Attitudes and Perception of Risk-stratified Cancer Screening among a Patient-Public Panel in National Cancer Center Japan: A Qualitative study

Background Risk-stratified cancer screening (RSCS) aims to increase the effectiveness of screening while reducing potential harms by tailoring screening intervals and modalities in accordance with the individual's cancer risk. Japan already provides a population-based cancer screening program through a standardized nationwide protocol, and public acceptance and perceptions of RSCS remain largely unexplored. In this study, we investigated public attitudes toward RSCS through discussions with a Patient-Public Panel at National Cancer Center Japan, using ABC Gastric Cancer Screening as a focal case study. Methods We organized a workshop on RSCS for a Patient-Public Panel in 2023. 69 panel members were provided with educational materials and lectures for the subsequent group discussion. After the workshop, 62 participants completed a web-based questionnaire on their attitudes toward RSCS and understanding of its benefits and harms. Open-ended responses in the questionnaire were evaluated by qualitative exploratory analysis, and concepts, categories, subthemes and themes were identified. Results While 22 (35.5%) of respondents supported the introduction of the RSCS, 34 (54.8%) expressed conditional acceptance only, dependent on specific factors. Three key themes were identified: perceived benefits of RSCS, concerns about RSCS, and challenges to future implementation. Regarding perceived benefits, respondents frequently noted that RSCS could enhance motivation for screening, but many expressed concern that rigorous implementation might limit personal choice and reduce screening opportunities consequent to risk assessment. Key challenges for RSCS implementation included the establishment of robust scientific evidence, effective public communication, and well-structured support systems. Conclusions Although some respondents recognized the benefits of RSCS, they were reluctant about its implementation. A comprehensive understanding of the reasons underlying these public opinions is critical, and will facilitate the development of effective communication strategies and establishment of support systems.