Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Prevention and Control, 4770 Buford Highway, NE, Mailstop K55, Atlanta, GA 30341-3717, USA.
Cancer Causes Control. 2012 Jan;23(1):207-11. doi: 10.1007/s10552-011-9855-z. Epub 2011 Oct 21.
Although the association between in utero exposure to diethylstilbestrol (DES) and clear cell adenocarcinoma of the cervix and vagina (CCA) was first reported among young women, subsequent case reports and cohort studies suggest that an elevated risk for CCA may persist with age. Data from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology and End Results (SEER) Program were used to construct indirect standardized incidence ratios (SIR) comparing CCA risk among women born during the exposure period 1947 through 1971, when DES was prescribed to pregnant women, to the relevant time period for nonexposed women born before or after DES exposure period. CCA incidence among the women born before the DES exposure period (ages 30-54 at diagnosis of CAA) or after the DES exposure period (ages 15-29 at diagnosis) were used to calculate the expected rates for women born during the DES exposure period. Among women aged 15-29 years, CCA risk increased with age and peaked in the 25-29 year age group, but the risk estimates were unstable (SIR = 6.06; 95% CI: 0.97, -251.07, SEER data). Among women aged 40-54 years, CCA risk was greatest in the 40-44 year age group (SIR = 4.55; 95% CI: 1.11, 40.19, SEER data and SIR = 3.94; 95% CI: 1.06, 33.01, NPCR/SEER data) and remained significantly elevated throughout this age group in the combined data set. Risk was not elevated among women aged 30-39 years. The observed risk of CCA, if causally related to DES exposure, reflects a persistent health impact from in utero exposure that is widespread in the general population. When assessing a woman's cancer risks, whether her mother took DES while pregnant may still be a relevant aspect of the medical history for women born during the period of DES use in pregnancy.
虽然子宫内暴露于己烯雌酚（DES）与宫颈和阴道透明细胞腺癌（CCA）之间的关联最初是在年轻女性中报告的，但随后的病例报告和队列研究表明，CCA 的风险可能会随着年龄的增长而持续增加。国家癌症登记处（NPCR）和监测、流行病学和最终结果（SEER）计划的数据被用来构建间接标准化发病率比（SIR），比较 1947 年至 1971 年 DES 被用于孕妇的暴露期间出生的女性与未暴露于 DES 暴露期间出生的女性在相关时期的 CCA 风险。在 DES 暴露期间出生的女性（诊断为 CAA 时年龄为 30-54 岁）或 DES 暴露后出生的女性（诊断时年龄为 15-29 岁）的 CCA 发病率用于计算 DES 暴露期间出生的女性的预期发病率。在 15-29 岁年龄组的女性中，CCA 风险随年龄增长而增加，并在 25-29 岁年龄组达到峰值，但风险估计不稳定（SIR = 6.06；95%CI：0.97，-251.07，SEER 数据）。在 40-54 岁年龄组的女性中，CCA 风险在 40-44 岁年龄组最大（SIR = 4.55；95%CI：1.11，40.19，SEER 数据和 SIR = 3.94；95%CI：1.06，33.01，NPCR/SEER 数据），在合并数据集的整个年龄组中，风险仍然显著升高。在 30-39 岁年龄组的女性中，风险没有升高。如果 CCA 的观察到的风险与 DES 暴露有关，那么这反映了普遍存在于普通人群中的子宫内暴露的持续健康影响。在评估女性的癌症风险时，她的母亲在怀孕期间是否服用 DES 可能仍然是她在怀孕期间使用 DES 期间出生的女性病史的一个相关方面。
