Context: The association between in utero exposure to diethylstilbestrol (DES) and clear cell adenocarcinoma (CCA) of the vagina and cervix is well known, yet there has been no systematic study of DES-exposed daughters to determine whether they have an increased risk of other cancers. As many as 3 million women in the United States may have been exposed to DES in utero.
Objective: To determine whether women exposed to DES in utero have a higher risk of cancer after an average of 16 years of follow-up.
Design: A cohort study with mailed questionnaires and medical record review of reported cancer outcomes.
Participants: A cohort of 4536 DES-exposed daughters (of whom 81% responded) and 1544 unexposed daughters (of whom 79% responded) who were first identified in the mid-1970s.
Main Outcome Measures: Cancer incidence in DES-exposed daughters compared with population-based rates and compared with cancer incidence in unexposed daughters.
Results: To date, DES-exposed daughters have not experienced an increased risk for all cancers (rate ratio, 0.96; 95% confidence interval [CI], 0.58-1.56) or for individual cancer sites, except for CCA. Three cases of vaginal CCA occurred among the exposed daughters, resulting in a standardized incidence ratio of 40.7 (95% CI, 13.1-126.2) in comparison with population-based incidence rates. The rate ratio for breast cancer was 1.18 (95% CI, 0.56-2.49); adjustment for known risk factors did not alter this result.
Conclusions: Thus far, DES-exposed daughters show no increased cancer risk, except for CCA. Nevertheless, because exposed daughters included in our study were, on average, only 38 years old at last follow-up, continued surveillance is warranted to determine whether any increases in cancer risk occur during the menopausal years.
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Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada; Stollery Children's Hospital, 8440 112 St, Edmonton, AB, T6G2B7, Canada; Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, Hubei, PR China. Electronic address:
Diethylstilbestrol (DES) was an orally active estrogen prescribed to the pregnant women to prevent miscarriages. DES is known as a 'biological time bomb' and long-term effects of DES have been recorded in the mothers exposed to DES and their offspring (DES-daughters and DES-sons). Adverse pregnancy outcomes, infertility, cancer, and early menopause have been discovered in women exposed to DES, and some events occur in their offspring and subsequent generations.
View Article and Find Full Text PDFPrenatal diethylstilbestrol exposure and high-grade squamous cell neoplasia of the lower genital tract.
Am J Obstet Gynecol
September 2016
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD.
Background: Prenatal diethylstilbestrol (DES) exposure is associated with an excess risk of clear-cell adenocarcinoma of the vagina and cervix, and of high-grade squamous neoplasia.
Objective: We explored whether neoplasia risk remains elevated among DES-exposed women as they age.
Study Design: In all, 4062 DES-exposed and 1837 unexposed daughters were followed for approximately 30 years (1982 through 2013) for pathology-confirmed diagnoses of cervical intraepithelial neoplasia grade ≥2 (CIN2+) of the lower genital tract (n = 178).
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