Cancer is a leading cause of death in Samoa. Cultural beliefs shape attitudes towards disease and disease prevention in Pacific countries, and are a barrier to engaging in cancer screening services. A survey of 205 Samoan adults conducted as part of the evaluation of the first cancer awareness campaign implemented in Samoa explored beliefs about cancer causation. Lifestyle factors associated with a departure from fa'aSamoa (traditional lifestyle) were most commonly cited as causing cancer. Cancer was also attributed to pathogens and person-to-person transmission, and, to a lesser extent, cultural beliefs including supernatural agency (spirits, God). Addressing misconceptions whilst integrating certain aspects of fa’aSamoa into cancer control strategies could support greater engagement in health promotion practices and screening initiatives.