Public (un)willingness to trade-off benefits and harms in decisions about cancer screening - A discrete choice experiment

Sep 22, 2026

This study quantifies the harms participants are willing to accept alongside varying benefits from cancer screening after receiving information. Two online samples of the UK public completed a discrete choice experiment. Benefits included numbers of diagnoses and deaths prevented, while harms covered overdiagnoses, false positives, and false negatives over lifetime screening exposure. Conditional logistic regression and latent class analysis assessed preference heterogeneity and uptake probabilities by class.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

Public (un)willingness to trade-off beneﬁtsand harms in decisions about cancer screening: A discrete choice experiment J Med Screen 2026, Vol. 33(3) 152–162 © The Author(s) 2026 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/09691413261422933](DOI: 10.1177/09691413261422933)[ ](DOI: 10.1177/09691413261422933)[journals.sagepub.com/home/msc](journals.sagepub.com/home/msc) Rebecca A Dennison 1 , Stuart Wright2, Georgios Lyratzopoulos3, Nora Pashayan 1, Stephen Morris 1, Brian Nicholson4, Thiscovery Authorship Group*, and Juliet A. Usher-Smith 1 Abstract Objectives: To quantify the harms participants are willing to accept for varying beneﬁts from cancer screening following provision of information. Methods: We conducted an online discrete choice experiment with two samples of the UK public. Attributes were number of cancer diagnoses and deaths prevented (beneﬁts) and overdiagnoses, false positives and false negatives (harms) for a population who are/are not screened for an unspeciﬁed cancer over their lifetimes. After selecting the best-ﬁtting conditional logistic regression model for each sample, we used latent class analysis to investigate preference heterogeneity and calculated the probability that each class/group would take up screening with different beneﬁt and harm levels. Results: In total, 1018 participants completed the discrete choice experiment. Cancer deaths prevented was the most important attribute, followed by the number of false positively/negatively detected cancers; cancers prevented and overdiagnosed were deemed relatively unimportant. Three latent classes were identiﬁed. The largest class (approximately two-thirds) chieﬂy opted for screening, focusing on deaths prevented; this group would strongly prefer screening participation even with harms only (probability 76%–92%). Approximately a quarter of each sample traded off beneﬁts and harms; this group would likely take up screening with outcomes like those of colorectal screening (68%–87%). Conclusions: A minority of the public express preferences for screening that are inﬂuenced by trading-off potential beneﬁts/ harms, but most have strong preferences for cancer screening, focusing on the associated reduction of cancer deaths. The ﬁndings emphasise public health responsibility in appraising or generating evidence on beneﬁts and harms to support decisions about the introduction or modiﬁcation of screening programmes. Keywords Discrete choice experiment, early detection of cancer, health policy, mass screening, overdiagnosis Date received: 16 October 2025; accepted: 21 January 2026 Introduction Screening aims to identify early-stage cancer when it is often easier to treat successfully and, for some cancers, to prevent occurrence by intercepting pre-malignant lesions. Screening for cervical, breast and colorectal cancer has been estimated to prevent around 9000 deaths each year in England, 1 with targeted lung cancer screening rolled out recently.2 Additionally, screening brings other less measurable beneﬁts, including reassurance from a negative result and recognition of an individual’s value to society.3 However, screening can also result in psychological, physical and ﬁnancial harms and opportunity costs. Some harms are associated with the screening test itself, such as pain, exposure to radiation or anxiety. Others arise from inaccuracies in the 1 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK 2Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK 3 Research Department of Behavioural Science and Health, University College London, London, UK 4 Nufﬁeld Department of Primary Care Health Sciences, University of Oxford, Oxford, UK *Thiscovery authorship group: Jay Dean-Lewis, Jordan Moxey, Andre Sartori, and Jenni Burt Correspondin

FAQs

What was the main objective of the study?

To quantify the harms participants are willing to accept for different benefits from cancer screening after provision of information.

How was the study conducted?

An online discrete choice experiment recruited two UK public samples. Participants evaluated benefits (diagnoses and deaths prevented) and harms (overdiagnoses, false positives, false negatives) across lifetime screening scenarios.

What did the results show about different types of participant preferences?

Three latent classes were identified. The largest class primarily preferred screening focused on deaths prevented, while a smaller group traded off benefits and harms and showed uptake patterns comparable to colorectal screening outcomes.

Sep 22, 2026

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