Increased incidence of cervical and vaginal dysplasia in 3,980 diethylstilbestrol-exposed young women. Experience of the National Collaborative Diethylstilbestrol Adenosis Project
S. J. Robboy, K. L. Noller, P. O'Brien, R. H. Kaufman, D. Townsend, A. B. Barnes, J. Gundersen, W. D. Lawrence, E. Bergstrahl, S. McGorray and al. et
The incidence rates of dysplasia and carcinoma in situ (CIS) of the cervix
and vagina were determined in 3,980 young women exposed prenatally to
diethylstilbestrol. Strict criteria were developed to minimize selection
bias among the subset of 744 pairs of matched exposed and unexposed
(control) cohort participants, all of whom were identified through review
of prenatal obstetrical records. A high degree of compliance was achieved
throughout the seven-year study period since in each group about 90% of the
women remained as active participants, kept 77% of the annual anniversary
examinations, and had separate Papanicolaou smears of the cervix and vagina
performed in 99% of the anniversary examinations. The incidence rate for
dysplasia and CIS was significantly higher in the women exposed to
diethylstilbestrol than in those not exposed in the matched cohort (15.7 v
7.9 cases per 1,000 person-years of follow-up). The rates were higher in
the exposed women if squamous metaplasia extended to the outer half of the
cervix or onto the vagina. In other respects, the matched cohorts were
strikingly similar.
