy (CPL) levels and awareness of the European Code Against Cancer (ECAC) among the adult population in the European Union (EU), as well as identify social determinants associated with CPL. A cross-sectional study was conducted (February-March 2024) via an online survey across 23 EU-countries (n = 2312). Multivariate logistic regression models examined associations between explanatory variables (age, gender, educational level, history of cancer, region, and digital health literacy [DHL] quartiles) and knowledge outcomes (CPL, ECAC awareness, and cancer prevention specific knowledge topics). Although 81.4% of participants demonstrated sufficient CPL, 61.1% were unaware of the ECAC. Men were less likely to have sufficient CPL than women (OR = 0.66, [0.49-0.89]), and participants with an education below the university level had lower odds of CPL than those with higher education (OR = 0.50, [0.39-0.64]). DHL was the strongest predictor of CPL, with, participants in the highest DHL quartile being more than three times more likely to have sufficient CPL than those in the lowest quartile (OR = 3.11, [2.12-4.67]). Having a personal or family history of cancer also increased the odds of sufficient literacy (OR = 1.47, [1.10-1.94]). The findings reveal that while overall CPL appears sufficient, ECAC awareness remains alarmingly low. Persistent social and gender inequalities exist; lower educational level, male gender, and older age were consistently associated with lower CPL. DHL emerged as a key CPL determinant. Coordinated and targeted interventions are required to address these social inequalities and maximize the ECAC's preventive impact across Europe.