Applying the 5P framework to improve cancer prevention in European health systems.

Cancer remains one of the leading causes of premature mortality in Europe, with nearly half of all cases attributable to modifiable risk factors. While preventive strategies are well-established, their implementation across European health systems remains fragmented, underfunded, and insufficiently aligned with population needs. This paper applies the 5P model, which is predictive, preventive, personalized, participatory, and psycho-cognitive, as a diagnostic and normative framework to assess national cancer prevention infrastructures. Focusing on Sweden, Germany, Romania, and the United Kingdom, we conducted a qualitative comparative analysis informed by structured policy mapping and literature review. Our findings revealed significant divergence in system alignment with 5P principles, particularly in participatory governance, personalization, and anticipatory planning. While high-income countries tend to have better predictive infrastructure and screening coverage, they often lack formal mechanisms for community engagement and tailored communication. In contrast, under-resourced systems show lower alignment across multiple domains, underscoring the risks of top-down, technocratic strategies without trust-building or contextual sensitivity. We argue that the psycho-cognitive dimension, that is capturing values, perceptions, and behavioral drivers, is essential to translating prevention into practice. We conclude with actionable policy recommendations, emphasizing participatory infrastructure, cross-sectoral foresight, and ethical evaluation as core components of sustainable cancer control.