Open Access Open Badges Research article

Increased cancer awareness among British adolescents after a school-based educational intervention: a controlled before-and-after study with 6-month follow-up

Richard G Kyle1*, Liz Forbat1, Petra Rauchhaus2 and Gill Hubbard1

Author Affiliations

1 Cancer Care Research Centre, School of Nursing, Midwifery and Health, University of Stirling, FK9 4LA, Stirling, UK

2 College of Medicine, Dentistry and Nursing, University of Dundee, DD1 5EH, Dundee, UK

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BMC Public Health 2013, 13:190  doi:10.1186/1471-2458-13-190

Published: 4 March 2013



There is a lack of evidence around the effectiveness of school-based interventions designed to raise adolescents’ cancer awareness. To address this deficit this study assessed the impact of an intervention delivered in the United Kingdom by Teenage Cancer Trust on: recall (open question) and recognition (closed question) of cancer warning signs; knowledge of common childhood, teenage, male and female cancers; awareness of the relationship between cancer and age; anticipated medical help-seeking delay; perceived barriers to seeking medical advice about cancer; and examined variation of intervention effect by gender and whether adolescents reported that they knew someone with cancer.


The Cancer Awareness Measure (CAM) was completed by 422 adolescents (male: 221, 52.4%) aged 11-17 years old (mean age=13.8, standard deviation=1.26) two weeks before and two weeks after the intervention in three schools, and on two occasions four weeks apart in a fourth (control) school. Intervention schools were followed-up 6-months post-intervention.


Recognition of nine common cancer warning signs significantly increased two weeks after the intervention (4.6 to 6.8, p<0.001) and was maintained at 6-month follow-up (6.2, p<0.001). Endorsement of emotional barriers to help-seeking ‘not confident to talk about symptoms’ (53% to 45%, p=0.021) and ‘worried about what the doctor might find’ (70% to 63%, p=0.021) significantly decreased two weeks after the intervention but changes were not maintained at 6-months. The intervention had a greater impact on females and those who knew someone with cancer.


The intervention is an effective way to raise adolescents’ cancer awareness, especially of cancer symptoms. Further development and evaluation is required to maximise intervention impact, particularly on barriers to help-seeking behaviour.