Background
It is estimated that around 40% of cancer cases in the EU could be prevented by reducing exposure to known risk factors and implementing effective prevention strategies. The European Code Against Cancer (ECAC) provides evidence-based recommendations for reducing cancer risks and aims to raise awareness of modifiable risk factors among the general public. Europe’s Beating Cancer Plan sets a target for 80% of Europeans to be aware of the ECAC by 2025. However, awareness levels in Sweden have not been studied.

Objectives
The overall objective of this study was to examine the awareness of and attitudes towards the ECAC among the general public in Sweden. The study also aimed to investigate attitudes towards cancer prevention in general among this population, as well as to examine possible differences between population groups.

Methods
This cross-sectional study is part of the Joint Action Prevent Non-Communicable Diseases and Cancer (EU JA Prevent NCD). A survey was conducted in April 2024 using a study-specific online questionnaire distributed to a randomly selected sample of 1,520 adults (aged 18–84) recruited from a national survey panel in Sweden. The questionnaire included general questions regarding cancer prevention as well as awareness and attitudes specific to the ECAC. Data were analysed univariately and with adjusted logistic regression, applying post-stratification weights based on gender, age, education level, and political orientation.

Results
In total, 3.7% of respondents had heard of the ECAC before taking the survey. Awareness was higher among those with college/university education (odds ratio [OR] 2.23; 95% Confidence Interval [CI] 1.23–4.06) and lower among males (OR 0.56; 95% CI 0.32–0.99) and individuals living alone (OR 0.47; 95% CI 0.23–0.95). After reading the ECAC, 58.6% of the respondents reported that they learned something new about cancer prevention and 60.6% agreed with the ECAC recommendations. Motivation to improve lifestyle increased for 27.4% of the respondents after having read the ECAC, with higher motivation among those with college/university education (OR 1.34; 95% CI 1.01–1.78) and lower among older participants (OR 0.99 per year; 95% CI 0.98–1.00). Only 16.3% of the respondents reported having previously changed their lifestyle due to cancer prevention information, and 29.2% intended to make changes to reduce their cancer risk.

Conclusions
Awareness of the ECAC among the Swedish general population is very low, despite broad agreements with its recommendations. Findings from this study indicate that while the ECAC motivates some individuals to adopt healthier lifestyle habits, its overall impact on behaviour change remains limited. These results emphasize the need for strengthened cancer prevention communication strategies tailored to diverse population groups, combined with comprehensive societal interventions. Consequently, further research is warranted on how the ECAC best could and should be used to improve cancer prevention awareness and motivation.
 
This document is part of a project that has received funding from the European Union’s EU4Health programme under grant agreement No 101128032. The information reflects only the authors´ view and the European Commission is not responsible for any use that may be made of the information it contains.

 
DOI: 10.1186/s12889-025-22803-3