Objective  To explore the intention and willingness-to-pay for cancer screening among rural residents for providing evidences to the development of strategies on cancer screening promotion and improvement.

  Methods  Using a self-designed questionnaire and stratified random sampling, we conducted a face-to-face interview among 1 086 residents aged 18 years and above in rural regions of 6 municipalities across Shandong province from October 2019 to March 2020. The resident's intention and willingness-to-pay for cancer screening were statistically described and chi-square was adopted in analysis on disparities in the intention and willingness.

  Results  Of the 1 083 residents with valid responses, 81.90% reported the intention for cancer screening free of charge and 70.10% reported the willingness-to-pay for charged cancer screening. Being difficult to pay for charged cancer screening and considering cancer screening as unnecessary were the two main reasons which were listed by 57.85% and 38.70% of the residents reporting the unwillingness for charged cancer screening. The residents with the education of junior high school and above and an annual household income of 10 000 yuan (RMB) and more had a significantly higher willingness-to-pay for charged cancer screening (P < 0.05). For a cancer screening process with the total cost of 500, 1 000, and 2 000 yuan, the average expense the residents willing to pay were 194.29, 373.25, and 668.83 yuan, accounting for 38.86%, 37.33%, and 33.44% of the total cost, respectively. Higher amount of self-paid expense, accounting for 39.27% – 61.67% of total cost of cancer screening process, were reported by the residents under 40 years old, with senior high school education or above, having a medical insurance for urban employees, and having an annual household income of ≥ 20 000 yuan.

  Conclusion  Among rural residents in Shandong province, the intention for cancer screening free of charge is high but the willingness-to-pay and the reported ratio of self-paid expense for charged cancer screening are not high. The results suggest that comprehensive measures should be taken to increase the compliance with cancer screening in the population.