There is a growing pool of research addressing the burden of radiation exposure in infants born with OA/TOF. Babies born with OA/TOF undergo a series of medical imaging both pre and post surgery as part of diagnosis, monitoring and therapeutic intervention.
Children are more vulnerable to the potentially carcinogenic effects of such radiation than adults as their tissues are still rapidly dividing and growing, plus they have a much longer lifespan than adults. Whilst the levels of exposure are less than those children treated for paediatric cancers, they are greater than those infants born prematurely or with necrotising enterocolitis. (144) Zamiara et al. (145) found their cohort underwent numerous imaging, including multiple chest X-rays, abdominal X-rays and oesophagrams. Their population group received the equivalent of seven years of background radiation in the first year of life. However, this is extremely variable, depending on the complexity of the patient, with Gottrand et al. (214) finding an estimated increase in cancer mortality varying between a 130-fold average to a maximum of 1,575-fold in one complex patient.
There isn’t an equivalent pool of research for adults born with OA/TOF, but one can safely say that this patient group had increased exposure to radiation in infancy. An additional factor is that those born with OA/TOF with ongoing respiratory or gastrointestinal symptoms will likely have had further X-rays, barium swallows, CT scans etc across their lifespan. Whilst the data is lacking as to whether this will in turn lead to malignancy in this population, the cumulative radiation exposure is worth consideration in this patient group. This will be particularly true in long-gap OA patients and those with VACTERL syndrome or other syndromic or genetic conditions that may necessitate radiological imaging.