Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States).
OBJECTIVE
Women exposed prenatally to diethylstibestrol (DES) have an excess risk of clear-cell adenocarcinoma of the vagina and cervix, but the effect on the incidence of squamous neoplasia is uncertain. The purpose of the current study was to evaluate the long-term risk of developing high-grade squamous neoplasia of the genital tract among women exposed prenatally to DES.


METHODS
A cohort comprising 3,899 DES-exposed and 1,374 unexposed daughters was followed for 13 years (1982 1995) for pathology-confirmed diagnoses of high-grade squamous intraepithelial neoplasia (HSIL) of the genital tract. Poisson regression analysis was used to compute relative risks (RR) and 95% confidence intervals (95% CI), adjusting for age, calendar year, and other covariates.


RESULTS
The RR (95% CI) among DES-exposed versus unexposed, based on 111 cases of high-grade disease, was 2.1 (1.2-3.8). Adjustment for screening history estimated by the number of years since the last Pap smear had little effect. Risk estimates were higher with earlier intrauterine exposure; the RR (95% CI) for exposure within 7 weeks of the last menstrual period was 2.8 (1.4-5.5). Only two cases of invasive squamous cervical cancer occurred in total, precluding separate analysis.


CONCLUSIONS
The findings support an association between in-utero DES exposure and high-grade squamous neoplasia, although a role for more intensive screening among DES-exposed women in the production of this excess could not be completely ruled out.
Hatch
E E
EE
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA. eehatch@bu.edu
Herbst
A L
AL
Hoover
R N
RN
Noller
K L
KL
Adam
E
E
Kaufman
R H
RH
Palmer
J R
JR
Titus-Ernstoff
L
L
Hyer
M
M
Hartge
P
P
Robboy
S J
SJ
D002294:Carcinoma, Squamous Cell / Q000139:chemically induced* / Q000453:epidemiology; D015331:Cohort Studies; D004054:Diethylstilbestrol / Q000009:adverse effects*; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D014625:Vaginal Neoplasms / Q000139:chemically induced* / Q000453:epidemiology
D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol