Diethylstilbestrol (DES) Update: Recommendations for the Identification and Management of DES-Exposed Individuals

Summary

The National Cancer Institute estimates that between 5 and 10 million people were exposed to DES in the United States between 1938 and 1971, with the most widespread use occurring between 1946 and 1960. Use of this drug was not evidence based and was eventually found to be not only ineffective in improving pregnancy outcomes but harmful to the women and their offspring who were exposed. An estimated absolute risk of clear cell cancer is 1:1000 in DES-exposed daughters. Genital tract abnormalities cause increased rates of infertility, ectopic pregnancies, spontaneous abortions, and preterm births. There is a modest increased risk for breast cancer for the women who took DES during their pregnancies. Sons exposed in utero to DES have increased rates of genital and sperm abnormalities, but they have not experienced an increased rate of infertility. Although these risks are known, it is clear that DES has long-term effects that may develop over time. The health effects of DES exposure that may impact DES-exposed persons as they age are unknown; therefore, it is essential that health care providers continue to identify persons exposed to DES and continue to offer increased surveillance. By learning of the most recent and relevant DES research, women's health care providers are in an excellent position to help identify, educate, care for, refer, and follow DES-exposed women in their practices.

Special thanks to Stephanie Lent of the University of Wisconsin Center for Women's Health and Women's Health Research and to Tekoa King, editor of this journal for their unending support in this process.

J Midwifery Womens Health. 2003;48(1) © 2003  Elsevier Science, Inc.