What synthetic estrogen exposure must be specifically asked about in family history?

• A. Whether the patient was exposed to DES in utero
• B. Whether the patient uses estrogen-containing birth control
• C. Whether the patient has a family history of breast cancer
• D. Whether the patient's mother took diethylstilbestrol (DES)

Answer: (A)

In family history and exposure screening, some prenatal exposures have distinct implications that must be asked about directly. Diethylstilbestrol (DES) is a synthetic estrogen that was prescribed to pregnant women in the past. If a patient was exposed to DES in utero, she has specific risks for reproductive tract anomalies and certain cancers, notably vaginal and cervical clear cell adenocarcinoma. Because these risks are tied to fetal exposure, the most precise question is whether the patient was exposed to DES while in the womb.

Estrogen-containing birth control relates to current medication use rather than a prenatal exposure with this particular risk profile. A general family history of breast cancer doesn’t identify DES exposure. Asking whether the mother took DES is related but indirect; the clearest, most direct way to capture this risk is asking the patient about in utero DES exposure herself.