Awareness campaigns are effective measures to educate and improve health literacy and can be integrated into broader cancer prevention, diagnosis and care strategies. Their universal applicability lies in their flexibility to adapt to different health system needs and national priorities. To achieve meaningful impact, several enabling conditions are essential:
Without these foundations, awareness campaigns may struggle to achieve broad impact or long-term sustainability. Notably, limitations in financial and human resources can greatly obstruct effective implementation and expansion. Ongoing evaluation is crucial to determine whether campaigns are successfully reaching their intended target populations. |
Raising awareness through public campaigns
Low health literacy is linked to increased challenges in understanding and navigating cancer-related information, as well as to a lower quality of life and less positive care experiences (Holden et al., 2021). Cancer awareness and educational campaigns serve as crucial tools in public health strategies, aiming to enhance knowledge, influence health behaviours and promote preventive measures. Evidence suggests that such campaigns are effective in
- raising awareness (e.g., breast cancer awareness campaigns in Canada that effectively increased knowledge and awareness among young women; Larsen, 2022),
- increasing early diagnoses (e.g., an increase in breast cancer diagnosis in the US associated with the implementation of National Breast Cancer Awareness Month; Jacobsen & Jacobsen, 2011), and
- reducing barriers to care (e.g., by encouraging timely consultations with general practitioners; Saab et al., 2021).
Several cross-border organizations or associations in Europe, like the European Code Against Cancer or Cancer Prevention Europe, have become key vehicles for communicating primary and secondary prevention. Further, Europe’s Beating Cancer Plan (EBCP) explicitly aims to raise awareness and address key risk factors of cancer (European Commission, 2021). Public awareness and education are thus key strategies for enhancing prevention efforts and improving health literacy. Consequently, individual countries also launch their own specifically targeted awareness/educational campaigns, as seen in Portugal, Malta and the Netherlands (see Box 1), to address country-specific issues regarding:
- High cancer burden
- Lack of early detection
- Poor care coordination, patient access and navigation
- Awareness and education deficits
- Policy/structural barriers
Box 1: Summary of different use of awareness campaigns Malta: Malta’s cancer care system previously suffered from fragmentation and delays across the care continuum, particularly between referral and treatment. Furthermore, patients frequently expressed facing difficulties navigating the system. As a result, the Directorate for Cancer Care Pathways (DCCP) was established in 2014 to streamline cancer services and promote coordination. Key interventions include: a Research Unit to foster innovation; a fast-track e-referral system for general practitioners; nurse navigation and nurse-led clinics; and expanded ambulatory services. Additionally, the DCCP has embedded health promotion into its programming, leveraging the annual national “Pink Oct-Movember” campaign to deliver educational content via broadcast media and school outreach. Portugal: As a result to high incidence and mortality rates from gastric cancer, Portugal has piloted an innovative, population-based screening initiative. This programme targets Helicobacter pylori (H. pylori) infections, a known major risk factor for gastric cancer. Launched by the National Cancer Hub of Portugal (NCH-PT) on Terceira Island in the Azores, this initiative employs a person-centred approach via local pharmacies. Adults aged 18 and above receive free stool sample kits and return them for testing. Positive cases are further referred for medical follow-up and antibiotic treatment. The pilot aims to estimate the prevalence of asymptomatic H. pylori infections and to evaluate the feasibility of scaling the program nationally. To raise awareness, literacy and communication, the initiative was also featured in mass media, including social media, TV and newspapers. This has yielded positive results, as evidenced by high participation levels (with 1,800 kits distributed and 1,500 returned within four months). The Netherlands: Cancer of unknown primary (CUP) is recognized as one of the deadliest forms of cancer in the Netherlands, with patients having had no access to genomic sequencing diagnostics for this condition. As a result, the patient advocacy group “Missie Tumor Onbekend” initiated systematic awareness and advocacy activities between 2020 and 2021. Their outreach targeted healthcare providers, diagnostic firms, insurers and policymakers. Using data from the national cancer registry, they presented a robust business case illustrating CUP-related mortality, healthcare usage and the cost-effectiveness of molecular diagnostics. Their efforts directly contributed to policy shifts, culminating in the approval and reimbursement of whole-genome sequencing for CUP patients in specialized clinics. These developments mark a significant step toward personalized medicine and improved outcomes for this underserved patient group. |
Using converging strategies in diverging measures
The cases of Portugal, Malta and the Netherlands illustrate how public awareness campaigns can be effectively aligned with country-specific health system objectives, each touching on key WHO building blocks (2007): Portugal focuses on prevention and early detection (Service delivery), Malta on streamlining care pathways (Service delivery) and the Netherlands on enhancing diagnosis (Medical products) and treatment access (Access). Despite these differing priorities, all three initiatives share a common emphasis on raising public awareness, through mass media outreach (Portugal, Malta), national campaigns (Malta) and advocacy efforts (the Netherlands), and they demonstrate how to successfully include different stakeholders, such as politicians, the educational sector and media (Governance).
However, notable distinctions emerge across the cases, illustrating varied service delivery approaches. Firstly, the initiatives target different cancer types and population groups: These spread from asymptomatic adults (Portugal) to cancer patients (Malta and the Netherlands), to school children (Malta). Secondly, they operate at varying scales: from regional pilots (Portugal) to nationwide strategies (Malta and the Netherlands). Thirdly, they employ different leadership models: While Portugal and Malta pursued top-down approaches, led by public health institutions and government agencies, the Netherlands exemplifies a bottom-up model, with a patient advocacy group catalyzing change through evidence-based lobbying and stakeholder mobilization. These differences underscore the flexibility of awareness campaigns as tools that can be adapted to diverse national contexts, healthcare challenges and institutional structures, while engaging with multiple building blocks to strengthen overall health system performance.
Awareness campaigns thrive with policy support, funding and stakeholder collaboration
In all three cases, awareness and educational campaigns served as complementary instruments within broader cancer control strategies. Their successful implementation was dependent on the presence of supportive institutional, financial and policy environments. In Malta, the availability of government funding (Financing), alongside established policies and standard operating procedures (Governance), provided a strong foundation for the development of coordinated cancer care initiatives. Similarly, Portugal’s efforts were reinforced by the inclusion of gastric cancer screening in the European Commission’s recommendations, lending both legitimacy and strategic alignment to its pilot program (Governance).
A key enabling factor across contexts was the involvement and coordination of diverse stakeholders. This was particularly evident in the Netherlands, where the patient advocacy-led initiative drew heavily on national cancer registry data (Information) and benefitted from collaborative efforts in the development of national protocols and guidelines (Governance) for molecular diagnostics. These alliances not only strengthened the campaigns’ evidence base but also enhanced their influence on policy and practice.
Resource constraints as common implementation barriers
Across both national and local initiatives, a key challenge was ensuring sufficient resources to move from concept to implementation (regarding both the awareness campaign and the primary intervention it supports). In Portugal and the Netherlands, initial funding limitations (Financing) required project leaders to mobilize support from multiple sources to sustain their efforts. Meanwhile, Malta and the Netherlands experienced health workforce shortages (Workforce), which posed significant obstacles to scaling up services and maintaining continuity of care. These barriers underscore the need for not only strategic planning and stakeholder engagement, but also sustainable financing and adequate human resource capacity to translate awareness campaigns (and the measures they refer to) into effective action.
Harnessing awareness campaigns as versatile tools in cancer control
The experiences of Portugal, Malta and the Netherlands demonstrate how awareness campaigns can be effectively embedded within broader strategies to enhance cancer prevention, diagnosis and care. While each country pursued distinct goals, ranging from early detection to improved care coordination and access to diagnostics, all three initiatives used public awareness as a key lever to address structural or service delivery gaps. These diverse approaches underscore the adaptability of awareness campaigns and their capacity to adapt to various health system contexts, policy settings and population needs. Public engagement and media involvement proved to be valuable assets, as reflected in Portugal’s high distribution of kits at the start of its pilot. Malta’s use of Awareness Month, promoted through schools and mass media, can be seen as capable tools to effectively expand public understanding, while early health literacy education emerges as a promising strategy to address low literacy and reduce access barriers from a young age. The Netherlands’ case study exemplifies how information and awareness can drive change not just through top-down education, but also through grassroots advocacy that actively influences health policy and system-level decisions. The successful campaign, which led to the approval and reimbursement of whole-genome sequencing for CUP patients, serves as a compelling model for other patient advocacy groups seeking to influence systemic change and to advance equitable access to innovative diagnostics and personalized care.
However, the success of these campaigns depends on adequate resources, including funding and workforce capacity. Additionally, robust evaluation mechanisms are useful to measure impact and guide future improvements.
References
European Commission. (2021). Europe’s Beating Cancer Plan – Communication from the Commission to the European Parliament and the Council.
Holden, C. E. , Wheelwright S., Harle A., Wagland R. (2021) The role of health literacy in cancer care: A mixed studies systematic review. PLoS ONE 16(11): e0259815. https://doi.org/10.1371/journal.pone.0259815
Jacobsen, G. D., & Jacobsen, K. H. (2011). Health awareness campaigns and diagnosis rates: evidence from National Breast Cancer Awareness Month. Journal of health economics 30(1), 55–61.
Larsen, L. (2022). “I think it is a powerful campaign and does a great job of raising awareness in young women”: Findings from Breast Cancer Awareness campaigns targeting young women in Canada. Canadian Oncology nursing Journal 32(1), 61.
Saab, M. M., FitzGerald, S., Noonan, B., Kilty, C., Collins, A., Lyng, Á., ... & Hegarty, J. (2021). Promoting lung cancer awareness, help-seeking and early detection: A systematic review of interventions. Health promotion international 36(6), 1656–1671.
World Health Organization (2007). Everybody business: Strengthening health systems to improve health outcomes – WHO’s framework for action. 2007;44.
For further information please visit
Cancer Prevention Europe: https://cancerpreventioneurope.iarc.fr
European Code Against Cancer: https://cancer-code-europe.iarc.fr/index.php/en
Missie Tumor Onbekend: www.missietumoronbekend.nl
Malta’s cancer care pathways: https://health.gov.mt/public-bodies/cancer-care-pathways
