Giusti R M, Iwamoto K, Hatch E E
Division of Cancer Treatment, National Cancer Institute, Bethesda, MD 20892-2440, USA.
Ann Intern Med. 1995 May 15;122(10):778-88. doi: 10.7326/0003-4819-122-10-199505150-00008.
To review the literature on the long-term health effects of exposure to diethylstilbestrol (DES) among women prescribed DES during pregnancy (DES mothers), among their children exposed inutero to the drug (DES sons and daughters) and among the progeny of these exposed sons and daughters (DES grandchildren).
English-language articles were identified through MEDLINE and CANCERLIT searches and through review of the bibliographies of identified articles.
All human studies relevant to long-term health effects of exposure to DES were reviewed.
Descriptive data on existing DES cohorts were extracted from early publications. Risk estimates for health effects were extracted from published reports.
An estimated 5 to 10 million Americans received DES during pregnancy or were exposed to the drug in utero. Exposure to DES has been associated with an increased risk for breast cancer in DES mothers (relative risk, < 2.0) and with a lifetime risk of clear-cell cervicovaginal cancer in DES daughters of 1/1000 to 1/10,000. The association between DES exposure and testicular cancer in DES sons remains controversial. Exposure to DES has also been linked to reproductive tract abnormalities in DES sons and daughters that consist of immune system disorders and psychosexual effects. No evidence for transgenerational effects currently exists. Recommendations for screening persons exposed to DES are reviewed.
Further research is needed to define long-term health effects related to DES exposure. Such research would provide a basis for counseling persons exposed to DES and would further understanding of environmental and pharmacologic compounds similar to DES.
回顾关于孕期服用己烯雌酚（DES）的女性（DES母亲）、在子宫内接触该药物的子女（DES子女）以及这些接触过DES的子女的后代（DES孙辈）接触DES后的长期健康影响的文献。
通过医学文献数据库（MEDLINE）和癌症文献数据库（CANCERLIT）检索以及查阅已识别文章的参考文献来确定英文文章。
对所有与接触DES的长期健康影响相关的人体研究进行了回顾。
从早期出版物中提取了现有DES队列的描述性数据。从已发表的报告中提取了健康影响的风险估计值。
估计有500万至1000万美国人在孕期服用了DES或在子宫内接触过该药物。接触DES与DES母亲患乳腺癌的风险增加有关（相对风险<2.0），DES女儿患透明细胞宫颈阴道癌的终生风险为千分之一至万分之一。DES儿子接触DES与睾丸癌之间的关联仍存在争议。接触DES还与DES子女的生殖道异常有关，包括免疫系统紊乱和性心理影响。目前尚无跨代效应的证据。对接触DES者的筛查建议进行了回顾。
需要进一步研究来确定与接触DES相关的长期健康影响。此类研究将为为接触DES者提供咨询提供依据，并将进一步了解与DES类似的环境和药物化合物。
