Vaginal epithelial changes associated with in utero DES exposure.

Abstract

To determine the true prevalence of vaginal epithelial changes in DES-exposed offspring, the National Cancer Institute funded the DESAD Project, a study designed to follow up these women for 4 years and to determine the prevalence of cancer and various other abnormalities in DES-exposed women. 3339 women have constituted the project study cohort as of 12/31/76. Each woman in the DESAD Project undergoes breast, pelvic and colposcopic examinations, as well as vaginal and cervical cytology. Details of her gynecologic, sexual, and reproductive history are also obtained. 34% of the record review participants had vaginal epithelial changes (this rate is much lower than previously reported); no clear cell adenocarcinoma nor severe dysplasia or carcinoma in situ of either the vagina or cervix had been found in any of the women participants. A multivariate analysis of various factors of participant history and examination findings indicate that timing of onset of exposure to DES; total dosage of DES; duration of DES exposure; and age at initial examination correlated with vaginal epitheliel changes. Vaginal epithelial changes were also found to occur less frequently after 26 years of age. Maternal history (indication for use of DES); maternal age; and exposure to other hormones did not correlate with vaginal epithelial changes. The DESAD Project is currently investigating the changes in vaginal epithelium over time, and is also examining women for any evidence of neoplasia of the lower reproductive tract.