DES investigated for testicular cancer link
Emma Patten-Hitt, PhD / Reuters 13apr01
[Journal of the National Cancer Institute 4apr01 Abstract below]
ATLANTA -- Men may face an increased risk of testicular cancer if their mother took the drug DES during pregnancy, study findings suggest.
DES, short for diethylstilbestrol, is a synthetic form of estrogen that was given to over 2 million American women to prevent miscarriage. It was introduced in 1941 but was banned in 1971. The plight of 'DES daughters' is well known; studies have shown that women whose mothers took DES have increased rates of infertility, miscarriages and cancers of the female reproductive system. But the effects of DES on men whose mothers took the drug are less well understood.
A study published in the April 4th issue of the Journal of the National Cancer Institute indicates that men may be at increased risk of testicular cancer if they were exposed to DES before birth.
William C. Strohsnitter of Tufts University School of Medicine in Boston, Massachusetts, and colleagues were interested in seeing whether DES exposure would increase the number of testicular cancer cases. They followed 3,613 men for 16 years and found that overall cancer rates among DES-exposed men were similar to those among unexposed men. But they also found that men exposed to DES might be at a threefold increased risk of developing testicular cancer compared with those who were not exposed.
However, the researchers point out that it is difficult to conclude definitively whether or not DES exposure increases the risk of testicular cancer because the number of cases of testicular cancer in the sample was so small--28 in the DES-exposed men and 21 in the unexposed men.
"Since we had so few cases we could not precisely determine testicular cancer rates," Strohsnitter, a doctoral student at Tufts and lead author of the study, told Reuters Health. "Continued follow-up may provide us with more definitive answers regarding an association between DES and testicular cancer," he said.
Strohsnitter advised that men between the ages of 20 and 50 should examine their testicles for lumps on a monthly basis regardless of whether or not their mothers took DES. "Regular self-examination by men will increase the likelihood of early detection and successful treatment," he said, pointing out that when testicular cancer is detected early enough it is a very curable disease.
"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," the authors note. But further study of these men will help determine what, if any, cancers are affected by prenatal exposure to DES, they add.
Cancer Risk in Men Exposed In Utero to Diethylstilbestrol
Journal of the National Cancer Institute, v.93, n.7, 545-551, 4apr01
Affiliations of authors: W. C. Strohsnitter, K. L. Noller, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA; R. N. Hoover, E. E. Hatch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; S. J. Robboy, Department of Pathology, Duke University Medical Center, Durham, NC; J. R. Palmer, Department of Epidemiology and Biostatistics, Slone Epidemiology Unit, Boston University School of Public Health, Brookline, MA; L. Titus-Ernstoff, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; R. H. Kaufman (Department of Obstetrics and Gynecology), E. Adam (Department of Epidemiology), Baylor College of Medicine, Houston, TX; A. L. Herbst, Department of Obstetrics and Gynecology, University of Chicago, IL.
Correspondence to: William C. Strohsnitter, M.S., Department of Obstetrics and Gynecology, New England Medical Center, North Bldg., 750 Washington St., Boston, MA 02111 (e-mail: wstrohsnitter@lifespan.org).
Background: An association between prenatal diethylstilbestrol (DES) exposure and cancer in men, especially testicular cancer, has been suspected, but findings from case–control studies have been inconsistent. This study was conducted to investigate the association between prenatal DES exposure and cancer risk in men via prospective follow-up. Methods: A total of 3613 men whose prenatal DES exposure status was known were followed from 1978 through 1994. The overall and site-specific cancer incidence rates among the DES-exposed men were compared with those of the unexposed men in the study and with population-based rates. The relative rate (RR) was used to assess the strength of the association between prenatal DES exposure and cancer development. All statistical tests were two-sided. Results: Overall cancer rates among DES-exposed men were similar to those among unexposed men (RR = 1.07; 95% confidence interval [CI] = 0.58 to 1.96) and to national rates (RR = 0.99; 95% CI = 0.65 to 1.44). Testicular cancer may be elevated among DES-exposed men, since the RRs for testicular cancer were 3.05 (95% CI = 0.65 to 22.0) times those of unexposed men in the study and 2.04 (95% CI = 0.82 to 4.20) times those of males in the population-based rates. The higher rate of testicular cancer in the DES-exposed men is, however, also compatible with a chance observation. Conclusions: To date, men exposed to DES in utero do not appear to have an increased risk of most cancers. It remains uncertain, however, whether prenatal DES exposure is associated with testicular cancer.
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