Prenatal diethylstilbestrol exposure and cancer risk in women.
Level 3 - non-randomized controlled study
Non-randomized cohort follow-up study comparing exposed to unexposed individuals and population rates.
PubMed 29124779 · doi:10.1002/em.22155
What was done
Cancer risk among women prenatally exposed to diethylstilbestrol (DES) was evaluated in the Diethylstilbestrol Combined Cohort Follow-up. The study calculated age- and calendar-year-specific standardized incidence ratios (SIR) relative to general population rates and hazard ratios (HR) adjusted for birth year and cohort relative to an unexposed cohort.
What was found
Clear cell adenocarcinoma (CCA) incidence was markedly elevated in exposed women (SIR 27.6; 95% CI 7.51-70.6). Pancreatic cancer incidence was elevated compared to the general population (SIR 2.43; 95% CI 1.21-4.34), with an adjusted HR of 7.16 (95% CI 0.84-61.5) versus unexposed controls. Breast cancer showed a small excess compared to population rates (SIR 1.17; 95% CI 1.01-1.36) but not internally (adjusted HR 1.05; 95% CI 0.79-1.41). Endometrial cancer showed reduced risk among the exposed (SIR 0.61; 95% CI 0.35-0.98; adjusted HR 0.45; 95% CI 0.22-0.93). Overall cancer risk was not elevated compared to the general population (SIR 1.06; 95% CI 0.95-1.17) or unexposed controls (adjusted HR 1.03; 95% CI 0.84-1.25).
Why it matters
This study reinforces the high risk of clear cell adenocarcinoma and identifies potential excess risks for pancreatic and breast cancers in DES-exposed daughters, while showing no broad increase in overall cancer risk.
Limits
The abstract does not state the total sample size, number of cancer cases, or person-years of follow-up. Rare outcomes such as pancreatic cancer had very wide confidence intervals, indicating substantial imprecision.
Cited by
- supports Diethylstilbestrol (DES) taken during pregnancy caused cancer in children born to those women.