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Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States)

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Abstract

Objectives: 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 3899 DES-exposed and 1374 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.

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Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    E. E. Hatch, R. N. Hoover & P. Hartge

  2. Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA

    A. L. Herbst

  3. Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester, MA, USA

    K. L. Noller

  4. Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA

    E. Adam & R. H. Kaufman

  5. Slone Epidemiology Unit, Boston University School of Public Health, Boston, MA, USA

    J. R. Palmer

  6. Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    L. Titus-Ernstoff

  7. Information Management Services, Rockville, MD, USA

    M. Hyer

  8. Departments of Pathology and Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

    S. J. Robboy

Authors
  1. E. E. Hatch
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  2. A. L. Herbst
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  3. R. N. Hoover
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  4. K. L. Noller
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  5. E. Adam
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  6. R. H. Kaufman
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  7. J. R. Palmer
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  8. L. Titus-Ernstoff
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  9. M. Hyer
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  10. P. Hartge
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  11. S. J. Robboy
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Hatch, E.E., Herbst, A.L., Hoover, R.N. et al. Incidence of squamous neoplasia of the cervix and vagina in women exposed prenatally to diethylstilbestrol (United States). Cancer Causes Control 12, 837–845 (2001). https://doi.org/10.1023/A:1012229112696

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  • DOI: https://doi.org/10.1023/A:1012229112696

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