Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults (R21) | PA 17 109

Opportunity Information: Apply for PA 17 109

The National Institutes of Health (NIH) funding opportunity titled "Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults (R21)" (Funding Opportunity Number PA-17-109) supports early-stage, exploratory research aimed at cutting down on unnecessary cancer screening among average-risk older adults. The central issue driving this announcement is that, while public health campaigns and clinical practices have successfully increased use of cancer screening overall, screening can be overused in later life or in situations where the likely benefit is small. In those cases, screening can expose older adults to avoidable harms such as false positives, anxiety, follow-up procedures, complications, and downstream treatments that may not improve longevity or quality of life.

This FOA is focused specifically on overscreening for three common cancer types: breast cancer, cervical cancer, and colorectal cancer. The target population is average-risk older adults, meaning people who do not have elevated risk due to factors like strong family history, high-risk genetic syndromes, or prior related conditions that would warrant different screening approaches. The opportunity emphasizes research conducted in healthcare settings, reflecting the idea that overscreening often happens within routine clinical workflows, referral pathways, electronic reminders, and institutional performance norms.

A major theme of the announcement is that overscreening is not caused by just one thing, and it often persists because of reinforcing pressures at multiple levels. The FOA highlights potential drivers at the individual level (patient preferences, fear of cancer, misunderstanding of screening benefits and harms), the healthcare team level (clinician habits, discomfort with stopping screening, communication challenges), the healthcare system level (standing orders, automated reminders, quality metrics, financial incentives, fragmented records), and the community organization level (local norms, outreach programs, messaging that promotes screening without nuance). Because these forces can interact, NIH is looking for studies that do more than address a single point in the chain.

To align with the FOA, proposed projects are expected to intervene at two or more levels and to measure outcomes at two or more levels, while explicitly accounting for interactions across levels. In practice, that could mean designing an intervention that combines patient-facing decision support with clinician training and changes to electronic health record prompts, then measuring both patient outcomes (such as screening rates, informed decision-making, satisfaction, anxiety, or follow-up testing) and system or clinician outcomes (such as ordering patterns, adherence to guideline-concordant stopping, workflow impacts, or changes in reminder systems). The overall expectation is that funded research will generate clearer evidence about why overscreening happens and will test practical, scalable strategies that health systems can use to reduce overuse without undermining appropriate screening for those who can benefit.

The research goal is not simply to reduce the number of screening tests, but to improve health, independence, and quality of life for older adults by avoiding low-value or potentially harmful care. This includes deepening understanding of the real-world consequences of overscreening, such as complications from colonoscopy, overdiagnosis and overtreatment, burdensome follow-up imaging or biopsies, and the opportunity costs of time, attention, and resources that could be directed toward more beneficial preventive or chronic care services.

From an administrative standpoint, this is a discretionary grant opportunity using the NIH R21 mechanism, which typically supports exploratory or developmental work that can lead to larger future studies. The award ceiling listed is $200,000. The original closing date in the source information is January 24, 2018, and the FOA was created on January 9, 2017. The activity category is listed under Education and Health, and the CFDA number is 93.394. The sponsoring agency is the National Institutes of Health.

Eligibility is broad and includes many organization types across the public, private, and nonprofit sectors. Eligible applicants include state, county, and local governments; special district governments; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; federally recognized Native American tribal governments; tribal organizations that are not federally recognized; public housing authorities and Indian housing authorities; nonprofits with or without 501(c)(3) status; for-profit organizations (other than small businesses); and small businesses. The FOA also explicitly calls out additional eligible applicants such as Alaska Native and Native Hawaiian Serving Institutions, Asian American Native American Pacific Islander Serving Institutions (AANAPISISs), Hispanic-serving institutions, Historically Black Colleges and Universities (HBCUs), Tribally Controlled Colleges and Universities (TCCUs), faith-based or community-based organizations, eligible federal agencies, regional organizations, non-U.S. entities (foreign organizations), and U.S. territories or possessions.

In short, PA-17-109 is aimed at shifting cancer screening in older adults toward more appropriate, patient-centered, and evidence-aligned care by funding multi-level healthcare-based interventions that can reduce overscreening and its harms, while generating practical knowledge that health systems can use to improve outcomes that matter to older adults.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "Reducing Overscreening for Breast, Cervical, and Colorectal Cancers among Older Adults (R21)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.394.
• This funding opportunity was created on 2017-01-09.
• Applicants must submit their applications by 2018-01-24. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $200,000.00 in funding.
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

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