January 3, 1986

The Incidence of Cervical and Vaginal Dysplasia After Exposure to DES

Author Affiliations

The Sloane Hospital for Women New York

JAMA. 1986;255(1):36-37. doi:10.1001/jama.1986.03370010038013

To the Editor.—  With regard to the article entitled "Increased Incidence of Cervical and Vaginal Dysplasia in 3,980 Diethylstilbestrol-Exposed Young Women" by Robboy et al,1 I wish to point out that the data may have a bias that makes them difficult to interpret. I believe the conclusion that there is an increased incidence of cervical intraepithelial neoplasia (CIN) in diethylstilbestrol (DES)-exposed women may be unwarranted.As we have pointed out previously2 the metaplastic epithelium in DES-exposed women is more commonly cytologically atypical than in non-DES-exposed women, and it is frequently overdiagnosed as CIN. In addition, when the human papilloma virus (HPV) infects a metaplastic epithelium, it commonly produces the appearance of high-grade CIN and leads to erroneous diagnoses.3 It is now generally agreed4 that HPV is usually, and possibly always, present in cervical squamous cell cancers and their precursors and that it may be difficult for