Environment and Breast Cancer: Science Review

Evidence From Humans
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Cancer risk in women exposed to diethylstilbestrol in utero
Hatch, E. E., Palmer, J. R., Titus-Ernstoff, L., Noller, K. L., Kaufman, R. H., Mittendorf, R., Robboy, S. J., Hyer, M., Cowan, C. M., Adam, E., Colton, T., Hartge, P., Hoover, R. N. JAMA. 1998. 280:7, 630-4.
Topic area
Early life exposures
Study design
Retrospective cohort
Study Participants
Menopausal Status
The menopausal status of women included in this study is listed here.
Number in Cohort
Cohort: 6080 (4326 exposed and 1544 unexposed)
Participant selection: Inclusion and exclusion criteria
Criteria used to select participants in the study.
National Cooperative Diethylstilbestrol Adenosis (DESAD), the Dieckmann cohort, and the Horne cohort In: Women participating in DESAD or Dieckmann, or daughters of women who were treated with DES by an infetility specialist in Boston, MA area (Horne). Women not exposed to DEX in utero in the DESAD cohort were selected from the same record sources as the exposed subjects or were sisters of exposed subjects. Unexposed women in Horne cohort were unexposed sisters of exposed women whose mothers were treated with DES during pregnancy.
Comment about participation selection
Enlarged sample size as a multi-center study. Limitations: The study was able to achieve complete follow-up on only 80% of the eligible study population. The study population were relatively young, leading to a limited expected number of breast cancer.
Exposure Investigated
Exposures investigated
In utero exposure to DES
How exposure was measured
DESAD: prenatal record review or self-referral or referred by physician Dieckmann cohort: randomly assigned in a randomized clinical trial Horne cohort: treatment during pregnancy
Exposure assessment comment
Different approaches to assess exposure were used: medical record review, self-referral and referred by physician. No validation data were presented.
Statistical Analysis
Breast cancer outcome investigated
Primary incident breast cancer
Ethnic groups with separate analysis
If this study provided a separate analysis by ethnic or racial group, the groups are listed here.
Confounders considered
Other breast cancer risk factors, such as family history, age at first birth, and hormone replacement therapy use, that were taken into account in the study.
BMI, race, parity, menopausal status, alcohol consumption, and family history of breast cancer
Genetic characterization included
If the study analyzed relationships between environmental factors and inherited genetic variations, this field will be marked “Yes.” “No”, if not.
Description of major analysis
SIRs and 95% confidence intervals were calculated as the ratio of observed number of cases to the expected number of cases. Expected number of cases was computed using age- and calendar year-specific incidence rates for white women to the appropriate pers
Strength of associations reported
All women: SIR=1.19 (0.83, 1.72)
Results Comments
The study found no overall difference in breast cancer incidence between women exposed to DES in utero and those who were not exposed.
Author address
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7362, USA.