Abstract

PIP:

A DES (diethylstilbestrol) Task Force formed in February by the Office of the Assistant Secretary for Health, examined the health effects of DES in pregnancy. This report is an outline of the Task Force's recommendations. Physicians should advise women to whom they prescribe the drugs of their exposure and of the need for follow-up medical care for themselves and their offspring. Physicians are also to provide patients inquiring of possible past DES exposure, complete and accurate information whenever possible, and such information should be provided free of charge. The incidence of clear cell adenocarcinoma for DES-exposed daughters is between 1.4/100 to 1.4/10,000. Periodic examination, rather than active therapeutic intervention (e.g., surgery) is recommended for patients with adenosis. For asymptomatic DES daughters, periodic screening examinations should start at age 14 or at menarche; vaginal bleeding/discharge should be promptly evaluated. Hystersosalpingography should not be used as a routine screening procedure in DES daughters but should be reserved for cases of repeated pregnancy loss or infertility. Asymptomatic DES mothers should have routine screening (e.g., annual pelvic exam including bimanual palpation and Pap smear; breast exam) appropriate for women with no prior estrogen exposure. DES exposed males have been known to have: 1) history of cryptochirdism; 2) hypoplastic testes; 3) epididymal cysts; and, 4) sperm abnormalities (low sperm counts, decreased motility). DES males should have physical examination, appropriate medical follow-up or corrective measures, as the case may be. Use of DES postcoital contraception should be limited to situations where the fully informed patient or her physician deems that there is no alternative. For more information, contact the Office of Cancer Communications, National Cancer Institute, NIH, 9000 Rockville Pike, Bethesda, Maryland 20014.