Thursday, June 9, 2016

Talcum Powder and Ovarian Cancer – Even More Complicated?

The recent $55 million judgment against Johnson & Johnson over the death of an African American woman with ovarian cancer not only revives previous concerns about the potential link between talcum powder and ovarian cancer but also raises important new questions about risk to African American women in particular.   As far back as 1971, researchers in the UK noted talc particles in ovarian tumors, and in 2006 the International Agency for Research on Cancer (IARC) classified talcum powder as a “possible human carcinogen” if used in the female genital area.   Although a number of observational studies have linked use of talcum powder to increased risk of ovarian cancer, others have not, and a direct cause-and-effect relationship has never been proven.  These observational studies may have suffered from recall bias and included mainly white women.  The Food and Drug Administration has stated that there has been no conclusive evidence to establish causality, though it is plausible that talc may elicit a foreign-body-type inflammatory reaction. In some exposed women, this could potentially play a role in the development of ovarian cancer. 
African-American women historically have reported higher use of feminine hygiene products, including powder, than their white counterparts.  According to documents made public in recent lawsuits, in the 1990s, Johnson and Johnson focused their advertising efforts toward African American and Hispanic women.  And yet, until now, there have been very little data in this population.
A recently published epidemiology cancer study* from the University of Virginia of more than 1300 African American women from 11 different states reported that regular genital powder use was associated with a greater than 40 % increased risk of ovarian cancer, with a dose-response relationship based on frequency and duration of use.  Non-genital powder use also carried an increased risk of more than 30 %, suggesting risk regardless of the route of application. not definitive proof, these kinds of observations give us pause.  According to the American Cancer Society, in 2016 more than 22,000 women will be diagnosed with ovarian cancer and over 14,000 will die from it.  There are no good tests for finding ovarian cancer early.  It accounts for about 3% of cancers among women, but causes more deaths than any other cancer of the female reproductive system.  If indeed there could be any increased risk of cancer associated with the use of baby powder, especially in African American women, perhaps we should think carefully about our use of these products.   At the very least, women should be informed.
* Schildkraut JM, Abbott SE, Alberg AJ, et al.  Association between Body Powder and Ovarian Cancer: the African American Cancer Epidemiology Study (AACES).  Cancer Epidemiol Biomarkers Prev.  Published on line first May 12, 2016.
                                                                                                                                     Judith Wolf, MD   Associate Director, WHEP

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