Background: Effective cancer prevention depends on the translation of scientific evidence into equitable, system-level public health action, particularly in low- and middle-income countries (LMICs), where the cancer burden is rising rapidly. Many cancer-related risk behaviors are established during adolescence, yet cancer prevention remains insufficiently integrated into school health policies. In Brazil, the national Programa Saúde na Escola (PSE) and recent cancer control legislation create a strategic policy window for embedding cancer literacy within public systems. However, implementation-focused evidence demonstrating feasibility, impact, and scalability of such interventions is limited.
Objectives: To evaluate the effectiveness of a school-based cancer education intervention (Oncoeducação) as an implementation strategy for cancer prevention and to generate policy-relevant evidence supporting its integration into national school health and cancer control frameworks in an LMIC context.
Methods: We conducted a quasi-experimental, longitudinal implementation study between March 2024 and July 2025 in public middle schools in Belo Horizonte, Brazil. Eighth-grade students participated in a structured, in-person educational intervention addressing cancer biology, modifiable and non-modifiable risk factors, prevention, early detection, treatment modalities, and patients’ rights within the Brazilian Unified Health System (SUS). Specific content included legally established timelines for cancer care, as well as guidance on navigation across primary, secondary, and specialized SUS services following suspicion of cancer. The intervention was implemented in partnership with municipal education authorities, using a standardized, low-cost, two-hour format designed for replication and scalability across public schools. Structured questionnaires assessed cognitive, attitudinal, and behavioral outcomes at baseline, immediately post-intervention, and six months later. Analyses included descriptive statistics and chi-square tests with Bonferroni correction.
?Results: A total of 479 students completed the baseline assessment, 453 the immediate post-test, and 420 the six-month follow-up. The intervention led to significant improvements in knowledge of cancer concepts and risk factors (p<0.001), with partial retention at six months. Gains were most pronounced for modifiable risk factors, including alcohol consumption, overweight, physical inactivity, unhealthy diet, unprotected sun exposure, HPC vaccine, unsafe sexual practices, and concepts of screening and early detection. Importantly, awareness of patients’ rights within the SUS increased, particularly regarding legally mandated timeframes from cancer suspicion to diagnostic confirmation and from diagnosis to first treatment. Understanding of care pathways across SUS units for screening and suspected cancer also improved, reflected by a marked reduction in “don’t know” responses. At six months, 68.5% of participants reported adopting at least one healthier behavior, and over half reported sharing cancer-related information with family or peers.
Conclusions/Implications: This study provides implementation-oriented evidence that school-based cancer education can effectively translate prevention research into sustainable public health action in an LMIC setting. By embedding a low-cost, standardized intervention within existing public programs and aligning content with national cancer control policies, Oncoeducação strengthens the science-policy interface and supports scalability within education and health systems. The findings highlight adolescents as agents of cancer prevention and health advocacy, contributing to equity, capacity-building, and long-term cancer control. The partial decline in knowledge observed at follow-up indicates that periodic refresher training sessions may be needed to sustain knowledge retention over time.