One third of DES-exposed women are not receiving annual Pap smear examinations
DES Follow-up Study Summary
In this study we evaluated whether women who were exposed in utero to Diethylstilbestrol (DES) follow the recommendations for cervical screening and general physical examinations.
DES-exposed (3140) and unexposed women (826) from the Houston, Boston, Rochester and Los Angeles sites reported on the 1994 questionnaire how frequently over the preceding five years (1990-1994) they had Papanicolau (Pap) smears and general physical examinations.
The study found that DES-exposed women exceeded the recommended frequency of Pap smear screenings compared to unexposed women. The DES exposed women also exceeded the annual recommendations for physical examinations among women without a history of chronic disease when compared to unexposed women. Whereas most DES-exposed women are receiving cervical cancer screening at recommended intervals, a third are not having these annual Pap smear examinations.
2008 Study Abstract
Objective: To estimate whether women exposed in utero to diethylstilbestrol (DES) report receiving more cervical and general physical examinations compared to unexposed women.
Materials and Methods: 1994 Diethylstilbestrol Adenosis cohort data are used to assess the degree of recommended compliance of cervical screenings found in 3,140 DES-exposed and 826 unexposed women. Participants were enrolled at 4 sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data, which included reported frequency over the preceding 5 years (1990-1994) of Papanicolaou smearsand general physical examinations.
Results: Diethylstilbestrol-exposed women exceeded the recommended frequency of Papanicolaou smear screenings [adjusted odds ratio (aOR) = 2.15, 95% CI (confidence interval) = 1.60-2.88] compared to the unexposed. This association held among those without a history of cervical intraepithelial neoplasia (aOR = 1.88, 95% CI = 1.35-2.62). Diethylstilbestrol-exposed women exceeded annual recommendations for physical examinations (aOR = 2.27, 95% CI = 1.16-4.43) among women without a history of chronic disease when compared to unexposed women.
Conclusions: Most DES-exposed women are receiving cervical cancer screening at least at recommended intervals, but one third of the women are not receiving annual Papanicolaou smear examinations.
Cervical screening and general physical examination behaviors of women exposed in utero to diethylstilbestrol, NCBI, PMID: 18369304, 2008 Apr;12(2):111-7. doi: 10.1097/LGT.0b013e31815ae980.
A Cervical Cancer survivor, Amy Weber shares her journey of leaving her hometown to pursue her dreams in the entertain- ment industry, battling cancer twice and experiencing infertil- ity challenges. Through dedication and persistence, Amy was able to become a mom of energetic twins.
Share a little background about yourself.
What was your journey that led you to the entertainment industry?
When you moved to Los Angeles, how did you find out you had cancer?
How were you able to go through all that without a good support system?
What top advice would you share with those preparing for or currently undergoing treatment for cancer?
Now that your reproductive system was affected, what was your process of becoming pregnant?
Model, actress and billboard recording artist Amy Weber opens up about her struggle to become a mother after undergoing treatment for cervical cancer, brought on by a now banned pregnancy drug called DES. In May 2009, Amy was finally able to fulfill her dream of becoming a mother. See what she went through during her high-risk pregnancy, and meet her family!
Reproductive and Maternal Health in the Post-2015 Era: Cervical Cancer Must Be a Priority
In her Essay, Ruby Singhrao and colleagues from the University of California San Francisco, argue that the global health community is neglecting prevention, screening, and treatment for cervical cancer in low- and middle-Income Countries LMICs. They propose four arguments, each one illustrative of a larger framework that has equity and socioeconomic, gender, public health, and health services dimensions:
The Burden Falls on Women of Reproductive Age
Association with Reproductive Capacity
Cancer Prevention Can Be Integrated into HIV, Maternal Health, or Reproductive Health Services
HPV Vaccination Can Protect Girls from a Fatal Disease
They conclude that there exists feasible, affordable, and effective prevention options to make dramatic global reductions in cervical cancer incidence a realistic goal in our lifetime.
In utero DES exposure associated with severe clear-cell adenocarcinoma in DES Daughters
A variety of vaginal and cervical abnormalities have been encountered in the offspring of women who have taken stilbestrol or chemically related nonsteroidal estrogens during pregnancy.
Cervical erosion has been noted most often, but vaginal adenosis has been proven by biopsy in over 30 percent, and transverse vaginal and cervical ridges have been seen in approximately 10 percent of the exposed population. Although the use of these drugs had been widespread during the last two decades, the Registry of Clear-Cell Adenocarcinoma of the Genital Tract in Young Females has been able to collect only 170 cases of vaginal and cervical cancers of this type from all over the world.
It is important that cytologists and pathologists become familiar with the various non-enoplastic and neoplastic disorders related to these hormones in order that additional epidemiologic, clinical and pathological information be acquired without delay.
The majority of these mothers who said they did not take DES were indeed DES positive by written records…
The written obstetric records of maternal exposure to diethylstilbestrol (DES) were used as a criterion standard and compared with the DES exposure history recalled by mothers of women with vaginal, cervical, or indeterminable vaginal/exocervical clear cell adenocarcinoma. Among cervical cases, the sensitivity of maternal recall was 50% (N = 2), and its specificity was 100%. Among vaginal and vaginal/exocervical cases, this sensitivity was 72%; specificity was 60%; and the majority of these mothers who said they did not take DES were DES positive by written records. Thus investigators should avoid using maternal recall alone to measure DES exposure. Among subjects for whom written maternal obstetric records were available, 88% of vaginal cases and 46% of cervical cases were DES positive. The authors conclude that few cases of vaginal clear cell adenocarcinoma should occur in young women as the cohort of women exposed in utero to DES continues to age, whereas cases of cervical origin may continue to occur.
Clinical Human Papillomavirus Detection Forecasts Cervical Cancer Risk in Women Over 18 Years of Follow-Up
Carrying out a virus test before traditional cervical screening could prevent around 600 cases of cancer a year in England, research suggests. Scientists found that more than 40% of 8,750 women with cervical cancer had received a negative screening test result within six years of their diagnosis. They then predicted how many more cases of cervical cancer would have been avoided if human papilloma virus (HPV) testing had been used ahead of screening for abnormal cells.
KwaliteitsCriteria bij Screenings-Protocol van DES-dochters
DES Centrum: ” Het jaar 2012 heeft niet alleen in het teken gestaan van verhuizing en reorganiseren. We hebben ons ook gericht op twee projecten. Het doel van beide projecten is te komen tot optimale medische zorg voor DES-dochters. ”
Another good reason for women to have regular Pap smears.: ” Women with screen-detected cervical cancer had a 26% absolute increase in cure rate as compared with women who were symptomatic at diagnosis, results of a Swedish study showed. ”
Objective To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.
Design Nationwide population based cohort study.
Participants All 1230 women with cervical cancer diagnosed during 1999-2001 in Sweden prospectively followed up for an average of 8.5 years.
Main outcome measures Cure proportions and five year relative survival ratios, stratified by screening history, mode of detection, age, histopathological type, and FIGO (International Federation of Gynecology and Obstetrics) stage.
Results In the screening ages, the cure proportion for women with screen detected invasive cancer was 92% (95% confidence interval 75% to 98%) and for symptomatic women was 66% (62% to 70%), a statistically significant difference in cure of 26% (16% to 36%). Among symptomatic women, the cure proportion was significantly higher for those who had been screened according to recommendations (interval cancers) than among those overdue for screening: difference in cure 14% (95% confidence interval 6% to 23%). Cure proportions were similar for all histopathological types except small cell carcinomas and were closely related to FIGO stage. A significantly higher cure proportion for screen detected cancers remained after adjustment for stage at diagnosis (difference 15%, 7% to 22%).
Conclusions Screening is associated with improved cure of cervical cancer. Confounding cannot be ruled out, but the effect was not attributable to lead time bias and was larger than what is reflected by down-staging. Evaluations of screening programmes should consider the assessment of cure proportions.
It could be dangerous to use antiviral treatments or therapeutic vaccines with women whose lesions already show signs of HPV integration
A new understanding of the genetic process that can lead to cervical cancer may help improve diagnosis of potentially dangerous lesions for some women, and also raises a warning flag about the use of anti-viral therapies in certain cases – suggesting they could actually trigger the cancer they are trying to cure.