Framework for Ethical Personalized Risk-Stratified Prevention

Cancer and other non-communicable diseases (NCDs) account for a substantial share of Europe’s preventable disease burden. As policymakers and healthcare systems seek more effective ways to reduce this burden, personalised risk-stratified prevention (PeRiSt) has emerged as a promising approach. Potential benefits include more precise targeting of preventive interventions for those most likely to benefit, more efficient use of healthcare resources, and reduced harms associated with over-screening or unnecessary procedures. However, because stratification treats individuals differently by design, its legitimacy depends on whether these differences are perceived as fair, respectful of individuals’ autonomy, and compatible with social cohesion and solidarity. As Member States consider moving toward more personalised and risk-based models of prevention, new questions emerge about how risk is defined, communicated, and acted upon, and how these changes resonate with citizens’ values, expectations, and lived realities. This report offers a possible ethical framework for the responsible implementation of PeRiSt grounded in insights from four national citizen engagement initiatives in France, Iceland, Norway, and Sweden, supported by a targeted literature review and expert input. The framework therefore represents how citizens themselves understand risk and stratification approaches, and how these concepts intersect with their expectations and values.