The higher risk group of DES-exposed women need early detection of cervical and vaginal adenocarcinomas
2015 Study Abstract
Women in the 1940s-1960s were prescribed Diethylstilbestrol (DES), a nonsteroidal estrogen, to prevent miscarriages, but the practice was terminated after it was discovered that the daughters so exposed in utero were at increased risk for developing clear cell adenocarcinoma (CCA) of the vagina or cervix at early ages. Pap smear screening is one of the principal methods used to identify tumor development and is necessary in this group of women to maintain their health. Currently, little is known about the factors associated with nonutilization of this screening tool in this high-risk population of women.
National cohort data from the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study during 1994, 1997, 2001, and 2006 were used to determine which factors were associated with Pap smear screening nonutilization in 2006 among DES-exposed and unexposed women. Self-reported questionnaire data from 2,861 DES-exposed and 1,027 unexposed women were analyzed using binary logistic regression models.
DES exposure, not having a previous gynecologic dysplasia diagnosis, lack of insurance, originating cohort, increasing age, and previous screening behavior were all factors associated with not reporting a Pap smear examination in the 2006 questionnaire, although college education reduced nonutilization.
Understanding which factors are associated with not acquiring a screening exam can help clinicians better identify which DES-exposed women are at risk for nonutilization and possibly tailor their standard of care to aid in the early detection of cervical and vaginal adenocarcinomas in this high-risk group.
Factors associated with a lack of pap smear utilization in women exposed in utero to diethylstilbestrol, NCBI PMID: 25768943, J Womens Health (Larchmt). 2015 Apr;24(4):308-15. doi: 10.1089/jwh.2014.4930. Epub 2015 Mar 13.
Cervical cancer is not just a young woman’s disease…
Cervical screening programmes in many countries stop at around the age of 65 and much of the focus is often on younger women. For example, recent media campaigns in England and Wales have centred on lowering the age at first screening. Comparatively little attention has been given to older women despite the fact that they account for about a fifth of cases each year and half of deaths. Of the 3121 women diagnosed on average each year between 2009 and 2011 in the UK, only 64 were younger than 25 compared with 616 who were older than 65. As the population ages, this number of older women affected is set to increase. Susan Sherman and colleagues argue that screening programmes should reflect this.
Sources and more information
Cervical cancer is not just a young woman’s disease, BMJ 2015;350:h2729, 15 June 2015.
Review calls for urgent change to perception of cervical cancer risk in older women, Keele University, 15 June 2015 .
Cervical cancer screening: review calls for urgent screening changes, medicalnewstoday, 16 June 2015.
Reminding people of the importance of smear tests by sharing your lipstick smear selfie for Cervical Cancer Prevention Week
What is #SmearForSmear?
Smear tests (cervical screening) save 5,000 lives a year yet one in five women who are eligible to attend do not take up their invitation.
For young women aged 25-29 this rises to one in three.
#SmearForSmear allows you to remind people of the importance of smear tests by sharing your lipstick smear selfie and nominating your friends to do the same.
Together we can help prevent cervical cancer.
Put on your lipstick.
Smear your lipstick and take a selfie.
Use #SmearForSmear and @JoTrust then nominate a friend.