Girl holding a heart of light to symbolise congenital heart disease

Congenital heart disease increases cancer risk in young people

Congenital heart disease increases cancer risk in young people

New research reveals a link between congenital heart disease and cancer in children and young adults

New research shows that kids with congenital heart disease have double the risk of cancer before they hit the age of 40, compared with healthy kids who’ve never had to go through similar surgery. Their risk of being diagnosed with cancer before age 18 was 1.5%, which is pretty high if you think about it.

Could their exposure to gadolinium based contrast MRIs have anything to do with the increased risk?

The authors bring up lifestyle choices, like exercise. Certainly having fatigue and difficulty breathing could be a reason not to exercise, play sports, or run about as much. And so can serious conditions like critical aortic stenosis, where children might be advised to take it easy for their heart health. I can absolutely believe that not being able to exercise and move well could lead to an increased risk of cancer. Exercise is also good for our gut microbiomes, immune systems, stress levels, mental health and insulin sensitivity.

Having said that, gastrointestinal cancers were some of the most common ones, so what about other causes? And what do we know about cancer risks?

Have you heard about the metabolic theory of cancer?

Cancer cells are different from healthy cells in that their metabolism is broken. We know that the mitochondria (the energy-producing parts of our cells) are very badly damaged in cancer cells. I’ve written more about the mitochondria and their vulnerability to toxicity and malnutrition in this post.

Lots of different things can cause damage to our mitochondria, including:

• Nutrient imbalances 

• Toxic exposures 

• Chronic inflammation 

• Gut dysbiosis (upsets in the gut microbiome)

• Radiation exposures 

• Poor sleep patterns

• Medications

• Genetic predispositions

I’ll focus on just a few of these, because they might be a bit more likely to occur in kids with congenital heart disease.

Problems with the gut microbiome can happen for lots of reasons. But being born by Caesarean section (eg if the pregnancy was high risk because of known congenital heart disease diagnosed antenatally, or because the baby gets into difficulty during labour and has to be delivered in a hurry). We inherit most of our gut microbes from our mums when we pass through the birth canal. These sorts of things are pretty unavoidable. It’s better to have a baby born by section in good condition and alive than to have that baby become very unwell to avoid the section. But in the future we might make more of an effort to inoculate babies born by section by transferring some of their mum’s vaginal microbiome to them immediately after birth.

And then when it comes to feeding, breast feeding is best for establishing a good gut microbiome. But if a baby has a significant heart defect they might be too breathless to feed at all, let alone breast feed.

What about antibiotics and the gut microbiome?

When I started training in Paediatrics it was pretty routine to give antibiotic prophylaxis to all kids with congenital heart disease to try to reduce the risk of bacterial endocarditis (a really nasty infection in the heart itself). Kids got antibiotics for fairly routine dental work where healthy kids wouldn’t, as well as for other operations. By the time I left Paediatrics that practice was starting to change, and fewer courses of antibiotics were being recommended.

But kids with heart disease are more prone to picking up respiratory infections, and since they can get so sick with them, they may be more likely to be treated with antibiotics.

Every course of antibiotics can also alter the gut microbiome. More worrying is the fact that some antibiotics are directly toxic to mitochondria too. Particularly antibiotics like the fluroroquinolones (like ciproxin), and doxycycline.

Even without antibiotics can congenital heart disease alter your microbiome?

It’s conceivable that people with congenital heart disease could also have an altered gut microbiome because sometimes their condition means that they have low oxygen levels in the blood all the time, and this can affect how the immune cells and gut cells function.

How about other medications? Could they increase cancer risk?

You’re also at increased risk of being prescribed medications for other reasons if you’ve got congenital heart disease. You may have to have multiple general anaesthetics for surgeries, and if you’re a young kid even for some scans. You might spend weeks on pain killers after operations. You might need diuretics, blood pressure lowering tablets and other medications.

Many medications have a toxic effect on our mitochondria. But at the same time you have to weigh up the risks, and it might be that the benefits of taking the medications do outweigh the risks in the short to medium term at the very least. But could medication usage contribute to the increased cancer rate?

The last thing I wanted to mention was the use of radiological investigations.

Multiple radiation exposures occur because some of the ways to monitor the heart and lungs is to do chest X-rays, angiography, and CT scans.

And is there a risk associated with gadolinium contrast MRI or MRA scans?

But cardiac MRA with gadolinium contrast is another type of radiological investigation. It’s becoming much more commonplace. But there is no research showing that gadolinium contrast is safe in the long term. In fact there are several very troublesome studies which indicate that gadolinium and gadolinium contrast agents are mutagenic (can cause cells to mutate into cancer cells), and that they cause mitochondrial toxicity.

And gadolinium contrast agents aren’t even necessary to look at the heart and blood vessels. They can now perform non-contrast MRIs and use the FBI technique to digitally manipulate the images. This can  give the same amount of information as using contrast agents. But the non-contrast scans are cheaper, faster, and safer. So why aren’t they the industry standard?!

What do you think of the increased incidence of cancer in young people with congenital heart disease?

You can read more in the article here.

Let’s start a conversation about this below. Did you know that damage to the metabolism can increase your risk of cancer?

Did you ever have a cardiac MRA with gadolinium to check for congenital heart disease or degenerative heart disease, like I did

Have you developed any chronic illnesses after an MRI with gadolinium? Did your doctor ever suggest that gadolinium might have been the cause for a deterioration in your health?

If you need help recovering after a gadolinium based contrast MRI you can contact me here.

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