Diethylstilboestrol (DES): Screening guidelines for women exposed in utero to diethylstilboestrol (DES)

Diethylstilboestrol, or DES (also known as stilboestrol), is a synthetic oestrogen which was used between 1940 and the early 1970s to prevent miscarriage in women with a previous poor pregnancy outcome.

In the early 1970s, cases of a rare form of vaginal adenocarcinoma (clear cell adenocarcinoma) were reported in young women exposed to DES in utero ("DES daughters")¹.

In June 2004 the TGA in association with the Adverse Drug Reactions Advisory Committee (ADRAC) published² information on other adverse effects associated with DES that have been identified in DES daughters. This publication advised any women with a history of exposure to DES (mothers and daughters) to follow the current national cervical and breast screening recommendations.

The current cervical screening recommendations were published by the National Health and Medical Research Council (NHMRC) in June 2005, "Screening to Prevent Cervical Cancer: Guidelines for the Management of Asymptomatic Women with Screen Detected Abnormalities". These guidelines contain a specific section regarding women exposed in utero to diethylstilboestrol (DES). The guidelines advise that women with DES exposure should be offered annual cytological screening and colposcopic examination of both the cervix and the vagina. Screening should begin any time at the woman's request and continue indefinitely. A balanced perspective should be maintained. DES-exposed women who have a screen-detected abnormality should be managed in a specialist centre by an experienced colposcopist.

In February 2008, the National Breast and Ovarian Cancer Centre published a position statement*; based on a review of the published literature, suggesting that exposure to DES in utero may increase the risk of breast cancer. The statement concludes that: "While the precise estimation of the magnitude of this risk is limited by the lack of adequate follow-up, the direction of the effect, its relationship to age and its consistency of association with other breast cancer risk factors all support the potential for this link to be present".

More information on DES is available at the Cancer Council of New South Wales - Diethylstilbestrol (DES) and Cancer*; or at NSW Health - DES (Diethylstilboestrol or Stilboestrol)*.

References

1. Herbst AL, Ulfelder H, Poskanzer DC. Adenocarcinoma of the vagina - Association of maternal stilboestrol therapy with tumour appearance in young women. N Engl J Med 1971; 284: 878.
2. The legacy of diethylstilboestrol (DES) from the 50s and 60s, Australian Adverse Drug Reactions Bulletin, Volume 23, Number 3, June 2004