The research team, led by Nicholas Matovu of the Centre for Public Health at Queen’s University Belfast together with colleagues from the Uganda Cancer Institute, the Ugandan Ministry of Health and Queen’s University Belfast, set out to fill a conspicuous gap in the literature. While considerable research has examined public awareness of established cancer risk factors such as tobacco use, alcohol consumption, unhealthy diets, physical inactivity and infections, far less attention has been paid to the mythical causes of cancer, defined as exposures or agents that the public perceives as carcinogenic despite the absence of scientific consensus for a causal link. This gap is particularly relevant in Africa, where cultural norms and traditional beliefs can shape perceptions of illness in ways that diverge sharply from biomedical evidence.

To measure awareness, the researchers adapted the validated Cancer Awareness Measure Mythical Causes Scale, originally developed in the United Kingdom with twelve items, expanding it to twenty by adding eight myths drawn from the published literature and from locally circulating beliefs about cancer in Uganda. Participants rated each statement on a five-point Likert scale during face-to-face interviews conducted in English and Luganda. Following the original scoring approach, disagreeing with a statement earned a point, while agreeing, strongly agreeing or being unsure scored zero. The modified twenty-item tool showed good internal consistency, with a Cronbach’s alpha of 0.87, suggesting it could be reliably adapted for use in comparable low-income settings.

The results were unambiguous. Endorsement of the listed items as genuine cancer causes was high across the board. The most widely believed myth was that eating food cooked or steamed in a polythene bag causes cancer, endorsed by 95.3 percent of participants, followed closely by the belief that eating food containing artificial sweeteners is carcinogenic, endorsed by 93.9 percent. At the other end of the spectrum, the least endorsed items were receiving vaccinations, at 28.7 percent, and staying in the sunshine for long hours, at 30.8 percent. When the analysis flipped to myth recognition, meaning correctly identifying that an item is not an established cause of cancer, vaccinations topped the list at 44 percent, followed by stress at 32.4 percent and prolonged sun exposure at 32 percent. The items least often recognised as myths were drinking or eating food containing pieces of broken glass, correctly identified by just 0.7 percent of participants, and food containing artificial sweeteners, recognised by only 1.17 percent.

The survey recruited participants through multistage random sampling across sub-counties, parishes and households, achieving a response rate of 93 percent from the 460 people initially approached. The sample had a mean age of 36.5 years, ranging from 18 to 82, and 61.2 percent of participants were female. Kampala, home to roughly 1.8 million people according to the 2024 national census, was chosen alongside rural Mpigi district, with an estimated population of 322,131, to capture a diverse range of sociodemographic and ethnic groups. Individuals with a current or previous cancer diagnosis, those unable to provide informed consent, and those with physical or cognitive impairments preventing participation were excluded.

Beyond the headline figures, the study identified clear demographic patterns in who was more or less likely to see through the myths. Older participants, those aged 30 to 59 and 60 and above, scored significantly lower than adults under 30. Married individuals scored significantly lower than single respondents, with a mean score of 2.0 compared with 3.2, and participants in the other marital category scored lowest of all at 1.2. Education mattered as well: those with secondary-level qualifications scored significantly higher than participants who had never attended school, with mean scores of 3.1 versus 1.4. Intriguingly, having a family member or relative with cancer was associated with better myth recognition, with a mean score of 3.0 compared with 2.2 among those without such a family history, a statistically significant difference.

The authors interpret the strong endorsement of technology-linked myths through a cultural lens. In many African communities, including Uganda, modern technology from Western countries is often viewed with suspicion and regarded as harmful to health and traditional values. Because many of the mythical items assessed, such as artificial sweeteners and polythene bags, carry an explicit association with modern Western technology, participants may have judged them harmful and therefore carcinogenic. Consistent with this interpretation, items such as stress and physical trauma, which have no such technological association, were among the least endorsed. The researchers also point to the broader role of health misinformation circulating in the media, which has been shown to fuel public myths in many countries, and to the widespread notion that everything causes cancer, a view endorsed by nearly half of respondents in a separate online survey.

The study is careful to acknowledge the inherent complexity of labelling certain exposures as mythical. The classification rests on the International Agency for Research on Cancer’s monograph system, which grades the strength of evidence linking agents to cancer. Group 1 agents carry sufficient human, animal and mechanistic evidence of carcinogenicity, while agents in other groups lack sufficient evidence for such classification, which does not entirely rule out carcinogenicity. Polyethylene itself, for example, has not been classified by IARC as a Group 1 carcinogen, nor have heat-related by-products such as phthalates, even though heated plastics can leach chemicals into food that are harmful to health. Aspartame, one of the world’s most widely used artificial sweeteners, is classified as Group 2B, meaning it is possibly carcinogenic based on limited evidence. The inclusion of prolonged sun exposure as a mythical item is explicitly contextual, reflecting the relatively lower incidence of sun-related skin cancers among Black African populations compared with lighter-skinned groups rather than a denial that ultraviolet radiation causes cancer.

Comparisons with other countries highlight how unusually low awareness was in this Ugandan sample. In a population-based study in Pakistan, participants correctly identified about 46 percent of thirteen proposed myths as non-carcinogenic, roughly six of thirteen items, compared with the 12 percent average score recorded here. In England, a cross-sectional survey found that 36 percent of twelve mythical causes were correctly identified as such, about four of twelve. The Ugandan findings therefore sit well below both other low- and middle-income and high-income benchmarks, reinforcing the authors’ argument that cancer awareness initiatives in the region must do more than promote evidence-based risk factors; they must actively dispel the myths that circulate alongside them.

The implications for public health are considerable. Believing in incorrect causes of cancer can mislead public understanding, foster stigma and mistrust, and prompt individuals to seek help from traditional healers or remedies rather than medical sources, delaying access to appropriate healthcare, screening and treatment. Previous work in Uganda and South Africa has documented site-specific beliefs, such as attributing breast cancer to putting money in a bra or cervical cancer to poor personal hygiene, but this study is among the first to assess general, non-site-specific mythical cancer causes in the country. The authors caution that the cross-sectional design precludes causal interpretation, that self-reported responses may carry recall bias, and that cultural differences across Uganda’s regions limit generalisability. They also note that responses may have been influenced by participants’ engagement with the broader colorectal cancer awareness survey in which the mythical causes module was embedded. Even so, the message for policymakers is clear: sensitisation campaigns should target older and less-educated populations in particular, pairing accurate information about established risk factors with concerted efforts to correct the misconceptions that fuel unnecessary anxiety and delay care.

Subject of Research: Public awareness of mythical causes of cancer among adults in central Uganda

Article Title: Awareness of the mythical causes of cancer in central Uganda: a community cross-sectional survey

Article References: Awareness of the mythical causes of cancer in central Uganda: a community cross-sectional survey. (n.d.). https://doi.org/10.1007/s10552-026-02249-7

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02249-7

Keywords: cancer myths, cancer awareness, Uganda, Cancer Awareness Measure, mythical causes scale, health misinformation, cancer prevention, IARC carcinogen classification, polythene bag cooking, artificial sweeteners, cross-sectional survey, cancer epidemiology