[DES Daughter--expertise remains necessary]

Area of Science:

• Endocrinology
• Gynecology
• Oncology

Background:

• Synthetic estrogen diethylstilbestrol (DES) was prescribed to pregnant women in the Netherlands until the late 1970s, despite known toxicity risks since the 1950s.
• DES Daughters, offspring of these pregnancies, were monitored for genital abnormalities and clear cell adenocarcinoma (CCA).

Purpose of the Study:

• To re-evaluate the long-term health monitoring needs of DES Daughters.
• To emphasize the importance of continued screening for non-oncological late effects and specific cancers.

Main Methods:

• Review of historical DES prescribing practices and associated health risks.
• Analysis of current screening recommendations for DES Daughters.
• Emphasis on the limitations of general cervical cancer screenings for detecting DES-related conditions.

Main Results:

• The risk of clear cell adenocarcinoma decreases with age, altering the focus of periodic check-ups.
• Standard cervical cancer screenings are inadequate for detecting clear cell adenocarcinoma.
• Non-oncological late effects of DES require ongoing medical attention.

Conclusions:

• DES Daughters require specialized, regular cytological check-ups (every 2 years until age 60) by their general practitioner.
• Physicians must maintain vigilance for both oncological and non-oncological late effects of prenatal DES exposure.
• Continued monitoring is essential due to the inadequacy of general cancer screenings for detecting DES-related malignancies.