Upper reproductive tract radiographic findings in DES-exposed female offspring

Wc, Nunley; Tl, Pope; Bg, Bateman

doi:10.2214/ajr.142.2.337

Cited by 5 publications

(2 citation statements)

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“…Endometrial cancer incidence was significantly lower in the exposed than in the general population; this would not be due to greater prevalence of hysterectomies in the exposed women, as we were able to account for that in the comparisons to unexposed participants. DES associated hypoplasia of the uterus [Kaufman et al, ; Kaufman, ; Nunley et al, ] could explain the lower risk in the exposed women, however, there was no difference in the HRs for DES and endometrial cancer in parous and nulliparous women, with the latter more likely to have uterine abnormalities. Pancreatic cancer incidence was elevated in exposed women compared with population rates and was highly elevated, but not statistically significant, compared with unexposed women.…”

Section: Discussionmentioning

confidence: 99%

Prenatal diethylstilbestrol exposure and cancer risk in women

Troisi

Hatch

Titus

et al. 2017

Environ and Mol Mutagen

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In the Diethylstilbestrol [DES] Combined Cohort Follow-up, the age- and calendar-year specific standardized incidence ratio [SIR] for clear cell adenocarcinoma [CCA] was 27.6 (95% confidence interval [CI] 7.51-70.6) for the exposed women. The SIR for breast cancer was 1.17 (95% CI 1.01-1.36) and the hazard ratio [HR] adjusted for birth year and cohort for comparison with the unexposed was 1.05 (95% CI 0.79-1.41). The SIR for pancreatic cancer was 2.43 (95% CI 1.21-4.34) and the adjusted HR for comparison with unexposed women was 7.16 (95% CI 0.84-61.5). There was little evidence of excess risk for other sites. There appeared to be a deficit in risk for endometrial cancer among the exposed (SIR 0.61; 95% CI 0.35-0.98), and an excess in the unexposed (SIR 1.55; 95% CI 0.95-2.40); the adjusted HR was 0.45 (95% CI 0.22-0.93) for the internal comparison. There was no overall excess cancer risk in exposed women compared with general population rates (1.06; 95% CI 0.95-1.17) or with unexposed participants (adjusted HR 1.03; 95% CI 0.84-1.25). These data do not support the suggestion that there is a diathesis of cancers in DES exposed female offspring The excess risk of breast and pancreatic cancers that we observed is concerning and warrants continued follow-up and mechanistic investigation. Environ. Mol. Mutagen, 2017. Published 2017. This article is a US Government work and is in the public domain in the USA.

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Section: Discussionmentioning

confidence: 99%

Prenatal diethylstilbestrol exposure and cancer risk in women

Troisi

Hatch

Titus

et al. 2017

Environ and Mol Mutagen

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“…Of these, 729 were duplicates and 1674 were excluded after reading the title and abstract as they were not related to T‐shaped uterus (Figure 1). We evaluated 132 potentially eligible records in full text, of which 112 were excluded because T‐shaped uterus was related to DES exposure ( n = 64) 5,13–75 ; the article was not related to T‐shaped uterus ( n = 26) 76–101 ; the study included fewer than 10 women with a T‐shaped uterus ( n = 15) 4,102–115 ; no detailed results for T‐shaped uterus were reported ( n = 4) 116–119 ; and the article was a descriptive review ( n = 3) 120–122 . Therefore, 20 studies were eventually included in this systematic review 2,9,123–140 (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Neto

Ludwin

Martins³

2021

Ultrasound in Obstet & Gyne

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Objectives To summarize in a systematic review the current evidence regarding definitions, diagnosis, prevalence, etiology, clinical relevance and impact of surgical treatment for T‐shaped uterus not related to diethylstilbestrol (DES) exposure, and to highlight areas on which future research should focus. Methods A search of PubMed, Scopus and EMBASE was performed on 9 April 2020 using the search terms ‘t‐shaped OR t‐shape OR infantile OR (lateral indentation) OR (diethylstilbestrol OR DES) AND (uterus OR uterine OR uteri) AND (anomaly OR anomalies OR malformation OR malformations)’. Additionally, the reference lists of the included studies were searched manually for other relevant publications. All studies presenting data on T‐shaped uterus not associated with DES exposure and including at least 10 women were considered eligible. Studies regarding DES‐related T‐shaped uterus were excluded because DES has not been used since 1971. There were no restrictions on language, date of publication or status of publication. Results Of 2504 records identified by the electronic search, 20 studies were included in the systematic review. The majority of studies were of poor quality. In 11 of 16 studies reporting on the diagnosis of T‐shaped uterus, the diagnostic method used was three‐dimensional ultrasound. There is no consensus on the definition of T‐shaped uterus, but the most cited criteria (4/16 studies) were of the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy (ESHRE/ESGE; 2013). The prevalence of T‐shaped uterus varied from 0.2% to 10% in the four included studies reporting such data. With respect to etiology (except for DES), T‐shaped uterus was considered a primary condition in three studies and secondary to adhesions in five and adenomyosis in one. T‐shaped uterus was related to worse reproductive outcome based on subfertility (nine studies), miscarriage (seven studies), preterm delivery (two studies), ectopic pregnancy (one study) and repeat implantation failure (seven studies). Of the 12 studies that reported on the effects of surgical treatment of T‐shaped uterus by hysteroscopic metroplasty, some mentioned an improvement in pregnancy rate (rates ranging from 49.6% to 88%; eight studies), live‐birth rate (rates ranging from 35.1% to 76%; seven studies) and term‐delivery rate (four studies) and a reduction in miscarriage (rates ranging from 7% to 49.6%; five studies) and ectopic pregnancy (one study). However, the evidence is of very low quality with serious/critical risk of bias toward overestimating the intervention effect. Some authors reported no complications related to the procedure, while others mentioned persistence of the dysmorphism (rates ranging from 1.4% to 11%; three studies), bleeding (1.3%; one study), infection (2.6%; one study) and adhesions (11.1% and 16.8%; two studies). Conclusions The prevalence, etiology and clinical relevance, with respect to reproductive outcome, of T‐shaped uterus remain unclear and there is no conse...

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Ovaries and Fallopian Tubes: Normal Findings and Anomalies

Forstner

2017

MRI and CT of the Female Pelvis

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Upper reproductive tract radiographic findings in DES-exposed female offspring

Cited by 5 publications

References 5 publications

Prenatal diethylstilbestrol exposure and cancer risk in women

Prenatal diethylstilbestrol exposure and cancer risk in women

Definition, prevalence, clinical relevance and treatment of T‐shaped uterus: systematic review

Ovaries and Fallopian Tubes: Normal Findings and Anomalies

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