A review of perineal talc exposure and risk of ovarian cancer

Our plain-English summary of A review of perineal talc exposure and risk of ovarian cancer, by B.L. Harlow, P.A. Hartge (Regulatory Toxicology and Pharmacology, 1995).

The study

• Authors: B.L. Harlow, P.A. Hartge
• Journal: Regulatory Toxicology and Pharmacology
• Published: 1995;21(2):254-60
• Type of article: Review
• Cited by: 32 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The authors provide a detailed review of the events that led to the interest in talc as a possible ovarian carcinogen, the epidemiological studies published to date, and their perspective on the interpretation of the findings including potential limitations, biases, and issues surrounding the plausibility of a causal association. The authors conclude that the range of relative risk estimates from epidemiology, 1.0 to 1.8, is plausible, but that additional epidemiologic studies, especially prospective investigations are needed. In addition, clinicopathological studies are needed to confirm or deny the reports of talc embedded in human ovarian tissue and reports of talc migration through the human female reproductive tract.

In plain English

This article was a review, not a new study. The authors traced how talc came to be suspected as a cause of ovarian cancer, including its chemical similarity to asbestos and earlier reports linking asbestos exposure to ovarian cancer. They then examined nine case-control studies of women's perineal (genital-area) talc use. They reported that five studies of direct perineal application after bathing all found odds ratios above 1.0, with statistical significance in only one. Results on how often or how many years women used talc were inconsistent. In one study's data shown in a table, women with more than 10,000 lifetime applications had a relative risk of 1.8 (95% confidence interval 1.0 to 3.0). When only use before tubal ligation or hysterectomy and during ovulatory periods was counted, the relative risk was 2.8 (1.4 to 5.4). The authors judged that study design showed no clear pattern of results. They also judged that recall bias was not a likely explanation. They concluded that more epidemiologic studies, especially prospective ones, and pathology studies of talc in ovarian tissue were needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of pathological, clinical and epidemiological literature on perineal talc exposure and ovarian cancer
• Who was studied: Nine published case-control studies of ovarian cancer and perineal talc use, plus earlier pathological and clinical reports
• Exposure: Perineal talc use (for example, direct application after bathing). Talc was examined because of its chemical similarity to asbestos.
• Main results:
  • All five studies that assessed direct perineal application after bathing reported odds ratios greater than 1.0.
  • Among those five studies, statistical significance was reported in only one (the word 'significance' appears scanned as 'incidence').
  • Results on whether frequency or years of perineal talc use affected ovarian cancer risk were inconsistent across studies.
  • In the review's Table 3 (lifetime applications), women with more than 10,000 applications had a relative risk of 1.8 (95% CI 1.0 to 3.0) for all exposure, compared with no use.
  • In the same table, for exposure before tubal ligation or hysterectomy and during ovulatory periods only, more than 10,000 applications had a relative risk of 2.8 (95% CI 1.4 to 5.4).
  • Using data from Harlow and colleagues, there was no excess ovarian cancer risk with increasing talc applications during nonovulatory time periods.
  • Across the nine studies, study design showed no clear pattern of effects being seen with one design but not others.
  • The authors judged that none of the studies showed obvious failure to control for potential confounders.
  • The authors judged that recall bias should not be regarded as a likely explanation for the talc effect.
  • The authors stated that clinicopathological studies are needed to confirm or deny reports of talc embedded in ovarian tissue and of talc migration through the female reproductive tract.
• The authors' conclusion: The authors concluded that additional epidemiologic studies, especially prospective investigations, are needed. Their statement about the range of relative risk estimates is cut off in the text.
• Limitations the authors state:
  • If cases and controls recalled talc use differently, relative risk estimates would be distorted.
  • Dose-response data were available from only a few studies.
  • High nonresponse rates among cases or controls can distort results.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Ovarian cancer, Talc and vermiculite.

Medical terms in this study, explained in our Lexicon: Talc, Ovarian Cancer, Relative Risk, Epidemiology.

Related studies

• Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California — P.K. Mills, D.G. Riordan, et al. (2004)
• Perineal use of talc and risk of ovarian cancer — H. Langseth, S.E. Hankinson, et al. (2008)
• Perineal talc use and ovarian cancer risk: a case study of scientific standards in environmental epidemiology — M. Huncharek, J. Muscat (2011)
• Perineal talc use and ovarian cancer: a critical review — J.E. Muscat, M.S. Huncharek (2008)
• Ovarian cancer and talc: a case-control study — D.W. Cramer, W.R. Welch, et al. (1982)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)

Browse more research in Regulatory Toxicology and Pharmacology, or return to medical research.