Epidemic of breast enlargement in a school population: A twenty-year follow up

Aims. The aim of this study was to evaluate the medium-long terms effects of oestrogen exposure in an Italian school population affected by breast enlargement. Methods. We performed a prospective study in a group of 290 subjects, 22 years after exposure to oestrogen, and in a control group of 829 subjects. All subjects received a questionnaire investigating on social level, pubertal development, fertility, hormone-dependent pathologies, chronic pathologies and incidence of tumours. The clinical phase consisted of a physical examination, ultrasound, hormonal and sperm count evaluation. Results. One hundred seventy-two exposed subjects and 343 controls returned the questionnaire (response rate 59.3% and 41.4%, respectively); 76 among exposed (44.2%) and 90 among controls (26.2%) took part in the clinical phase. Puberty onset had occurred sooner in exposed females and puberty attainment slightly sooner in exposed males. Exposed males presented reduced testicle volume associated with decreased fertility; the result of semen analysis was subpathological in both cases and controls. No increase in urogenital cancer was found except for one exposed subject who was affected by seminoma. Discussion. This study suggests that even a short term exposure to oestrogen could be responsible for subtle alterations; therefore it underlines the importance to monitor both presence and levels of endocrine disrupters as well to study the potentially dangerous consequences of these compounds.