Identification and management of DES-exposed women

Diethylstilbestrol (DES), a synthetic estrogen compound, was prescribed to many women with history of miscarriage between the years 1940 and 1971. As a result of prolonged use of DES in gynecological practice, an estimated 1 million to 1.5 million women were exposed prenatally, resulting in multiple upper and lower genital tract abnormalities. These anomalies may affect reproductive function and place women at greater risk for developing clear cell adenocarcinoma (peak incidence at age 19) and squamous cell carcinoma of the vagina and cervix (peak incidence at ages 35 to 40). Emphasis has been placed on screening for clear cell adenocarcinoma rather than squamous cell carcinoma and reproductive alterations. Despite the previous emphasis during the 1970s and a subsequent decline in public and practitioner awareness, women are at risk for the known effects of DES exposure until the year 2010. Greater effort must be made by practitioners to identify and screen for DES exposure in their practices, as well as to educate the public regarding the health risks posed by DES exposure so that affected women may be reached and receive care.