Cystic Fibrosis Colorectal Cancer Screening Consensus Recommendations

Denis Hadjiliadis; Alexander Khoruts; Ann G. Zauber; Sarah E. Hempstead; Patrick Maisonneuve; Albert B. Lowenfels


Gastroenterology. 2018;154(3):736-745. 

In This Article


The CF CRC screening task force recommends screening with colonoscopy beginning at age 40 years for non-transplanted patients with CF and age 30 years for persons who have undergone and successfully recovered from a transplantation procedure. All decisions around CRC screening should be made in concert with the adult with CF. These discussions should include the consideration of comorbidities, safety, treatments, and quality of life. These recommendations are similar to the guidelines for screening in the non-CF population, where the recommended age for initial screening is about 10 years earlier than the average age of onset of cancer. The task force recommendations assume selection of patients whose anticipated life expectancy is sufficient to benefit from a screening procedure. We do not recommend a specific lung function below which colonoscopy is not recommended, as survival depends on many more factors, best assessed by the CF health care team. At present, we have insufficient information to assess the utility of screening procedures other than colonoscopy; such modalities could be extremely valuable, especially for individuals with CF with reduced lung function. In addition, current age recommendations are based on best-available evidence and efforts to balance the burden of frequent potentially unnecessary screening vs the benefit of early identification of malignant polyps. These recommendations will need to be updated when additional information becomes available about the potential benefit of alternative screening procedures, and the role of other risk factors, such as sex, mutational status, and family history.