Diethylstilbestrol and adenocarcinoma of the vagina

Abstract

In the latter 1960s, 7 young women with vaginal cancers were treated in New England, primarily at the Massachusetts General Hospital. They were unique because of their young age (15-22 years) and the histologic characteristics of these vaginal tumors (clear cell adenocarcinomas). Dr Robert E. Scully and 11 published a clinicopathologic study of these tumors, and at that time their association with prenatal exposure to diethylstilbestrol (DES) was not known. We were aware, however, that the 7 cases exceeded the total number of these rare tumors in young women that could be identified in the world literature up to that time. These patients had been treated by the senior gynecologists at the Massachusetts General Hospital, Drs Howard Ulfelder (Chairman of Gynecology), Francis Ingersoll, and Thomas Green. As a junior facultymember, I also had been involved in their care. The mother of one of the patients related to Dr Ulfelder her concern that her prenatal care had included ingestion of DES, and she believed this may have been responsible for her daughter's tumor. A case-control epidemiologic study was planned to investigate the sudden occurrence of a cluster of these rare tumors in the Boston area. Dr David C. Poskanzer, a neurologist, was recruited because of his epidemiologic training, and Dr T.C. Colton, of the Harvard School of Public Health, was also consulted for his advice in the statistical design of the epidemiologic investigation. By the time the study had begun, there was an eighth patient who had also been treated elsewhere in Boston. We selected as controls for each patient 4 daughters from the birth records of New England hospitals in which the 8 patients had been born. A comprehensive epidemiologic questionnaire was designed to investigate the maternal, paternal, and patient health histories of the 8 subjects and 32 control subjects. During the course of the administrat ion of the questionnaire, another mother from the original 7 patients, whose daughter had died of the tumor, spontaneously reported that she ...had taken DES during pregnancy and felt certain it was the cause of her daughter's cancer. The results of this study, which were published in the New England Journal of Medicine in 1971,2 showed that 7 of the 8 mothers of the daughters with cancer had taken DES for the treatment