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Cervical Screening and General Physical Examination Behaviors of Women Exposed In Utero to Diethylstilbestrol

Camp, Elizabeth A. MSPH1; Coker, Ann L. PhD1; Troisi, Rebecca ScD2; Robboy, Stanley J. MD3; Noller, Kenneth L. MD4; Goodman, Karen J. PhD1; Titus-Ernstoff, Linda T. PhD5; Hatch, Elizabeth E. PhD6; Herbst, Arthur L. MD7; Kaufman, Raymond H. MD8,9; Adam, Ervin MD8,10

Journal of Lower Genital Tract Disease: April 2008 - Volume 12 - Issue 2 - p 111-117
doi: 10.1097/LGT.0b013e31815ae980
Original Articles

Objective. To estimate whether women exposed in utero to diethylstilbestrol (DES) report receiving more cervical and general physical examinations compared to unexposed women.

Materials and Methods. 1994 Diethylstilbestrol Adenosis cohort data are used to assess the degree of recommended compliance of cervical screenings found in 3,140 DES-exposed and 826 unexposed women. Participants were enrolled at 4 sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data, which included reported frequency over the preceding 5 years (1990-1994) of Papanicolaou smears and general physical examinations.

Results. Diethylstilbestrol-exposed women exceeded the recommended frequency of Papanicolaou smear screenings [adjusted odds ratio (aOR) = 2.15, 95% CI (confidence interval) = 1.60-2.88] compared to the unexposed. This association held among those without a history of cervical intraepithelial neoplasia (aOR = 1.88, 95% CI = 1.35-2.62). Diethylstilbestrol-exposed women exceeded annual recommendations for physical examinations (aOR = 2.27, 95% CI = 1.16-4.43) among women without a history of chronic disease when compared to unexposed women.

Conclusions. Most DES-exposed women are receiving cervical cancer screening at least at recommended intervals, but one third of the women are not receiving annual Papanicolaou smear examinations.

In keeping with provider recommendations for reproductive cancer screening, diethylstilbestrol-exposed women reported more frequent Papanicolaou screening and physical examinations than did unexposed women.

1School of Public Health, University of Texas Health Science Center, Houston, TX, 2Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 3Departments of Pathology and Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, 4Department of Obstetrics and Gynecology, University of Massachusetts Medical Center, Worcester, MA, 5Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, 6Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, 7Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, 8Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, 9Department of Obstetrics and Gynecology, Methodist Hospital, Houston, TX, and 10Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX

Reprint requests to: Raymond H. Kaufman, MD, 6550 Fannin, Suite 900, Houston, TX 77030. E-mail:

This study was supported by the National Cancer Institute under contract #1-CP-21166.

©2008The American Society for Colposcopy and Cervical Pathology