Breast cancer following diethylstilbestrol exposure in utero : a tragedy ?

Breast cancer following diethylstilbestrol exposure in utero: insights from a tragedyauthor reply to Dr. Bluming, who has been compensated on an hourly basis for testimony as an expert witness on behalf of defendant, Pfizer Pharmaceuticals, in DES litigation.

We thank Dr. Tournaire and his colleagues for sharing data on diethylstilbestrol (DES) doses prescribed in France. This information supports the notion that DES was prescribed in lower doses and for shorter periods during pregnancy in Europe than in the US. It would be particularly interesting to know whether any women in the French cohort developed vaginal epithelial changes as a marker of high-dose exposure. And it is unfortunate that the small size of the French cohort (110 women) does not allow an informative analysis of breast cancer risk.

Although we realize that our opinion may not be appreciated in some quarters, Dr. Bluming’s denial of the indicated statistical significance in the NCI cohort is strange. We can only encourage readers to scrutinize the two most informative studies and develop their own opinion. Exclusion of one component cohort in the most recent study, due to lack of information on vaginal epithelial changes as a marker of high exposure, reduces statistical power but does not compromise the validity of the study. Although we are fortunate to have one high quality, competently analyzed prospective study, causal inference is challenging as discussed in our Commentary.

Definition of a tragedy is obviously a subjective process. We doubt, however, that the millions of women who were prescribed a useless drug with several harmful effects would disagree with our judgment.

Dr. Adami, consultant in litigation on behalf of DES daughters claiming breast cancer injury due to DES exposure.

Sources

  • Breast cancer following diethylstilbestrol exposure in utero: a tragedy?, NCBI PubMed, European journal of epidemiology PMID: 22860252, 2012 Apr.
  • Featured image credit gofundme.
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