DES – An Endocrine Disruptor

An interesting NEJM article on the 40th anniversary of the seminal journal article on DES serves as a potent reminder of the potential effects of exposure to endocrine disruptors during critical times in development.

Beginning in the early 1960′s 1940’s, DES, a synthetic estrogen compound, was given to women in early pregnancy to prevent miscarriages. Females born from these pregnancies had an increased risk of a rare vaginal cancer during childhood, increased rates of uterine malformations that can cause infertility and premature birth, and are at a moderately higher risk for breast cancer. Use of DES in pregnant women stopped in the early 1970’s.

The lessons learned from the DES story are powerful. Endocrine disruptors may cause alterations in the reproductive tract that have severe consequences and form the basis of disease in adults decades later. Endocrine disruptors may come not only from ingested medicines, but potentially also from the environment through food. It is very difficult to recognize a teratogenic consequence of a prenatal exposure when the malformation does not manifest until 20 years later.

I’d actually never made the mental connection between DES and endocrine disruptors, and yet of course, that’s exactly how DES  functioned in this case. Remarkable, how a brief drug exposure during early gestation can lead to a cancer arising over a decade later.

An important reminder, indeed, as we begin to awaken to the possible endocrine effects of chemicals such as BPA that we are using on a daily basis without really knowing how they may be affecting us in the long term.

___________________________________________________

The CDC has a very comprehensive consumer site on DES