title: DES daughters in France: experts' points of view on the various genital, uterine and obstetric pathologies, and in utero DES exposure.
abstract: BACKGROUND
  Compensation of diethylstilbestrol exposure depends on the judicial system. In France, girls having been exposed to diethylstilbestrol are currently being compensated, and each exposure victim is being evaluated. Fifty-nine expert evaluations were studied to determine the causal relation between exposure to diethylstilbestrol and the pathologies attributable to diethylstilbestrol.
  
  
  METHODS
  The following were taken into consideration: age at the first signs of the pathology; age of the sufferer at the time of evaluation; the pathologies grouped into five categories: fertility disorders - cancers - mishaps during pregnancy - psychosomatic complaints - pathologies of "3rd generation DES victims"; submission of proof of DES exposure; the degree of causality determined (direct, indirect, ruled out).
  
  
  RESULTS
  61% of the cases related to fertility disorders, 28.8% to cancer pathologies (clear-cell adenocarcinoma), 18.6% to mishaps during pregnancy, 8.5% to disorders resulting from preterm delivery, and 3.4% to psychosomatic disorders. Some cases involved a combination of two types of complaints. Indirect causality was determined in 47.1% of the cases involving primary sterility, in 66.7% involving secondary sterility, and in 5 out of 6 cases of total sterility. There is direct causality between in utero diethylstilbestrol exposure and vaginal or cervical clear cell adenocarcinoma. Causality is indirect in the case of disorders linked to prematurity in third generation victims.
  
  
  CONCLUSIONS
  Causality was determined by the experts on the basis of scientific criteria which attribute the presenting pathologies to diethylstilbestrol exposure. When other risk factors come into play, or when exposure is indirect (third generation), this causality is diminished.
authors.affiliation: Laboratoire de Médecine Légale, Université de Nantes, France renaud.clement@univ-nantes.fr.
authors.forename: R
authors.initials: R
authors.lastname: Clement
authors.affiliation: Laboratoire de Médecine Légale, Université de Nantes, France Unit of Forensic Medicine, CHU Angers, France.
authors.forename: E
authors.initials: E
authors.lastname: Guilbaud
authors.affiliation: Laboratoire de Médecine Légale, Université de Nantes, France.
authors.forename: L
authors.initials: L
authors.lastname: Barrios
authors.affiliation: Unit of Forensic Medicine, CHU Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Rougé-Maillart
authors.affiliation: Unit of Forensic Medicine, CHU Angers, France.
authors.forename: N
authors.initials: N
authors.lastname: Jousset
authors.affiliation: Laboratoire de Médecine Légale, Université de Nantes, France.
authors.forename: O
authors.initials: O
authors.lastname: Rodat
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D035881:Compensation and Redress / Q000331:legislation & jurisprudence; D004054:Diethylstilbestrol / Q000009:adverse effects*; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007247:Infertility, Female / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D011297:Prenatal Exposure Delayed Effects; D002583:Uterine Cervical Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D014625:Vaginal Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D004968:Estrogens, Non-Steroidal; D004054:Diethylstilbestrol
keywords: DES daughters; clear-cell adenocarcinoma; fertility disorders; link of causality; mishaps during pregnancy; pathologies of 3rd generation DES victims