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Background Early cancer diagnosis significantly improves treatment outcomes and survival. Ambulance staff, often the first to assess undifferentiated presentations, are well placed to identify early signs and symptoms of cancer; however, there is limited research on their awareness, confidence, and training. This study aimed to explore pre-hospital clinicians’ exposure to cancer-specific education, the perceived value of that training, and their self-reported confidence in recognising cancer early.Methods An anonymised online survey was distributed to staff in one NHS ambulance service. It assessed self-reported awareness, confidence, and sources of cancer-related knowledge. Quantitative analysis was conducted using the statistical package R.Results A total of 141 eligible responses were received. Most respondents (78%) reported considering cancer as a differential diagnosis at least once a month. The majority felt their knowledge of early signs and symptoms was enhanced by personal experience (79%), internet searches (79%), and public health campaigns (80%), while fewer credited formal sources such as initial paramedic training (25%), JRCALC guidelines (12%), or ambulance service training (7%). Paramedics who completed higher education to level 6 were more likely to report enhanced knowledge during their studies (35%) than those who completed education to level 5 (16%). Respondents felt most confident identifying early signs and symptoms of bowel (53%), lung (50%), skin (49%), and breast (47%) cancers, and least confident with cancers of the kidney (15%), head and neck (13%), and lymphoma (11%).Conclusion Despite limited formal training, most ambulance clinicians consider cancer as a differential diagnosis at least monthly. Strengthening and standardising cancer-related education and resources could improve early recognition in the pre-hospital setting, supporting national diagnostic targets and outcomes. While this survey offers valuable insights, its generalisability is limited by potential sampling bias and regional variation; a UK-wide study is needed for broader understanding.