Breast cancer following DES exposure in utero

Diethylstilbestrol exposure: evaluation of the doses received in France, 2012


In an analysis of two prospective studies on the relationship between DES exposure in utero and breast cancer, Adami et al. oppose a dose dependent excess risk after the age of 40 years and the absence of evidence of such an excess risk. Indeed, the American study suggested an excess risk of breast cancer for women exposed in utero aged 40 years or more. The Incidence Rate Ratio (IRR) was 1.91 (95 % CI 1.09–3.33) relative to unexposed cohorts. Nevertheless, IRR was significant for high dose exposure (IRR = 2.16, 95 % CI, 1.18–3.96) but not for low-dose exposure (IRR = 1.63, 95 % CI, 0.87–3.08) relative to unexposed cohort. The Dutch study by contrast revealed no increase of breast cancer for DES-exposed daughters.

One hypothesis that may explain these discordant results, besides possible differences in age of the cohorts and methods, concerns the differences in doses of DES given in the United States and in the Netherlands. This could stimulate a renewed interest in prescribed doses of DES, especially in Europe. Adami et al. observed that additional informative studies seem unfeasible since the use of DES ended four decades ago. However, we would like to focus on information obtained 2 or 3 decades ago on the DES doses used in France since our results seem relevant.



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