Congenital diethylstilbestrol-associated vaginal/cervical adenosis (DES babies)
Barclay, D.L.
Journal of the Arkansas Medical Society 75(12): 451-452
1979
ISSN/ISBN: 0004-1858 PMID: 156173 Document Number: 154056
An epidemiologic study of clear cell vaginal adenocarcinoma in young women (15-22 years old) showed an apparent association with maternal ingestion of diethylstilbestrol (DES) during 1st trimester pregnancy. In 1971, a Registry of Clear Cell Adenocarcinoma of the Genital Tract in Young Females was established, and shortly thereafter the Food and Drug Administration warned that DES and chemically related nonsteroidal estrogens were contraindicated during pregnancy. DES-exposed females have a 0.14 to 1.4/1000 risk of developing adenocarcinoma of the cervix/vagina by age 24. Diagnoses of these cancers usually are made in girls between the age of 14 and 23 years with peak incidence at age 19; data further shows that DES is an incomplete carcinogen and that additional factors contribute to its carcinogenesis. About 20% of DES-exposed women will have a deformity of the upper vagina/cervix, and approximately 95% will have abnormal columnar epithelium on the cervix/upper vagina. 75% of patients whose mothers were exposed to DES in utero during the 8th week of gestation or earlier will have vaginal adenosis; 7% will have this finding if the mother's exposure occurred after the 17th week. Recent reports also indicate a high incidence of abnormalities in the uterus/oviducts associated with gross changes in the upper vagina/cervix. Asymptomatic girls who had DES exposure in uteru should have a complete annual pelvic examination at menarche or by age 14 years. Younger girls who develop abnormal vaginal bleeding/discharge should also have a periodic thorough examination and Pap smear, as well as palpation of the entire length of the vagina/cervix. So far, cervical/vaginal adenocarcinoma has been diagnosed at initial examination, with the ratio of vaginal to cervical adenocarcinoma being almost 2:1. There is no standard therapy yet for adenocarcinoma of young women. Treatment is on a case to case basis, and prognosis depends on the stage of the disease when diagnosed.