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Abstract & Commentary
Synopsis: Not one of 28 third-generation DES-exposed women had lower genital tract changes.
Source: Kaufman RH, Adam E. Obstet Gynecol. 2002; 99:197-200.
In 1974, the national cancer institute funded a large multicenter project with the purpose of identifying, examining, and following women whose mothers had taken DES while they were in utero (DESAD Project). Many of these women had epithelial and structural changes in the lower (and upper) genital tract. Because of the results of several animal studies that suggested that the effects of DES may be multigenerational, Kaufman and Adam contacted women who had enrolled in the DESAD project who were known to have daughters older than 15 years of age and requested that the daughters (third generation, granddaughters) appear for pelvic and colposcopic examination.
A total of 28 third-generation daughters were examined. At the time of examination, they averaged 20 years of age. Not one of these women was found to have any of the epithelial or structural changes that had been seen in their mothers and other women exposed in-utero to DES. A total of 61.5% of the mothers of the women examined in this report had been noted to have vaginal and/or cervical epithelial and/or structural abnormalities.
Kaufman and Adam conclude that it is unlikely that third-generation DES daughters will have the same problems that have been reported in their mothers. However, rare events, such as vaginal adenocarcinoma, cannot be excluded.
This is an extremely important article for the approximately 2 million women who were exposed in utero to DES. Most of these women have now completed their families and many of their daughters are teenagers or older. Many of the mothers who had DES abnormalities have asked questions about the chances that their daughters would have similar problems. This article shows convincingly that the epithelial and structural abnormalities seen in their mothers either do not occur at all, or occur with low frequency.
It may never be possible to determine whether or not the third-generation women have an increased risk of vaginal adenocarcinoma as it is such a rare condition even among women exposed in utero. Certainly there will be an occasional case of vaginal clear cell cancer in third-generation women, just as there are occasional cases in the general population. I just hope that the first reported case does not cause a national scare the way the original report did.
Dr. Noller is Professor and Chairman Department of OB/GYN, Tufts University School of Medicine, Boston, Massachusetts.