DES exposure Flashcards
What is DES?
Diethylstilbestriol is an oestrogen given to women in the 1950-1980s to reduce adverse pregnancy outcomes. In the end there was no evidence of benefit, and the practice stopped as DES was linked to rare vaginal/cervical clear cell cancers.
What are the effects for women who took DES?
- Increased risk breast ca
What are the effects for women who were exposed in utero to DES?
- uterine abnormalities (T-shape cavity, hypoplasia, intracavity synechiae)
- Cervical abnormalities (hypoplasia, cervical hood, collar or polyps)
- Consequently subfertility, miscarriage and preterm birth
- increased vaginal and cervical clear cell cancer (40x increase risk)
- increased risk of high grade CIN/VAIN
- increased risk of breast cancer
- increased risk of premature menopause
What are the effects for men who were exposed in utero to DES?
- epididymal cysts
- hypogonadism
- undescended testes (2%)
- NO increase in rate of testicular cancer, except that relate to undescended testes
What is the ongoing health advice for women who used DES?
- Enrol in regular breast screening program through BreastScreen Aoteroa, for 2 yearly screening from 45-69 years
- Should be advised to inform their children they were exposed to DES
What is the ongoing health advice for females who were exposed in utero to DES?
- Ix and documentation for uterine/cervical structural abnormality
- Annual gynaecology review, including colposcopy of cervix and vagina, cervical smear and HrHPV co-testing, and bimanual examination
- Enrol in regular breast screening program through BreastScreen Aoteroa, for 2 yearly screening from 45-69 years
What is the ongoing health advice for males who were exposed in utero to DES?
- Investigate and document any testicular abnormality
- Surgery if required for undescended testis in early childhood
What proportion of clear cell carcinoma of the cervix are due to DES? And HrHPV?
2/3 associated with DES exposure
1/3 associated with HrHPV
