Does talc powder cause ovarian cancer?

Tagged Ovarian Cancer; Posted 8 years ago by Andreas Obermair

A US court ordered Johnson & Johnson to pay more than $100 million (AUD) in damages to the family of an Alabama woman who died of ovarian cancer. The woman used talcum powder for over 35 years for feminine hygiene. Her family claimed that the talc powder caused her ovarian cancer and that the company directly knew of the risks and failed to warn its users. This is the first time damages have been awarded for the use of Talcum powder and further cases in the US are pending. Johnson & Johnson is expected to appeal the decision.

Is it safe for woman to use talc powder in the pelvic region?

In its natural industrial form, some talc may contain asbestos, which is known to cause cancer. However, modern domestic talcum powder used in pharmaceutical products does not contain asbestos. Since the 1970’s, talc powders are required by law to be asbestos-free.

The potential of talc potentially causing ovarian cancer is not a new concern. By contrast, we still don’t know what exactly causes ovarian cancer, hence researchers don't have a clear explanation about what might lead talc to cause cancer. One theory is that talc would travel through the reproductive tract, through the fallopian tubes to the ovaries and the inflammation caused by the talc particles could lead to female genital cancer.  

The evidence

Some case-control studies report a slightly increased risk from 24-40%, while other studies such as cohort studies have found no increase.

Case-control studies are based on asking women with and without ovarian cancer if they have used talc. These types of studies have limitations because they often rely on a person’s memory of talc use, its amount applied and duration from many years earlier.

Cohort studies prospectively follow a sample of a defined population over time.

Importantly, a 2003 meta-analysis of 16 studies and almost 12,000 participants found that an increase in ovarian cancer risk was associated with the use of talc by 33%, however there was no causal relationship found (1). A causal link (or dose-response relationship) is when the research finds that the longer women use talc powder, and the more times they apply it, the greater their risk of developing ovarian cancer.

A 2013 large pooled analysis of American studies involving 18,000 women (8,525 cases and 9,859 controls) had similar results for genital talcum powder use (2). Use of talc increased epithelial ovarian cancer risk by 24% compared with non-use (OR = 1.24, 95% CI = 1.15 to 1.33). A link with serous ovarian cancer was again found by a case-control study in 2008 in Australia conducted with 1,576 cases and 1,509 controls, but the small increase (adjusted odds ratio 1.17, 95% CI: 1.01–1.36) was small (3). Again, a dose-response relationship was not found.

In 2007, a combined analysis of nine studies did not find any causal association between the use of cosmetic talc-dusted diaphragms and ovarian cancer (4). This is an important finding as the talc on the diaphragm would have direct exposure to the female reproductive tract.

In a prospective cohort study in 2014, which would not have been affected by memory recall, genital talc powder use does not appear to influence ovarian cancer risk. This study was among 61576 postmenopausal women, followed for an average of 12.4 years.

The Australian Cancer Council website concludes that there is "inconclusive evidence that using talcum powder can cause cancer".

Should women be concerned?

In 2016, it is estimated that 1,480 new cases of ovarian cancer will be diagnosed in Australia. The current evidence points to the possibility that talcum powder may cause ovarian cancer but at this point in time it is insufficient to conclude that use of talc powder definitely leads to an increased risk of ovarian cancer.

The causal link (or dose-response relationship) between talc use and ovarian cancer has not been found in the majority of studies. According to an American Cancer Society report, more research is needed, but "if there is an increased risk, the overall increase is likely to very be small." With the evidence inconclusive talc powder is classified by the International Agency for Research on Cancer (IARC) as possibly carcinogenic to humans.

Alternatives

Women who are concerned about talc can use other products, such as cornstarch based powders or avoid using the products altogether.

References

1. Huncharek, M., J.F. Geschwind, and B. Kupelnick, Perineal application of cosmetic talc and risk of invasive epithelial ovarian cancer: a meta-analysis of 11,933 subjects from sixteen observational studies. Anticancer Res. 2003;23(2C):1955-60.
2. Terry KL, Karageorgi S, Shvetsov YB, et al. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer prevention Research. 2013;6(8):811-821.
3. Merritt MA, Green AC, Nagle CM, et al. Talcum powder, chronic pelvic inflammation and NSAIDs in relation to risk of epithelial ovarian cancer. Int J Cancer. 2008 Jan 1;122(1):170-6.
4. Huncharek M, Muscat J, Onitilo A, et al. Use of cosmetic talc on contraceptive diaphragms and risk of ovarian cancer: a meta-analysis of nine observational studies. Eur J Cancer Prev. 2007;16(5):422-9.
5. Houghton SC, Reeves KW, Hankinson SE. et al. Perineal powder use and risk of ovarian cancer. J Natl Cancer Inst. 2014;106(9).