Conducted every five years, this Barometer provides insight into the attitudes and behaviors of the French public regarding cancer. As a tool for guiding prevention policies, it is also useful for developing tailored approaches for specific populations.

The Cancer Barometer is a general population survey conducted every five years since 2005. This fourth edition, whose data was collected in 2021 from nearly 5,000 people aged 15 to 85, provides a “snapshot” at a given point in time of French people’s perceptions and behaviors regarding cancer and allows us to assess how these have evolved. It is also an indispensable tool for documenting health inequalities. All of the ^factors² studied help shape individuals’ health behaviors. While nearly half of all cancers could be prevented, it is essential to understand these trends in order to evaluate public policies and adapt them. The goal is to improve prevention and address health inequalities.

Key Highlights of the 4th Cancer Barometer

Together, the data from this Barometer allow us to better understand the opinions, perceptions, and behaviors of the French public regarding cancer, thereby better guiding and analyzing the impact of public health policies in the fight against cancer.
Thus, the French report feeling well-informed about cancer. However, we realize that when we look more specifically at risk factors—and particularly preventable risk factors—their perceptions are not really based on scientific knowledge. For example, the link between psychological factors and cancer (i.e., the stress of modern life, traumatic experiences) is often cited by the French. However, there is no proven scientific evidence for this link.

The results also reveal a tendency to distance oneself from individual risk based on one’s own behavior. For instance, regarding tobacco—the leading preventable risk factor for cancer—one in two smokers places at least one of the risk thresholds (i.e., the number of cigarettes smoked per day or the number of years of smoking) above their own consumption.

For alcohol, the second leading preventable risk factor for cancer, people who consume it are less likely to spontaneously cite it as a cancer risk factor than those who abstain. This distancing is all the more pronounced as consumption increases.

Furthermore, the Barometer’s results once again highlight differences in perceptions, beliefs, and attitudes based not only on educational attainment but also on income levels among the French population.

For example, they indicate that:

• fewer people with lower levels of education perceive the cancer risks associated with tobacco, likely downplaying the risk;

• when it comes to screening, women with the lowest incomes report participating less in cervical cancer screening. Yet this screening is crucial in women’s healthcare journey.

Finally, certain misconceptions persist or have even increased compared to the previous edition of the Cancer Barometer. This is the case with the statement that “cancer is hereditary”; a statement strongly endorsed by people with an educational level below the high school diploma. This last example also illustrates the issue of health literacy (this term refers to individuals’ motivation and skills to access, understand, evaluate, and use information to make decisions regarding their health).

These data are highly significant. They allow us to re-examine the information and intervention mechanisms that need to be developed to support everyone in accessing accurate information and achieving a proper understanding, so that these inequalities can be reduced or even eliminated.

Adapting each wave of the Cancer Barometer to changes, practices, and the broader context

The 4th edition of the Cancer Barometer has undergone significant changes in its questionnaire. While retaining the elements that allow for comparisons between different editions, it incorporates updates to prevention recommendations and accounts for variations across editions.

The chapter on perceptions of cancer and cancer risk factors was expanded with additional research that took into account the findings of the previous Cancer Barometer. The goal was to understand the reasoning behind responses that were unexpected. Furthermore, perceptions of risk factors were analyzed using a two-pronged approach: first, and for the first time in France, through an open-ended question to capture those perceived spontaneously; second, as in previous editions, through the presentation of a list of risk factors, whether proven or not.

Regarding the sections on tobacco and alcohol—the top two preventable cancer risk factors—the questions focused on the link between these factors and cancer. In these two sections, a question was also introduced regarding strategies to combat their consumption and their perceived effectiveness.

The section on behaviors and opinions regarding ultraviolet radiation (natural or artificial) has been thoroughly revised and expanded. It now includes questions on awareness of the UV index, tanning, and perceptions of the duration of sun exposure as a source of vitamin D, as well as the collection of opinions on regulations governing the use of tanning beds.

As for nutrition, the questionnaire has been expanded to include new food groups (whole grains, dietary supplements, ultra-processed foods, organic foods, and legumes). Additionally, opinions on fasting and the consumption of dietary supplements were surveyed for the first time.

The chapter dedicated to analyzing behaviors and perceptions regarding HPV screening and vaccination has been reintroduced in this 4th edition. It was not included in the previous 2015 wave. New questions were included regarding lung cancer screening, in connection with the pilot program to be launched by the National Cancer Institute, to define the parameters of a potential organized screening program.

Finally, a chapter dedicated to e-cigarettes provides, for the first time in France, data on usage and motivations, as well as on perceptions of the health risks associated with this device and its components. Although this device has only recently appeared in Europe (its rise dates back to 2010), it is widely known among the population (99.6% of respondents know what an e-cigarette is).