Diethylstilbestrol revisited: a review of the long-term health effects, 1995
The association between in utero DES exposure and the development of testicular cancer is controversial.
An increased risk for testicular tumors was observed in studies of mice exposed to DES, and an increased incidence of cryptorchidism, a strong risk factor for testicular cancer, has been observed in DES sons.
Several cases of testicular cancer in men exposed to DES have been reported , and two cohort studies have each reported one case of testicular teratoma.
The findings from six case-control studies that have examined the association between DES exposure in utero (or exposure to any exogenous hormone) and testicular cancer have been mixed.
On the basis of interviews with mothers of 79 men with testicular cancer that was diagnosed between 1972 and 1974 and interviews with 79 matched controls, Henderson and associates found a relative risk of 5.0 (P = 0.11; CI not given) for any hormone use during the pregnancy.
Schottenfeld and colleagues reported that drug use was associated with a relative risk of 1.96 (CI, 0.8 to 4.3) for bleeding, spotting, or threatened miscarriage during the pregnancy; however, 45% of case mothers and 63% of control mothers could not recall the specific drug taken.
In a study of 108 cases diagnosed in California between 1973 and 1979 and 108 matched controls, Depue and coworkers found that any exogenous hormone use during the first trimester was associated with an eightfold increased relative risk for testicular cancer; however, only two case mothers reported receiving DES.
In contrast to these suggestive studies, three studies have found no effects of DES exposure on the risk for testicular cancer.
Moss and colleagues reported an odds ratio of 0.9 for use of exogenous hormones during pregnancy; DES exposure, reported by four case mothers and two control mothers, resulted in a nonsignificant odds ratio of 2.0.
Similarly, Brown and associates found an odds ratio of 0.8 for hormone use, and Gershman and Stolley) reported an odds ratio of 0.8 for the receipt of drugs used to prevent miscarriage.
Problems common to these studies include the lack of documentation to confirm exposure and the difficulty of maternal recall of exposures during pregnancy. The relatively young age of the cohort at the time of study could also have precluded detection of an increased risk for testicular cancer, which in the general population peaks in the fourth decade of life.
Although these studies probably rule out a high level of risk, they are based on fairly small numbers, which may preclude the detection of a low to moderate increase in risk associated with DES. No other cancer sites in men have been implicated.
- Diethylstilbestrol revisited: a review of the long-term health effects, Annals of internal medicine, NCBI PubMed, PMID: 7717601, 1995.
- Featured image Jordan Whitfield.