Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology

Our plain-English summary of Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology, by B.L. Finley, S.M. Benson, G.M. Marsh (Inhalation Toxicology, 2017).

The study

• Authors: B.L. Finley, S.M. Benson, G.M. Marsh
• Journal: Inhalation Toxicology
• Published: 2017;29(4):179-185
• Type of article: Systematic review
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Due to some historical (and inaccurate) reports that asbestos might be present in some cosmetic talc products, questions are occasionally raised regarding the potential pleural mesothelioma risks associated with cosmetic talc products. Our objective was to determine the incidence of pleural mesothelioma of individuals exposed to cosmetic talc.

Materials And Methods: We conducted a systematic review of the epidemiological literature for cosmetic talc miners and millers and found three occupational cohort studies that evaluated pleural mesothelioma incidence in workers in Italy, Norway, France, and Austria. We conducted a second literature review to evaluate the incidence and mortality of pleural mesothelioma among patients who received talc pleurodesis treatments before 1965 and found retrospective clinical studies including over 300 patients with follow-up ranging from 14 to 40 years.

Results: There were no mesotheliomas reported in any of the cosmetic talc miner and miller cohorts. A pooled analysis of data from the cohort mortality studies indicated that four mesothelioma deaths would have been expected from the 90,022 person-years of observation, and this was associated with 84% and 67% statistical power to observe a 3-fold or 2.5-fold increase in pleural mesothelioma mortality, respectively. None of the patients who received talc pleurodesis treatments developed mesothelioma.

Conclusion: We conclude that there is no epidemiological evidence to support the hypothesis that exposure to cosmetic talc is associated with the development of pleural mesothelioma.

In plain English

This was a review of published studies, with a pooled analysis, asking whether cosmetic talc is linked to pleural mesothelioma. The authors searched PubMed and found three cohort studies of cosmetic talc miners and millers in Italy, Norway, and France and Austria. They also found three studies that followed patients treated with talc pleurodesis, a procedure in which talc is applied directly to the lining of the lung. No mesotheliomas were reported in the worker cohorts, which together covered 99,022 person-years of observation. Based on background rates, about four would have been expected. The authors calculated that the pooled data had 84% power to detect a 3-fold or greater increase in mesothelioma deaths, 67% power for a 2.5-fold increase, and 41% power for a 2-fold increase. No patient in the pleurodesis studies developed mesothelioma. Those studies included 114, 99 and 147 talc-treated patients, some of whom appeared in more than one study, followed for 14 to 40 years. The authors noted that each worker cohort study in the pooled analysis was, on its own, small and had low statistical power. They concluded that there is no epidemiological evidence supporting the hypothesis that cosmetic talc exposure is associated with mesothelioma.

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: Systematic review of epidemiological studies, with a pooled analysis and statistical power calculation for cosmetic talc miner and miller cohorts, plus a secondary literature review of long-term studies of talc pleurodesis patients
• Who was studied: Three published cohort studies of cosmetic talc miners and millers: Italy (1,795 workers, followed 1946 to 1995), Norway (117 mine and 332 mill workers, followed 1953 to 1987), and France (1,657 workers) and Austria (542 workers), followed to 1994 or 1995. Also three studies of talc pleurodesis patients: 114, 99 and 147 patients. Papers were drawn from PubMed searches covering 1946 to September 2016, English only.
• Exposure: Occupational exposure to cosmetic talc in mining and milling, reported by the authors as ranging from less than 1 mg/m3 to more than 315 mg/m3. Also medical exposure to talc through pleurodesis treatment.
• Main results:
  • In the combined miner and miller cohorts (99,022 person-years), no mesotheliomas were observed. About four would have been expected from background rates.
  • For the combined cohort, the pooled analysis had 84% power to detect a 3-fold or greater increase in mesothelioma mortality and 67% power to detect a 2.5-fold or greater increase (one-sided 0.05 significance level).
  • In the power table, with four expected mesothelioma deaths, power was 0.41 to detect a relative risk of 2.0 and 0.15 to detect a relative risk of 1.5.
  • Lange et al. (1988): 114 patients treated with talc pleurodesis from 1951 to 1963 and followed 22 to 35 years; 0 mesotheliomas.
  • Viskum et al. (1989): 99 patients treated from 1954 to 1964 and followed 22 to 32 years; 0 mesotheliomas.
  • The Viskum et al. study included some of the same patients as the Lange et al. study.
  • British Thoracic Association (1979): 147 talc-treated patients, treated before 1961 and followed 14 to 40 years; 0 mesotheliomas.
  • Six case reports or case series described tumors after talc pleurodesis. Four of the six reported benign tumors.
• The authors' conclusion: The authors concluded that there is no epidemiological evidence to support the hypothesis that exposure to cosmetic talc is associated with the development of mesothelioma.
• Limitations the authors state:
  • Taken one at a time, the worker cohort studies used in the pooled analysis had small cohort sizes and therefore low statistical power.

Topics

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

Medical terms in this study, explained in our Lexicon: Cosmetic Talc, Pleural Mesothelioma, Epidemiology, Systematic Review, Talc Pleurodesis, Mesothelioma, Meta-Analysis.

Related studies

• 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)
• Re: Brent L. Finley, Stacey M. Benson & Gary M. Marsh (2017): Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology, Inhalation Toxicology, DOI: 10.1080/08958378.2017.1336187 — M.M. Finkelstein (2017)
• Letter on: "Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology" — D. Mirabelli (2017)
• A quantitative weight of evidence assessment of Hill's guidelines for causal inference for cosmetic talc as a cause of mesothelioma — A.M. Ierardi, A. Urban, et al. (2021)
• Evaluation by electron microscopy techniques of asbestos contamination in industrial, cosmetic, and pharmaceutical talcs — L. Paoletti, S. Caiazza, et al. (1984)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)

Browse more research in Inhalation Toxicology, or return to medical research.