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Screenings by age and gender

Screenings if you have cystic fibrosis

MedlinePlus lists diabetes, liver disease, osteoporosis and colorectal cancer among the possible complications of cystic fibrosis (CF). (MedlinePlus) NICE says CF-related diabetes is uncommon in children under 10 but affects up to 1 in 2 adults, that chronic liver disease becomes more common with age until early adulthood, and that reduced bone density is also common. (NICE NG78) Most of these checks happen at the CF clinic's annual review. This page covers screening only, not treatment or medicines.

The annual review

NICE says to offer people with CF a comprehensive annual review that includes: (NICE NG78)

  • a lung (pulmonary) assessment
  • an assessment of nutrition and how well food is absorbed
  • an assessment for liver disease
  • testing for CF-related diabetes, from 10 years of age
  • an assessment for other possible CF complications
  • a psychological assessment, covering general mental health and wellbeing, quality of life and early signs of psychosocial problems

See mental health screenings by age. Newborn screening for CF is on newborn screening results, and carrier testing is on genetic carrier screening.

CF-related diabetes

The ADA says annual screening for CF-related diabetes should begin by age 10 in all people with CF, preferably with an oral glucose tolerance test (OGTT). If an OGTT is not feasible, A1C can be used as the first step of a two-step strategy: people with an A1C between 5.5% and 6.4% should have an OGTT within 3 months. (ADA, 2026) ISPAD also says a yearly 2-hour OGTT should begin at least by age 10, and adds that people with CF who are pancreatic sufficient and have normal glucose tolerance may have an OGTT every 3 to 5 years if the care team thinks it appropriate. (ISPAD, 2022) NICE says to test every year from 10 years of age, using continuous glucose monitoring, glucose testing over several days or an OGTT. (NICE NG78) NICE also lists times to test outside the yearly check: (NICE NG78)

  • people taking long-term systemic corticosteroids or receiving tube feeding
  • unexplained weight loss, a drop in lung function, more frequent chest flare-ups or excessive tiredness

Once CF-related diabetes is diagnosed, the ADA recommends yearly monitoring for diabetes complications beginning 5 years after the diagnosis. (ADA, 2026) See A1c and blood sugar test results and screenings if you have diabetes.

Pregnancy

The ADA and CF Foundation guidelines say women with CF who are planning a pregnancy or are pregnant should be screened for CF-related diabetes with an OGTT if they have not had a normal screen in the last 6 months, that gestational diabetes screening is recommended at both 12 to 16 weeks and 24 to 28 weeks, and that women who had gestational diabetes should have an OGTT 6 to 12 weeks after the pregnancy ends. (ADA and CFF, 2010) NICE says to test at the end of the first and second trimesters. (NICE NG78) See gestational diabetes glucose test results.

Colon cancer screening

The Cystic Fibrosis Foundation task force says the risk of colorectal cancer in adults with CF is 5 to 10 times that of the general population, and 25 to 30 times after an organ transplant. It recommends: (CFF colorectal, 2018)

  • colonoscopy as the screening test, starting at age 40 and repeated every 5 years
  • a repeat (surveillance) colonoscopy in 3 years if any adenomatous polyps are found, unless findings call for a shorter interval
  • for people with CF aged 30 or older who have recovered from a solid organ transplant: screening within 2 years of the transplant, unless a colonoscopy in the past 5 years was normal, then every 5 years
  • decisions shared between the person with CF and their provider

The task force found the evidence insufficient to recommend CT colonography, stool-based tests or flexible sigmoidoscopy for screening in CF. (CFF colorectal, 2018) See screening colonoscopy: what to expect, colonoscopy after polyps and colorectal cancer screening tests compared. Other cancer screening follows the usual schedule on cancer screenings by age.

Liver checks

The Cystic Fibrosis Foundation recommends, for all people with CF: (CFF liver, 2024)

  • liver blood tests every year from diagnosis (bilirubin, AST, ALT, alkaline phosphatase, GGT and platelet count), done at a time of clinical stability
  • an abdominal examination for an enlarged liver or spleen every year from diagnosis
  • an abdominal ultrasound of the liver and spleen at least every 2 years from age 3 (or from diagnosis, if later) until late adolescence

For adults, it says a baseline scan has value but the best interval after a normal result is unknown. (CFF liver, 2024) NICE includes a clinical assessment and liver function blood tests at each annual review, with a liver ultrasound if the blood tests are abnormal. (NICE NG78) See liver function test results.

Bone density

NICE says to consider DXA bone density scans for people with CF who have factors that put them at high risk of low bone density, such as: (NICE NG78)

  • frequent or long-term oral corticosteroid use
  • frequent intravenous antibiotic use
  • severe lung disease or undernutrition
  • previous low-impact fractures or previous transplants
  • being after menopause

A 2026 review summarizes the Cystic Fibrosis Foundation as advising DXA for all adults 18 and over and for children 8 and over with risk factors, and the European Cystic Fibrosis Society as advising routine DXA from age 8 to 10 for all children with CF. For adults, it says repeat scans are timed by the result: every 5 years if normal, every 2 to 4 years for a Z- or T-score between -1 and -2, and yearly at -2 or below. (Runchey, 2026 review) See bone density test: how often and DEXA scan: what to expect.

When to contact a provider

MedlinePlus, cystic fibrosis, when to contact a medical professional: (MedlinePlus)

  • Contact your provider if an infant or child has symptoms of CF, and experiences: Fever, increased coughing, changes in sputum or blood in sputum, loss of appetite, or other signs of pneumonia; Increased weight loss; More frequent bowel movements or stools that are foul-smelling or have more mucus; Swollen belly or increased bloating.
  • Contact your provider if a person with CF develops new symptoms or if symptoms get worse, particularly severe breathing difficulty or coughing up blood.

Where they differ:

  • Which diabetes test. The ADA prefers the OGTT and allows A1C as a first step when an OGTT is not feasible; (ADA, 2026) ISPAD says HbA1c is not a recommended screening test because of its low sensitivity; (ISPAD, 2022) NICE allows continuous glucose monitoring, several days of glucose testing or an OGTT. (NICE NG78)
  • When diabetes testing starts. The ADA, ISPAD and NICE start yearly testing at age 10, (ADA, 2026) (ISPAD, 2022) (NICE NG78) while ISPAD notes some centers and associations begin at 6. (ISPAD, 2022)
  • Colon cancer screening. The CF Foundation recommendations differ from general population guidelines in the starting age, the test (colonoscopy only), the bowel preparation and the interval. (CFF colorectal, 2018)
  • Who gets a bone density scan. NICE says to consider DXA for people with risk factors, (NICE NG78) while the CF Foundation and European Cystic Fibrosis Society guidance, as summarized in a 2026 review, screens all adults from 18 and, in Europe, all children from 8 to 10. (Runchey, 2026 review)

Your doctor decides what your result means for you.

Questions people ask

At what age does diabetes testing start with cystic fibrosis?

The ADA, ISPAD and NICE all say testing for cystic fibrosis-related diabetes should be done every year from age 10. The ADA and ISPAD prefer the oral glucose tolerance test (OGTT). (ADA, 2026) (ISPAD, 2022) (NICE NG78)

Is an A1C test enough to screen for cystic fibrosis-related diabetes?

ISPAD says HbA1c is not a recommended screening test because of its low sensitivity. The ADA says that if an OGTT is not feasible, A1C can be used as the first step of a two-step strategy, with an OGTT within 3 months for values between 5.5% and 6.4%. (ISPAD, 2022) (ADA, 2026)

When does colon cancer screening start with cystic fibrosis?

The Cystic Fibrosis Foundation recommends colonoscopy starting at age 40, repeated every 5 years. People with CF who are 30 or older and have had a solid organ transplant should start within 2 years of the transplant, unless they had a normal colonoscopy in the past 5 years. (CFF colorectal, 2018)

How often are liver checks done with cystic fibrosis?

The Cystic Fibrosis Foundation recommends liver blood tests and an abdominal examination every year from diagnosis, and an abdominal ultrasound at least every 2 years from age 3 until late adolescence. NICE includes a clinical assessment and liver function blood tests at the annual review. (CFF liver, 2024) (NICE NG78)

Who gets a bone density scan with cystic fibrosis?

NICE says to consider DXA scans for people with risk factors for low bone density, such as long-term oral corticosteroid use, frequent intravenous antibiotics, severe lung disease, undernutrition, past low-impact fractures, past transplants or being after menopause. A 2026 review says the CF Foundation advises DXA for all adults 18 and over and for children 8 and over with risk factors. (NICE NG78) (Runchey, 2026 review)

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