Establishing healthy habits during adolescence is crucial for preserving good health into adulthood. Some researchers have pointed out that high school and university students often have limited knowledge about cancer risk factors. Understanding these risk factors provides an opportunity to avoid them, thereby reducing the risk of developing cancer. In Poland, there is a lack of research on the attitudes and awareness of cancer risk factors and prevention among high school students. Only the study by Rucińska et al. and Moskal et al. assessed students’ knowledge in this area, although it focused only on a few selected aspects [9, 10].

According to the annual report of the National Cancer Registry, cancers were the second cause of death in Poland, accounting for 18.8% of deaths among men and 17.2% among women. Malignant tumors represent a significant health issue, particularly among young and middle-aged individuals (aged 15–64). The most prevalent male cancer is prostate cancer, followed by lung cancer. Nevertheless, for the last 20 years, we have witnessed a reduced incidence of lung cancer among the male population—new cases among men have decreased by 22% since 2000, which is directly associated with a reduced number of smokers. In the female population, the most common cancer is breast cancer, followed by lung and colorectal malignancies [11].

In the present study, we conducted a cancer education class for high school students and assessed the changes in their awareness and knowledge about cancer. Our findings revealed significant improvements following the educational project. Participants identified various risk factors contributing to cancer development, including behavioral, physiological, and environmental aspects. They acknowledged individual risks such as sun exposure, smoking or tobacco use, diet, alcohol consumption, and drug use as contributors to cancer. However, some participants admitted to lacking knowledge about cancer prevention. According to the World Health Organization (WHO), approximately 30–50% of cancer deaths could be prevented by avoiding major risk factors, coupled with early detection and diagnosis. Awareness of cancer signs and symptoms plays a crucial role in reducing mortality by enabling early diagnosis and treatment. Educational interventions targeting adolescents can enhance their understanding of cancer prevention and potentially lead to long-term benefits, including improved survival rates [12, 13].

Tobacco smoking is a significant risk factor for developing various cancer types, including lung cancer. It is estimated that 80–90% of lung cancer cases are associated with cigarettes [14, 15]. In the context of lung cancer, our seminar sessions and further survey questions focused on risk factors (especially cigarette smoking), symptoms, and early detection. In our observation during seminars, students were aware of the influence of smoking on lung or pharynx malignancies; however, they were somewhat surprised about the influence of tobacco on other cancers (such as cervical or pancreatic cancers) or cardiovascular diseases. Our observations align with results from the national Polish study from 2019. The study participants were a random sample of 1000 individuals, representative of the general population of Poland aged 15 and older. One of the main conclusions from the study was that Poles are relatively consistent that smoking causes lung cancer, while to a much lesser extent, agree that smoking is associated with strokes or heart attacks [16]. In 2015, a survey about the influence of smoking on lung carcinoma was carried out among high school students in Poland. Interestingly, in the analyzed group, 84.2% of respondents chose smoking as the leading lung cancer risk factor, but concurrently, 67.3% were active smokers. Additionally, smokers presented a lower level of knowledge about lung cancer in comparison to non-smokers [17]. In conclusion, more effort should be put into education about the various risks associated with smoking cigarettes. The risk of developing lung cancer itself seems insufficient to discourage smoking.

The cancer diagnosis stage is the most significant variable for further treatment response and prognosis. Society’s awareness of early symptoms and screening examinations might lead to diagnosis in earlier stages and result in a better prognosis. The most prevalent symptoms of lung cancer encompass shortness of breath, fatigue, coughing (also hemoptysis), chest pain, and weight loss [18]. In our study, almost 90% of students correctly chose symptoms of lung cancer—hemoptysis, shortness of breath, and cough. In 2023, the analysis focusing strictly on lung cancer symptoms was conducted among pharmacy and nursing undergraduates in Saudi Arabia. The results were far more disappointing, as only about 40% of participants reported coughing up blood and worsening or changing an existing cough as symptoms of lung cancer [19]. In the study by Alrabeeah et al. conducted on over 15,000 participants, 60% of respondents showed low confidence in identifying the signs and symptoms of lung cancer [20]. Awareness of the risk factors and symptoms of lung cancer depended on age, gender, education, marital, and employment status.

As previously mentioned, breast cancer is the most prevalent malignancy among women in Poland. Other gynecological cancers, such as endometrial, cervical, and ovarian, are also in the first ten of the most commonly diagnosed malignancies. They are also among the first ten most deadly cancers [11]. The statistics have been quite stable over the past few years despite implementing prophylaxis programs for breast and cervical cancers. Our study proved that the knowledge about prophylaxis programs is quite good; nevertheless, according to official national statistics from 2024, only about 30% of qualified Polish women benefit from mammography and only ~ 11% from cytology [21]. Results of the systematic review of 35 studies suggest that most women are aware of mammograms; however, there was significant variability regarding the awareness of the purpose of screening [22]. In the Polish study, among 100 women aged 20–45, almost 100% knew about the existence of mammography, but details about the frequency or the purpose of the examination were known by only 30–50% of respondents [23]. In various studies, the barriers most encountered towards mammography encompass a lack of detailed information about mammograms, fear of radiation exposure, fear of error in diagnosis, and fear associated with the possible discovery of cancer and further oncological treatment [24, 25]. Social campaigns and lessons for students about the details of prophylaxis programs and examinations are highly needed to overcome barriers leading to low attendance to cytology and mammography.

Given the current low rates of participation in cancer screening tests, we created opportunities for students to independently and collaboratively explore and present the reasons for undergoing such screenings. We believe these learning activities enhanced students’ understanding of the importance of regular checkups and the potential to overcome cancer through early detection and timely treatment.

A significant improvement was noted after the classes regarding young people’s knowledge of breast cancer prevention. After the classes, 37% more young people knew that every woman over the age of 20 should perform a breast self-examination once a month. It is essential because, according to the National Cancer Registry in Poland, among young adults (20–44 years old), standardized cancer incidence rates are twice as high as among men. Among middle-aged women, cancer causes over 1/3 of deaths (35% of deaths in 2021). In Poland, in the group of women aged 20 to 44, the most common cancer in terms of incidence is breast cancer. That is why it is so crucial for young people to know what breast cancer prevention is, to be able to reduce the risk of developing this cancer in the following years of life [11, 26].

More and more children in Poland are diagnosed with overweight and obesity. According to the World Health Organization (WHO), overweight and obesity were recorded in 32% of Polish children aged 7–9—8th place among European countries studied [27, 28]. Therefore, greater knowledge of children and adolescents on obesity prevention and the impact of this obesity on the development of many cancer diseases is crucial.

A recent meta-analysis by Shivappa et al. demonstrated increased risk in the incidence of CRC with certain foods by using the Dietary Inflammatory Index of food [29]. A higher DII score correlated with the pro-inflammatory potential, thereby increasing the risk of CRC. In contrast, a lower DII score correlated with anti-inflammatory potential, reducing the risk of CRC. In our study, approximately 25% of students, after the educational project, knew that dietary fiber and physical activity do not increase the risk of developing colon cancer. The knowledge that students gain may, in the future, translate into changing their habits and lifestyle to a more health-promoting one and to a lower risk of developing cancer.

A higher level of knowledge among high school students on cancer prevention after completing the project may translate into passing on this knowledge to their families and friends. The knowledge gained may influence the change in eating habits, where we know that improper diet is responsible for approximately 30% of cancer cases. Excessive body weight increases the risk of developing as many as 11 malignant tumors (including colon, kidney, and gallbladder cancer) [30].

A limitation of this study lies in its sample, which consisted solely of high school students from a single voivodeship in Poland. Additionally, the absence of a control group prevents immediate generalization of the findings.

This study highlighted changes in students’ awareness and knowledge about cancer brought about by implementing a cancer education project. Generally, high school students in Poland have basic knowledge about cancer and its risk factors. Most adolescents are aware of the significant impact of lifestyle on cancer risk. Our findings revealed that the proposed cancer education class led to short-term improvements in junior high school students’ awareness and understanding of cancer. It will be extremely valuable to assess the level of knowledge after a longer period following the educational sessions, as this will allow for an evaluation of the long-term effects of the project and the drawing of conclusions regarding the effectiveness of such initiatives. Early education on cancer prevention, mainly aimed at lifestyle changes, is crucial. Enhancing adolescents’ understanding of risk factors can play a significant role in lowering future cancer rates.