Determinants of acceptance, perceived fairness, and prevention-behaviour intentions regarding risk-adapted cancer screening in the NAKO Bremen cohort

Polygenic risk scores (PRS) have the potential to support population-scale, risk-adapted cancer screening by enabling more individualized risk estimation and screening recommendations. PRS have been developed for risk estimation of common cancers and may support risk stratification within cancer screening programmes (Dannhauser et al., 2024). Unlike genetic testing primarily used to investigate suspected hereditary cancer syndromes, PRS-based approaches could extend genetic risk assessment to broader population groups. This raises important questions about public acceptance of risk-adapted screening and the factors that shape willingness to participate. Previous research suggests that risk-adapted cancer screening is generally acceptable to the public, but that acceptance depends in part on how the rationale, individual risk estimates, and consequences of risk-based screening are communicated (Taylor et al., 2023a). Clear communication, comprehensible explanations of risk stratification, and opportunities for consultation and shared decision-making have also been identified as important considerations for implementation (Taylor et al., 2023b). Evidence specifically addressing public acceptance and communication of PRS-based, risk-adapted cancer screening remains limited, particularly in Germany. The study is an observational, cross-sectional online survey conducted among participants of the Bremen arm of the German National Cohort (NAKO Gesundheitsstudie), and examines acceptance and perceived fairness of risk-adapted cancer screening and intentions to engage in cancer-prevention behaviours. Further it investigates demographic, health-related, and psychosocial factors associated with these outcomes.