Background
Primary cancer prevention has long been emphasized in global cancer control strategies but remains weakly integrated into routine primary care in China. Evidence on whether and how it can be initiated and sustained in real-world community settings is scarce.
 
Objectives
To examine the feasibility of implementing primary cancer prevention in Chinese community settings and to identify key implementation pathways and system-level constraints relevant to scale-up under routine primary care conditions.
 
Methods
A mixed-methods pilot study was conducted in four communities in Chongqing, China. Adults aged ≥18 years were enrolled in a community-based primary cancer prevention program supported by a WeChat-based digital platform between April and September 2025. Quantitative data on cancer-related lifestyle behaviors were collected at baseline and at a 3-month follow-up through the platform. Semi-structured interviews were conducted with community residents at baseline (n=10) and follow-up (n=13), and with project staff at follow-up (n=10). Qualitative data were analyzed using framework analysis and interpreted using the RE-AIM framework.
 
Results
Reach: Of 1,603 enrolled participants, 943 (58.8%) completed both baseline and follow-up assessments. Baseline data revealed a high prevalence of modifiable cancer risk behaviors, including insufficient dietary fiber intake (94%), inadequate fruit (81%) and vegetable (89%) consumption, and insufficient physical activity (81%), indicating substantial unmet prevention needs at the community levele.
 
Effectiveness: At follow-up, significant improvements were observed in selected behaviors, including reduced alcohol consumption, decreased intake of high-temperature beverages, sweets, and fried foods, as well as increased uptake of hepatitis B and human papillomavirus (HPV) vaccination (all P<0.05). Changes in several diet-related behaviors were modest.
 
Adoption: Qualitative findings indicated that primary cancer prevention activities were acceptable and could be adopted within existing community health service structures, particularly when integrated into familiar primary care and chronic disease management workflows.
 
Implementation: Participation was facilitated by trust in authoritative public health information and by digital cancer risk assessment acting as a trigger for initial behavior change. However, participants reported limited translation of general recommendations into context-specific actions.
 
Maintenance: Sustained behavior change and program continuation were challenged by culturally embedded lifestyle habits, work-related time constraints, and limited follow-up support. From a provider perspective, staff highlighted that long-term maintenance and scale-up were constrained by insufficient institutional mandates, competing service priorities, and a lack of dedicated workforce capacity.
 
Conclusions
Aligned with the strategic goals of Healthy China 2030 and the WHO National Cancer Control Programme (NCCP) framework, this study provides early real-world evidence that primary cancer prevention is feasible in Chinese community settings, but sustainability depends on system-level integration. Scaling up primary cancer prevention in China will require embedding prevention activities into routine primary care workflows, strengthening institutional incentives and workforce capacity, and deploying implementation strategies that translate evidence-based recommendations into practical, context-specific actions.