Public Preferences for Emerging Cancer Screening Modalities: A Systematic Review of Discrete Choice Experiments.

Abstract

Background: Early detection of cancer reduces mortality and morbidity, but conventional screening methods often face challenges such as invasiveness, limited accessibility and high resource demands. Emerging cancer screening technologies could overcome these barriers, yet their adoption depends heavily on public acceptance. This systematic review synthesises evidence from discrete choice experiment (DCE) studies examining population preferences for emerging cancer screening technologies.

Methods: A systematic review was conducting following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Scopus, Web of Science and EconLit were systematically searched for studies published up to August 2025. Eligible studies employed DCEs to assess preferences for modalities including liquid biopsy, multi-cancer early detection tests, artificial intelligence reading systems, genetic and genomic testing, mobile Health applications, nanopill-based screening and breath analysis. Studies were screened independently by two reviewers and assessed for reporting quality using the DIRECT checklist. Data were summarised using descriptive statistics and narrative synthesis.

Results: In total, 23 studies published between 2014 and 2025 were included, most focusing on genomic testing (n = 8) or liquid biopsy (n = 5). Across studies, 32 attributes were identified and categorised under clinical risk, modality characteristics, screening process, outcomes, or ethical considerations. Respondents generally favoured screening programmes that were clinically effective, accessible and minimally disruptive. Sensitivity was most frequently reported as the most influential attribute. Modality specific attributes influencing public preferences were identified, including data privacy and insurability for genetic and genomic testing, and the role of test providers for mHealth technologies and AI screening tools. Heterogeneity in preferences, attribute importance and predicted uptake were observed across many studies, highlighting differential attitudes towards cancer screening and modality specific attributes within the population.

Conclusions: This systematic review provides the first synthesis of DCE evidence across a wide range of emerging cancer screening technologies. Findings reveal that public preferences were shaped not only by clinical performance, but also by convenience, cost and the perceived credibility of new modalities. Considerable heterogeneity in preferences signals the need for tailored strategies to engage different population subgroups and avoid widening disparities in uptake. As these technologies move towards clinical adoption, robust governance and regulatory safeguards will be essential to ensure their translation into equitable and effective cancer screening programmes.