Compensation for Diethylstilbestrol Injury, an Opinion

As members of the Dutch Expert Committee on DES-related Health Effects, we respond to the Comment by Ellen ‘t Hoen and Graham Dukes on compensation for diethylstilbestrol injury.

Contrary to the opinion expressed by ‘t Hoen and Dukes, we, as well as the Dutch DES Centre, strongly believe that the recently agreed collective settlement of diethylstilbestrol claims in the Netherlands is unique and highly beneficial for Dutch diethylstilbestrol victims. Our opinion is based on the large number of diethylstilbestrol-related disorders covered and the fact that individual women do not have to start an expensive and emotionally difficult legal procedure with uncertain outcome, which could last several years. Individual women can now be compensated on the basis of medical evidence of diethylstilbestrol exposure and the presence of a diethylstilbestrol-related disorder covered by the settlement.

Compensation for diethylstilbestrol injury, the lancet Correspondence, Vol 369 April 14, 2007.

In close collaboration with the DES Centre, a careful procedure was followed before a settlement was proposed. The Expert Committee first reviewed published data on diethylstilbestrol-related health effects and decided for which disorders a causal association with diethylstilbestrol was established. We believe that no causal association has been established for breast cancer and early age at menopause in women whose mothers took diethylstilbestrol during pregnancy (“DES daughters”) because increased risks were reported in only one study. Subsequently, we determined the relative risk associated with diethylstilbestrol, on the basis of all available published data.

A unique aspect of the Dutch collective settlement is that it also allows compensation for diseases with a weak but established association with diethylstilbestrol. DES mothers (those who took diethylstilbestrol during pregnancy) have a 1·35-fold increased risk of breast cancer. This implies that the attributable risk is 26%—ie, among DES mothers with breast cancer, one in four cases can be attributed to diethylstilbestrol. Since there is no way to identify the one woman whose breast cancer was indeed caused by diethylstilbestrol, it was agreed that all (living) DES mothers who developed (or will develop) breast cancer should be compensated, taking into account the attributable risk.

The proposed collective settlement was widely publicised among those exposed to diethylstilbestrol, and, of more than 100 000 affected, the Amsterdam court received only four objections. The court validated the diethylstilbestrol agreement and ruled against the four defendants. We regret that this information was not included the Comment.

We declare that we have no conflict of interest. ”
Flora E van Leeuwen, Elisabeth J M van Erp, Theo J M Helmerhorst, Peter A M Heintz,
Department of Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, Netherland.

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