Hatch E E, Palmer J R, Titus-Ernstoff L, Noller K L, Kaufman R H, Mittendorf R, Robboy S J, Hyer M, Cowan C M, Adam E, Colton T, Hartge P, Hoover R N
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7362, USA.
JAMA. 1998 Aug 19;280(7):630-4. doi: 10.1001/jama.280.7.630.
The association between in utero exposure to diethylstilbestrol (DES) and clear cell adenocarcinoma (CCA) of the vagina and cervix is well known, yet there has been no systematic study of DES-exposed daughters to determine whether they have an increased risk of other cancers. As many as 3 million women in the United States may have been exposed to DES in utero.
To determine whether women exposed to DES in utero have a higher risk of cancer after an average of 16 years of follow-up.
A cohort study with mailed questionnaires and medical record review of reported cancer outcomes.
A cohort of 4536 DES-exposed daughters (of whom 81% responded) and 1544 unexposed daughters (of whom 79% responded) who were first identified in the mid-1970s.
Cancer incidence in DES-exposed daughters compared with population-based rates and compared with cancer incidence in unexposed daughters.
To date, DES-exposed daughters have not experienced an increased risk for all cancers (rate ratio, 0.96; 95% confidence interval [CI], 0.58-1.56) or for individual cancer sites, except for CCA. Three cases of vaginal CCA occurred among the exposed daughters, resulting in a standardized incidence ratio of 40.7 (95% CI, 13.1-126.2) in comparison with population-based incidence rates. The rate ratio for breast cancer was 1.18 (95% CI, 0.56-2.49); adjustment for known risk factors did not alter this result.
Thus far, DES-exposed daughters show no increased cancer risk, except for CCA. Nevertheless, because exposed daughters included in our study were, on average, only 38 years old at last follow-up, continued surveillance is warranted to determine whether any increases in cancer risk occur during the menopausal years.
子宫内暴露于己烯雌酚（DES）与阴道和宫颈透明细胞腺癌（CCA）之间的关联已为人熟知，但尚未对暴露于DES的女儿们进行系统研究，以确定她们是否有患其他癌症的风险增加。在美国，多达300万妇女可能在子宫内暴露于DES。
确定子宫内暴露于DES的妇女在平均16年的随访后是否有更高的癌症风险。
一项队列研究，通过邮寄问卷和审查报告的癌症结局的医疗记录。
一组4536名暴露于DES的女儿（其中81%作出回应）和1544名未暴露的女儿（其中79%作出回应），她们于20世纪70年代中期首次被识别。
将暴露于DES的女儿的癌症发病率与基于人群的发病率进行比较，并与未暴露女儿的癌症发病率进行比较。
迄今为止，除CCA外，暴露于DES的女儿们并未经历所有癌症的风险增加（率比，0.96；95%置信区间[CI]，0.58 - 1.56）或个别癌症部位的风险增加。在暴露的女儿中发生了3例阴道CCA，与基于人群的发病率相比，标准化发病率为40.7（95% CI，13.1 - 126.2）。乳腺癌的率比为1.18（95% CI，0.56 - 2.49）；对已知风险因素进行调整并未改变这一结果。
到目前为止，除CCA外，暴露于DES的女儿们未显示出癌症风险增加。然而，由于我们研究中纳入的暴露女儿在最后一次随访时平均仅38岁，因此有必要继续进行监测，以确定在绝经期间是否会出现任何癌症风险增加。
