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Latest Developments in DES Issues Welcome to the latest update to www.deslaw.com, the website of Patricia Martin Stanford, P.A., Attorney at Law. Since my last update, there have been many important medical, legal, and political developments relating to DES exposure. Please browse through the following materials which I am sure will be of interest to DES-exposed individuals and their families. I encourage and invite your response to any of the issues discussed herein. Feel free to email me at pmslaw1@aol.com. Index DES and Breast Cancer: A new study was recently released which finally examines the risk of breast cancer in DES daughters. The study is published in the October 2002 issue of the journal, Cancer Causes and Control, a publication of the Harvard Center for Cancer Prevention, Harvard School of Public Health. Cancer Causes and Control 13: 753-758, 2002. © 2002 Kluwer Academic Publishers. Click here to view/download the study (pdf format). You can also receive a full text copy of the breast cancer study by calling my office at 904-733-1732 or by faxing a request to 904-739-2347. Latest Studies Involving DES. Two very important and long-awaited studies are finally in print and are the strongest evidence yet of the real difficulties DES daughters suffer in becoming and maintaining pregnancy. Also...a Netherlands study finds DES daughters there with a significantly higher rate of non-clear cell cervical cancer...and...the male counterpart to the third generation mouse study. Kaufman, et al. "Continued Follow-up of Pregnancy Outcomes in Diethylstilbestrol-exposed Offspring". OBSTET GYNECOL, Oct 2000; 96:483-489. This is the latest update of the ongoing DESAD/Dieckmann cohorts. While not providing a lot of new information, the study reinforces what we've long known, i.e., that DES daughters have significant difficulties in maintaining pregnancy. What is most important about the study is the strength of the statistical association between DES and various pregnancy outcomes. DES daughters were at least twice as likely to suffer spontaneous abortion, almost three times more likely to have preterm delivery, almost four times as likely to have at least one ectopic pregnancy, and more than four times as likely to suffer second-trimester losses. While first trimester losses were also more common among DES daughters, the incidence was not as statistically significant. The good news is that 64% of the exposed women had a successful full-term first pregnancy; however, this was as compared to almost 85% of the unexposed. Moreover, a successful first pregnancy outcome was not a predictor of subsequent successful pregnancies. As the authors state, "even if it is assumed that DES was no longer used in pregnancy after 1971 in the United States (which is not actually the case), there are still many DES-exposed women of reproductive age. Thus, it is important for obstetrician-gynecologists to be aware of the consequences of DES exposure in utero on pregnancy outcome." If your doctor seems to be in any way hesitant to treat you as a high-risk pregnancy patient, bring him this article and make sure it becomes a part of your chart! (Call or email me for a copy.) Palmer, Hatch, et al. "Infertility Among Women Exposed Prenatally to Diethylstilbestrol" AM J EPIDEM, Jun 2000, Supp 10, SER Abstracts #38. While only the abstract of this study is in print at the moment, even the limited data cited is of tremendous interest to DES daughters dealing with infertility. The study works off the same cohorts as used in the pregnancy article above. The study's findings indicate that exposed women were 1 ½ times more likely than unexposed women to have never been pregnant and more than 2 times more likely to have spent more than 12 months in unsuccessful efforts to become pregnant. DES daughters were more than twice as likely to suffer infertility than the unexposed, primarily due to uterine problems, tubal problems, and more than one type of problem. Ovulatory and hormonal factors as a cause of infertility among the DES-exposed was elevated, but not statistically significant. These findings are especially important in the context of DES product liability litigation. Prior to this study, the medical literature studying the relationship between DES exposure and infertility was controversial and came to quite opposite conclusions. The larger studies actually showed no difference in fertility between exposed and non-exposed women. While many practicing reproductive endocrinologists believed that DES exposure impacted fertility, they could point to few studies in support of this conclusion. Many other doctors relied on those negative studies for the opinion that DES did not affect fertility. While there is still quite a difference of opinion among these clinicians, this study is strong evidence of the connection between DES and infertility. It is hoped that the full study will be in print within the next year so that we can learn the full extent of its findings. Verloop, et al. "Prevalence of Gynecologic Cancer in Women Exposed to Diethylstilbestrol in Utero." NEJM, Jun 2000, 342:24, 1838-39. The results of this study conducted in the Netherlands was published as a letter to the editor in the prestigious New England Journal of Medicine. Contrary to the most recent American study published which found no increased risk of cancer--other than clear cell adenocarcinoma-in DES daughters (see Hatch, et al. "Cancer Risk in Women Exposed to Diethylstilbestrol in Utero", JAMA 1998; 280:630-34.), this study found a dramatic increase in non-clear cell cervical cancer. DES daughters in the study reported over a 5-fold increase in invasive cervical cancer. The authors reiterated findings from a 1984 DESAD study which showed that the risk of squamous cell dysplasia and carcinoma in situ was doubled in DES daughters (see Robboy, et al. "Increased evidence of cervical and vaginal dysplasia in 3,980 DES-exposed young women: experience of the National Collaborative Diethylstilbestrol Adenosis Project. JAMA 1984; 252:2979-88.), and suggested that additional, larger studies are needed to confirm their observations. Newbold, et al. "Proliferative lesions and reproductive tract tumors in male descendants of mice exposed developmentally to diethylstilbestrol." CARCINOGENESIS, Jul 2000, 21:7, 1355-63. This is the analog to the Newbold's previous study which examined female "grandchildren" of DES-exposed mice. As in that study, she found that the male "grandchildren" also suffered an increased incidence of reproductive tract tumor development. She concluded that "increased susceptibililty for tumors is transmitted from the DES 'grandmothers' to subsequent generations." CONTINUE TO EDUCATE YOUR DOCTOR. For those of you new to this site or new to the knowledge that you are DES-exposed, it can't be said enough that you must be vigilant about your own health care...alert your doctor to your exposure, demand the 4-quadrant vaginal Pap if he or she does not typically perform it, and EDUCATE your doctor about the risks and effects of DES exposure. Infertility Claims. A study found a strong association between DES exposure and infertility (see "Your Health" section of this update.) For those exposed women struggling with fertility problems, or those who have done so in the past, this study will provide new and stronger medical evidence to support legal claims for infertility caused by DES. In particular, it found that DES daughters were more than twice as likely as unexposed women to try unsuccessfully for twelve months or more to become pregnant. These findings may be important to discuss with your doctor in determining the type or duration of infertility workup you should undergo. Act Now. President Bush promises a strong push for tort reform legislation as he spearheaded in Texas. The goal of his party is a two-year, national statute of limitation. With this and other tort reform measures on the horizon, your chance to bring a DES claim is threatened more each day. If you think you may have a valid claim for DES-related injuries, you should contact an experienced attorney as soon as possible to avoid having your claim barred by the statute of limitations. Get Your Records. I've said it before, but I'll say it again! For anyone considering a DES lawsuit, it is to your advantage to attempt to ascertain as much information as possible about the drug your mother took. For example, you should try to obtain your mother's prenatal medical records from her obstetrician or your birth hospital, learn the name and address of the pharmacy where the drug was obtained, and find out the names and addresses of any pharmacists or employees of the pharmacy patronized by your mother. DES Sons. DES Sons have a new online opportunity to confidentially discuss issues related to their exposure. The DES Sons list serve, developed in conjunction with DES Action, can be accessed by visiting http://www.egroups.com/group/des-sons. Pregnancy List Serve. DES daughters with pregnancy questions may want to join a special list serve for those who are currently pregnant, trying to conceive, or considering a future pregnancy. Sign up by visiting http://www.onelist.com/subscribe/despregnancies.
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