Increased risk of testicular cancer in sons

Diethylstilbestrol (DES) Update: Recommendations for the Identification and Management of DES-Exposed Individuals, 2003

Abstract

An increased risk of testicular cancer in sons exposed to DES has not been ruled out or confirmed.

Depue et al. conducted a case control study of 108 cases of testicular cancer in men under 30 years old and found a relative risk of 8.0 for testicular cancer in DES sons compared with men who were not exposed to DES in utero.

An unpublished study by Sant et al. in 1985 found 3 of 11 DES-exposed sons with rete testis cancer, noteworthy because this type of cancer is exceedingly rare in the general population, typically occurring in men over age 50. (The rete testis is a discrete cell structure within the testicle.)

The most definitive clinical evidence of the association between in utero exposure to DES and testicular cancer was found in a prospective study of 3,613 men including four different DES cohorts. These investigators found elevated levels of testicular cancer among men exposed to DES in utero compared with men enrolled in the study who were not exposed to DES in utero (RR 3.05; 95% CI 0.65-22.0), a finding that was slightly more than in population-based rates.(RR 2.04; 95% CI 0.82-4.20). However, the increases were not statistically significant. The investigators concluded

“it is highly unlikely that DES exposure plays a major role in the increases in testicular cancer rates that have been observed in developed countries over the past 60 years.”

Nonetheless, they conclude that the findings of the study did

“lend support to the hypothesis that the prenatal hormonal environment may influence the development of testicular cancer in adults.”

Because some studies show that DES-exposed men have an increased prevalence of undescended and hypoplastic testicles, it is important for health care providers to remember that these conditions of themselves are secondary risks for testicular cancer.

References

  • Diethylstilbestrol (DES) Update: Recommendations for the Identification and Management of DES-Exposed Individuals, Journal of Midwifery & Women’s Health, medscape, 2003.
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