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Patients Who Are DES Daughters
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Most persons exposed to DES have not experienced
negative health consequences. However, it has been clearly demonstrated
that women exposed to DES in utero (DES Daughters) have an increased
risk of reproductive tract structural differences, pregnancy complications,
infertility, and clear cell adenocarcinoma (CCA) of the vagina and
cervix. Although the majority of cases of CCA in DES Daughters occur
before the age of 35, cases have been documented in women in their
40s (179). Therefore, it is essential to identify and continue to
screen all DES Daughters for CCA. Studies of midlife and later health
effects on persons exposed to DES in utero have not yet been completed.
Therefore, it is possible that identifying DES Daughters now may
allow for interventions if additional health risks are identified
as DES Daughters age.
In the United States, DES was prescribed primarily to prevent spontaneous
abortion and premature delivery between 1938 and 1971 (12). Never
patented, it was prescribed under more than 200 different brand
names under a variety of dosage regiments, including in combination
with vitamins (290). DES was shown to lack efficacy for prevention
of pregnancy complications in 1953 (291). However, it was still
widely prescribed until it was demonstrated, in the early 1970s,
that women exposed to DES in utero (DES Daughters) developed clear
cell adenocarcinoma (CCA) of the vagina and cervix at a rate significantly
higher than the general population (132,157).
Although public education campaigns were undertaken, not all DES
Daughters know about their exposure. DES was been prescribed to
pregnant women outside the United States after 1971, and is still
available in oral form for human use in some countries today (294).
For more information on the drug DES, including details of current
usage, refer to DES: Pharmacology.
Some women may be aware that their mother was prescribed DES while
pregnant. Others may report their mother had a history of recurrent
miscarriage and/or took medication to prevent miscarriage or preterm
labor between the years of 1938 and 1971. The youngest women exposed
to DES in utero are now in their 30s. The oldest are over 60 years
of age. Most have no health problems linked to DES. Others may exhibit
reproductive tract abnormalities, including vaginal adenosis (Figure
8), a cervical cockscomb (Figure 5) and
vaginal ridges (39,42,46,47,49,50,52,77,80,87,98,105,106,183). Of
these, vaginal adenosis and a T-shaped uterus (Figure 7), are most highly associated with in utero DES exposure.
Clear cell adenocarcinoma (CCA) of the vagina and cervix (Figure
2), is a very rare cancer that occurs more
commonly and at younger ages in women exposed to DES (132). Patients
who present with CCA, particularly before the age of 40, may have
been exposed to DES in utero.
DES Daughters should be encouraged to discuss the issue with their
mothers, and, when possible, obtain their mother's obstetrical records.
This is of particular importance since the health risks to women
exposed to DES in utero are still partially unknown. Many women
who were prescribed DES while pregnant are elderly. If their children
and grandchildren are not informed of their potential risk, opportunities
for future intervention may be lost.
For a complete list of the numbered citations
on this page see DES References.
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