Factors Associated with a Lack of Pap Smear Utilization in Women Exposed In Utero to Diethylstilbestrol

Abstract

Background: Women in the1940s-1960s were prescribed diethylstilbestrol (DES), a nonsteroidal estrogen, to prevent miscarriages, but the practice was terminated after it was discovered that the daughters so exposed in utero were at increased risk for developing clear cell adenocarcinoma (CCA) of the vagina or cervix at early ages. Pap smear screening is one of the principal methods used to identify tumor development and is necessary in this group of women to maintain their health. Currently, little is known about the factors associated with nonutilization of this screening tool in this high-risk population of women. Methods: National cohort data from the National Cancer Institute (NCI) DES Combined Cohort Follow-up Study during 1994, and 2006 were used to determine which factors were associated with Pap smear screening nonutilization in 2006 among DES-exposed and unexposed women. Self-reported questionnaire data from 2,861 DES-exposed and 1,027 unexposed women were analyzed using binary logistic regression models. Results: DES exposure, not having a previous gynecologic dysplasia diagnosis, lack of insurance, originating cohort, increasing age, and previous screening behavior were all factors associated with not reporting a Pap smear examination in the 2006 questionnaire, although college education reduced nonutilization. Conclusions: Understanding which factors are associated with not acquiring a screening exam can help clinicians better identify which DES-exposed women are at risk for nonutilization and possibly tailor their standard of care to aid in the early detection of cervical and vaginal adenocarcinomas in this high-risk group.

A Rare Case of Clear Cell Cervical Carcinoma to a Woman, 50 Years After Diethylstilbestrol Exposure for Lactation Suppression

“…That might mean that we could miss patients with a clear cell adenocarcinoma of the cervix as there is no correlation with HPV. There is currently no screening for in utero DES exposure for women, although they belong in a high-risk group [ 17 ]. In research papers investigating the correlation of in utero des exposure with cervical cancer, there is a higher documented risk for CIN2+.…”

“…A study in France also suggested annual screening of cervix and vagina for these women and that it continues beyond 65-years of age and after hysterectomy with cytological examination [ 19 ]. We would need to tailor the screening program and identify those few individuals with DES exposure to aid in the early detection of cervical and vaginal adenocarcinomas [ 17 ]. Recurrence of CCAC has been reported as long as 20 years after primary therapy, emphasizing the importance of prolonging follow up.…”