‘DES daughters’ need lifelong screening

DEAR DR. ROACH: I have a followup question regarding the risk of cervical cancer from HPV and herpes.

I have had cervical cancer and exposure to DES. You did not mention if this particular estrogen exposure is a risk factor, but I am wondering. — M.M.

ANSWER: Diethylstilbestrol, or DES, is a synthetic estrogen, which was used mostly in the 1950s and 1960s to prevent premature birth and miscarriages. It was shown to be ineffective.

Worse, in 1971, it was shown that DES increased the risk of breast cancer in the women who were given it. Worse still, the daughters born to women who had taken DES (called "DES daughters") were at risk for an unusual cancer, called "clear cell cancer of the vagina and cervix." (This is not the usual cervical cancer, which is almost always caused by HPV.)

They usually developed this cancer in their teens and 20s. However, women born to DES-treated mothers should continue to be screened for vaginal cancer their whole lives.

The risk of other cancers in DES daughters is a subject of debate. Although DES daughters do have increased risk of cervical abnormalities, there has been no clear increase in risk of the common form of cervical cancer. There also may be an increased risk for breast cancer.

Due to the uncertainty, any woman born to a DES-treated mother should get lifelong, annual screening for vaginal and cervical cancer, discuss frequency of breast cancer with her provider (who needs to know about the DES exposure) and consider becoming part of the registry at https://tinyurl.com/DESdaughters.

Men born to DES-treated women do not have an increased risk for cancer, and granddaughters of DEStreated women do not have adverse effects, as far as is known.

DEAR DR. ROACH: Can lymphoma be cured? —D.E.B.

ANSWER: There are many (over 10 different groups) lymphomas, and many are curable. Hodgkin's lymphoma is a common type of lymphoma, and is curable most of the time, though unfortunately not always.

Non-Hodgkin's lymphomas are a mixed group of diseases, and in general, aggressive types often are curable, while the slower-growing ones can be treated but not cured.

However, more and more, these cancers are being treated based not on how they look under a microscope but instead on the examination of the DNA of the tumor cells.

The prognosis depends on the exact type, and on how far advanced it is.

Keith Roach is asyndicated advice columnist and physician. Email ToYourGoodHealth@med.cornell.edu or write to them at P.O. Box 536475, Orlando, Fla., U.S.A., 32853-6475.