Authors' response to "malignant mesothelioma following exposure to cosmetic talc: Association, not causation"

Our plain-English summary of Authors' response to "malignant mesothelioma following exposure to cosmetic talc: Association, not causation", by T.S. Emory, J.C. Maddox, R.L. Kradin (American Journal of Industrial Medicine, 2020).

The study

• Authors: T.S. Emory, J.C. Maddox, R.L. Kradin
• Journal: American Journal of Industrial Medicine
• Published: 2020;63(7):651-652
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor in which the authors replied to Dr. Geyer's critique of their earlier case series of malignant mesothelioma. That series began with 140 patients and was reduced to 75 after the authors excluded those with a history of other asbestos exposures. The remaining patients' only known exposure to asbestos was through cosmetic talc. On the concern about recall bias, the authors said that experts for both plaintiffs and defense in legal cases search for all asbestos exposures, and that even if an odd case or two had been wrongly included, many cases would remain. On laboratory testing, they said scanning electron microscopy has low sensitivity for low levels of asbestos, and that they excluded such evidence from their final data. They acknowledged that a case series does not in itself prove causation. The authors concluded that their series is further evidence that cosmetic talc should be considered a probable cause of mesothelioma, and that regulating or removing talc-based products from the market is warranted.

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: Letter to the editor: the authors' reply to a published critique of their earlier case series.
• Who was studied: The earlier case series being defended: 75 patients with malignant mesothelioma, reduced from 140 after excluding patients with a history of other asbestos exposures. The cases were selected from the authors' medical-legal consultation practice.
• Exposure: Cosmetic talc, as the patients' only known exposure to asbestos.
• Main results:
  • On recall bias, the authors stated that in legal cases, experts supporting both plaintiffs and defense regularly search for all exposures to asbestos.
  • On testing methods, the authors stated that scanning electron microscopy has low sensitivity for detecting low levels of asbestos contamination, and that they excluded such evidence from the final reporting of their data.
• The authors' conclusion: The authors concluded that their series of 75 individuals is further evidence that cosmetic talc should be considered a probable cause of mesothelioma. They also concluded that regulation or removal of talc-based products from the market is warranted, because nontoxic alternatives are available.
• Limitations the authors state:
  • The authors acknowledged that a case series does not in itself prove causation.
  • The authors allowed that an odd case or two without a recollection of other asbestos exposures may have been included in the series.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Cosmetic Talc, Causation.

Related studies

• Malignant mesothelioma following exposure to cosmetic talc: Association, not causation — S.J. Geyer (2020)
• Authors' Response to "Evidence Does Not Support Exposure to Cosmetic Talc as a Cause of Malignant Mesothelioma" — J. Moline, K. Bevilacqua, et al. (2020)
• Response to letters regarding "Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology" — B.L. Finley, S.M. Benson, et al. (2018)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Mesothelioma Associated With the Use of Cosmetic Talc — J. Moline, K. Bevilacqua, et al. (2020)

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