Hormonal Time Bomb?

Beginning in 1946, pregnant women with histories of spontaneous abortions were frequently treated with diethylstilbestrol, an artificial hormone. No one knows the number of miscarriages prevented by stilbestrol among the many thousands of women who took it; by 1960, questions about the estrogen compound's efficacy had induced most doctors to avoid it in treating pregnant women. But there is no doubt that in at least a handful of cases, daughters of women so treated have fallen victim to vaginal cancer. The mothers' use of stilbestrol is suspected of planting a hormonal time bomb that can be deadly 15 or 20 years later.

Unlike the cervix, the vagina is rarely the site of cancer. In women under 50, vaginal cancer had been virtually unknown. Now at least a score of cases in teen-agers and women up to age 22 have been found in the U.S. The first seven, all detected since 1966, were reported a year ago by Drs. Arthur Herbst and Robert Scully of Boston's Vincent Memorial Hospital, the women's division of Massachusetts General. Another Boston doctor discovered an eighth case. The doctors then could not even hazard a guess to explain this sudden cluster of rarities. Moreover, all but one of the cancers were of a cell type different from that found in older women. So Herbst teamed with fellow Gynecologist Howard Ulfelder and Disease Detective David Poskanzer to do some backtracking.

Common Factor. The investigators reviewed the medical backgrounds of the victims and the pregnancy histories of their mothers. None of the cancer patients had used contraceptive pills. Nor were their mothers' experiences with breastfeeding, exposure to X rays or smoking habits any different from the average. But seven of the eight patients' mothers had one thing in common: they had been considered vulnerable to miscarriage and had been given stilbestrol.

Since the three doctors published their findings in the New England Journal of Medicine, five more cases have been found in New York and two more in the Boston area. Similar reports are trickling in from medical centers elsewhere. So far, only two of the patients are known to have died. Their cancers had spread too widely for surgery or radiation to be successful. All the other patients underwent major surgery and are now apparently well.

Unknown Mechanism. The Boston investigators do not claim to have proved that stilbestrol treatment was the cause of the cancers. But the evidence is so strong that Hollis S. Ingraham, New York State's commissioner of health, has sent a letter to 37,500 doctors warning them that synthetic estrogenic hormones should not be prescribed during pregnancy. He added that young women with irregular vaginal bleeding (usually attributed to ovulation failure) should be carefully checked for precancerous signs. Ingraham has also suggested to the U.S. Food and Drug Administration that it forbid outright the prescribing of stilbestrol during pregnancy. This type of compound is still considered valuable for men with prostate cancer and for some cases of breast cancer.

No one knows the mechanism by which the medication may affect the developing sex organs in a female fetus. How many such cancers may develop in later years cannot be estimated because none of the potential victims is over 25. But all authorities agree that on the basis of present evidence, the risk for today's teen-agers is extremely low. Is it possible that women now taking estrogens for other medical reasons are endangering their children? The chances of that should be negligible because the current estrogen treatments involve small doses, whereas the stilbestrol formerly prescribed during pregnancy was taken in much larger quantities.

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