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Risks of Cervical Intraepithelial Neoplasia Among DES-Exposed Women

From the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and the Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and the Department of Pathology, College of Physicians and Surgeons, Columbia University, New York, New York

Abstract

The increased occurrence of cervical intraepithelial neoplasia (CIN) in women with in utero exposure to diethylstilbestrol (DES) is described. Among 335 self-referred women exposed to DES, 14.9% (50) had at least 1 cytologic smear interpreted as CIN, and 16.2% (54) had at least 1 biopsy interpreted as CIN. Excluding those with grade 1 CIN, 8.7% (29) had at least grade 2 CIN on biopsy and 4.2% (14) had biopsies interpreted as grade 3 CIN. No invasive lesions were detected. Because the problem of differentiating true intraepithelial neoplasia from morphologically indistinguishable but benign lesions in DES-exposed women remains unresolved, the authors believe a conservative approach to treatment is still indicated. This study supports the recommendation that DES-exposed women merit continued thorough gynecologic evaluation, including regular cytologic evaluation and colposcopy, with biopsies as indicated.