Cancer screening services represent the optimal approach for early detection, diagnosis, and treatment of cancer, reducing incidence rates, improving survival rates, and optimizing healthcare resource allocation. However, individuals often exhibit irrational behaviors, such as underutilization of these services, due to inherent differences in risk preference types.This study aimed to investigate the influence of risk preference types on the underutilization of cancer screening services among Chinese residents.

A multistage stratified random sampling method was employed to survey 2 211 respondents aged ≥18 years across China from September to December 2019. Individual risk preference types were measured using the multiple price list (MPL) design, and multivariate logistic regression was applied to analyze their impact on the underutilization of cancer screening services.

Among the 2 211 participants, 39.48% were risk-seeking, and 51.87% underutilized cancer screening.Univariate analysis revealed statistically significant associations between underutilization and age, gender, education level, commercial health insurance participation, chronic disease status, family history, and distance to the nearest preventive healthcare facility (P<0.05). Multivariate logistic regression demonstrated that risk-seeking behavior (risk-seeking vs. non-risk-seeking: OR=2.065, 95% CI: 1.414-3.015), age, male gender (vs. female: OR=1.705, 95% CI: 1.196-2.431), chronic disease (yes vs. no: OR=2.406, 95% CI: 1.465-3.951), family history (yes vs. no: OR=5.823, 95% CI: 2.837-11.965), and distance to the nearest preventive healthcare facility (1 000-2 000 m vs. <1 000 m: OR=2.434, 95%CI: 1.068-5.547; >2 000 m vs. <1 000 m: OR=24.090, 95%CI:3.950-144.907) were positively associated with underutilization (P < 0.05). Conversely, purchasing commercial insurance (yes vs.no: OR=0.534, 95%CI: 0.334-0.853) was negatively associated with underutilization (P<0.05).

Residents’ decisions regarding cancer screening utilization are primarily influenced by their perceived risk of cancer and potential losses associated with screening. Governments and communities should enhance service accessibility, improve risk awareness, and emphasize the health consequences of non-screening to promote screening participation.