Background: Cancer remains a leading contributor to the global burden of disease, and primary prevention represents the most cost-effective strategy for cancer control. In China, the National Cancer Center has developed the China Code Against Cancer, which outlines 15 evidence-based recommendations tailored to the Chinese population. To support population-level implementation, a standardized questionnaire assessing core knowledge of primary cancer prevention was developed. However, empirical evidence on current levels of cancer prevention knowledge in China and its relationship with lifestyle behaviors remains limited.
Objectives: To assess the level of primary cancer prevention knowledge and examine its association with lifestyle behaviors among Chinese adults.
Methods: A cross-sectional study using cluster sampling was conducted between April and September 2025 among residents from four communities and three institutions in Jiangbei District, Chongqing, China. Data was collected using the Smart Health Management Digital Platform for Primary Cancer Prevention (SmartHMDP-PCP). Personal exposure profiles were collected through a 17-module questionnaire covering sociodemographic characteristics, lifestyle behaviors, infections and vaccination uptake, and personal and family disease history. Primary cancer prevention knowledge was assessed using a standardized 34-item questionnaire (total score: 59 total points). A correct response rate ≥ 80% (≥47.2) was defined as passing. Scores were further analyzed across 10 domains, classifying participants as full-scored or non-full-scored within each domain. Logistic regression model was used to evaluate associations between knowledge passing and lifestyle behaviors, with results reported as odds ratios (ORs) with 95% confidence intervals (CIs).
Results: A total of 1,603 participants were enrolled, of whom 1,471 completed the knowledge assessment. The mean age was 40.91 years old, and 64.58% were female. The mean and median knowledge scores were 45.44 and 48.50, respectively, with only 55.34% of participants achieving a correct rate ≥ 80%. Higher knowledge awareness was observed among participants aged <50 years, females, those with higher education, higher subjective socioeconomic status, annual family income ≥100,000 yuan, and those who were employed. The lowest full-score rates were observed in the domains of diet, air pollution, and infection, whereas occupation-related factors, physical activity, and alcohol consumption were the best-answered domains. Higher knowledge passing was positively associated with sweetened food intake ≥1 time/week (OR, 95%CI: 1.53 1.17-2.01), HPV vaccination (1.46, 1.08-1.96), and HBV vaccination (1.69, 1.23-2.32), and marginally associated with vegetable intake ≥200 g/day (1.37, 0.99-1.91). Processed food intake was negatively associated with knowledge passing (0.72, 0.55-0.93). No other significant associations were observed.
Conclusions: Awareness of primary cancer prevention knowledge remains suboptimal in this population, particularly in domains that are central to population-level cancer prevention, such as diet, air pollution, and infection. The weak and inconsistent associations between knowledge awareness and lifestyle behaviors suggest that knowledge alone may be insufficient to drive behavior change. These findings highlight the need for integrated, action-oriented cancer prevention strategies that translate scientific knowledge into effective and equitable public health interventions. Large, nationally representative studies using this standardized assessment tool are warranted to support evidence-based implementation of primary cancer prevention and to inform monitoring and evaluation under China’s national cancer control agenda.