ReThinking Cancer Prevention Through Participation: from 4P-CAN Rural Living Lab in Eastern Europe

Abstract Personalized prevention is receiving increasing attention as an alternative to standardized public health interventions, particularly in rural, underserved communities where structural and social barriers limit equitable outcomes. The Horizon Europe-funded 4P-CAN project piloted a community-driven approach to primary cancer prevention in rural Eastern Europe. A Living Lab was established in Lerești, Romania, to co-design cancer prevention interventions aligned with the European Code Against Cancer. The approach combined citizen engagement, Net-Map governance mapping, and personal network analysis to uncover influence structures and behavioral clusters related to modifiable cancer risks. This data informed the development of risk stratification personas and localized communication strategies. Key interventions included citizen juries, tailored health campaigns, a community Health Festival, and Romania's first walking football tournament for seniors. Contrary to initial assumptions, local public authorities emerged as pivotal actors, facilitating uptake and enabling the model's replication in 15 additional rural communities. Network-informed analysis revealed governance gaps and behavioral clusters, supporting a scalable model of community-based prevention. The 4P-CAN Living Lab illustrates how personalized cancer prevention can be operationalized in low-resource settings through participatory and network-informed methodologies. The findings underscore the importance of local ownership, context-sensitive design, and social science integration in advancing equitable cancer prevention, offering transferable lessons for structurally similar regions across Europe.