Understanding why patients do not attend cancer screening, such as a Pap smear, or continuing to smoke despite known risks remain key challenges in cancer prevention, even when clear guidelines are in place.

Cancer prevention is central to Europe’s Beating Cancer Plan, with the European Code Against Cancer (ECAC) providing evidence-based recommendations to reduce cancer risk. The fourth edition (ECAC4) focuses on individual behavioral change, but effective implementation requires insight into the individual and structural factors influencing adoption. Its fifth edition, now in development, strengthens a dual approach by combining individual guidance with policy measures that create environments that support healthier behaviors.

Effective implementation depends on understanding the factors that shape whether people adopt or avoid preventive actions.

A recent multicenter qualitative study published in The Lancet Regional Health Europe examined the barriers and facilitators influencing adherence to the ECAC among adults in nine European Union countries. The findings indicate that successful prevention depends not only on individual motivation but also on an environment that enables behavior change.

Behavior Drivers 

The study included 141 adults aged 18-65 years from Spain, France, Germany, Poland, and Portugal. Researchers have applied the COM-B model, a behavioral science framework that divides influences on behavior into three axes: ability, opportunity, and motivation.

The participants reported limited awareness of specific cancer risks, including radon exposure and occupational carcinogens, reflecting gaps in their capabilities. Many participants were uncertain about how to assess these risks or where to obtain reliable information.

Misinformation and false health claims act as barriers preventing evidence-based decision-making.

Structural Barriers 

Opportunity emerged as the dominant constraint. Participants found the cost of fresh food, lack of time due to work schedules, and reduced access to green spaces to be barriers to healthy behaviors.

In social settings, alcohol consumption is highly normalized, particularly at celebrations and gatherings, making abstinence or reduced intake difficult because of persistent peer pressure.

A key finding is that the healthcare system itself can act as a barrier in certain settings. Participants cited long waiting times, difficulty securing appointments, and limited time for proactive preventive care as factors that reduced their participation in colorectal and breast cancer screening programs.

Motivation Factors 

In contrast, motivation appeared to be the strongest facilitator. Fear of cancer, personal or family experience with the disease, and the desire to maintain quality of life in later years are powerful drivers that clinicians can use to support behavioral changes during consultations.

This study, which will inform ECAC’s fifth edition, highlighted a clear message: Health education is essential but not sufficient on its own.

To improve adherence to preventive recommendations, these findings suggest the following practical steps.

• Strengthen health literacy: Information alone is not enough. Patients need to clearly understand how and where to act, particularly for less familiar issues, such as human papillomavirus vaccination or radon exposure.
• Address contextual barriers: Acknowledging financial constraints and time limitations allows for more realistic and individualized prevention plans.
• Leverage the role of the family doctor: Advice from general practitioners remains one of the most trusted and influential sources of information, making them central to encouraging screening and lifestyle changes.

Ultimately, reducing the cancer burden in Europe will require translating individual recommendations into policies that support equitable access to prevention and reduce the responsibility placed solely on individuals.

The authors’ conflicts of interest are reported in the original study publication. 

This story was translated from Univadis Spain, part of the Medscape Professional Network.