DEAR DR. ROACH: I was born in 1954, and my mother took diethylstilbestrol (DES) to prevent miscarriages. I had a hysterectomy last year, and my doctor told me I didn’t need a Pap smear ever again. I told him I wanted one, and he said “no.” Since I have my cervix, I am afraid of getting cancer, which runs in my family on both sides. Now I found out there is a study that thinks I may have passed it on to my granddaughters. — J.M.

ANSWER: The provider expertise around DES is being lost, but it’s still critically important to understand how this drug affected the women who took it (“DES mothers”), their daughters and sons (“DES daughters and sons”), and possibly their grandchildren (“DES third-generation”).

As you say, DES was used to prevent miscarriages from 1945 until it was banned in 1971, but its peak use was during 1952-1954. DES mothers are at a higher risk for breast cancer, but most surviving DES mothers are over 90 now and may no longer be getting breast cancer screenings.

DES daughters are the most affected. The major risks to DES daughters are cancers: a type of vaginal and cervix cancer called clear cell; the more common type of cervical cancer, squamous cell cancer; and possibly breast cancer. Expert groups recommend continued annual cancer testing for a DES daughter at any age even after a hysterectomy, as long as she is in otherwise good health to benefit from screening.

This is in contrast to the usual guidelines where women who have a hysterectomy for reasons other than cancer and women over 65 without a cancer history can stop cancer screening safely. I am worried your gynecologist doesn’t understand the care of DES daughters.

By the way, a hysterectomy usually does remove the cervix. More than 90% of hysterectomies performed now are “total” hysterectomies, which remove the cervix. A “partial” or “supracervical” hysterectomy leaves the cervix in place. You should find out for sure which kind you had and get the operative note for your records if possible.

DES sons are at a higher risk of having an abnormality of their genital or urinary systems. Fortunately there does not seem to be a significantly increased risk of cancer of the urinary system — including testicular and prostate cancer — among DES sons, but it is possible that there is a very small increased risk, well below the ability of a study to identify it. For DES sons, there are no changes to the recommended cancer screenings.

Third-generation effects are not well-understood. There hasn’t been a proven increased risk in cancer, but there is a small increase in irregular periods and preterm delivery in females who are born to DES daughters. ADHD also seems more frequent in the third generation. You can read more at DESAction.org.

DEAR DR. ROACH: My friend had a chronic infection and lost 14 pounds. He’s had trouble maintaining his weight and eats four times a day, but his appetite is very poor. Any suggestions? — Anon.

ANSWER: Once the infection is under control, a person’s appetite usually comes back, and the weight will return. In the unlikely event it doesn’t, there are appetite stimulants, but I would look at his appetite as a good indication of whether the infection is really gone. Some chronic infections are hard to treat, and in addition, it can be hard to prove a cure. Cell-free DNA blood testing may be of benefit.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2025 North America Syndicate Inc. All Rights Reserved