Exposure to cosmetic talc and mesothelioma

Our plain-English summary of Exposure to cosmetic talc and mesothelioma, by J. Moline, K. Patel, A.L. Frank (Journal of Occupational Medicine and Toxicology, 2023).

The study

• Authors: J. Moline, K. Patel, A.L. Frank
• Journal: Journal of Occupational Medicine and Toxicology
• Published: 2023;18(1):1
• Cited by: 15 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Aim: Mesothelioma is associated with asbestos exposure. In this case series, we present 166 cases of individuals who had substantial asbestos exposure to cosmetic talc products as well as some who had potential or documented additional exposures to other asbestos-containing products and who subsequently developed mesothelioma.

Methods: Data were gathered for all subjects referred to an occupational and environmental medicine specialist as part of medicolegal review. Years of total cosmetic talcum powder usage was noted as well as the latency from the onset of talcum powder use to the mesothelioma diagnosis. Alternate asbestos exposure in addition to the exposure from cosmetic talc was categorized as none, possible, likely, and definite.

Results: In 122 cases, the only known exposure to asbestos was from cosmetic talc. For 44 cases, potential or documented alternate exposures in addition to the cosmetic talc were described.

Conclusion: Cumulative exposure to asbestos leads to mesothelioma; for individuals with mixed exposures to asbestos, all exposures should be considered. Use of cosmetic talc is often overlooked as a source of asbestos exposure. All individuals with mesothelioma should have a comprehensive history of asbestos exposure, including cosmetic talc exposure.

© 2023. The Author(s).

In plain English

This was a case series of 166 people with malignant mesothelioma, diagnosed between 2014 and 2021, who had used cosmetic talc. All were referred to an occupational medicine specialist as part of medicolegal review. Information on talc use and other asbestos sources came from the patients' sworn testimony and/or from family members. The authors relied on this history and had no tissue sampling data. The group was 124 women and 42 men, with an average age at diagnosis of 63.3 years. Talc use lasted an average of 40.8 years, and the average time from first talc use to diagnosis was 52.4 years. For 122 people (73.5%), cosmetic talc was the only known asbestos exposure. For the other 44 (26.5%), potential or documented other exposures were described, rated possible (7), likely (17) or definite (20). Of the 166 cases, 109 were pleural and 52 were peritoneal mesothelioma. The authors concluded that 122 cases would have had no identified asbestos source without a history of talc use. They noted possible bias from using cases in litigation, and possible unknown exposure sources.

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: Case series of mesothelioma patients referred for medicolegal review
• Who was studied: 166 individuals with exposure to cosmetic talc who were diagnosed with malignant mesothelioma between 2014 and 2021 and were referred to an occupational and environmental medicine specialist (one of the authors) for medicolegal review; 124 female, 42 male
• Exposure: Cosmetic talcum powder use: being diapered or powdered as a child, diapering or powdering children or others (including at work), and applying talc to oneself. Other asbestos exposures were rated none, possible, likely or definite. Exposure information came from sworn testimony of the patients and/or family members. Fiber types were not measured in this study.
• Main results:
  • In 122 of 166 cases (73.5%), the only known asbestos exposure was cosmetic talc. In 44 cases (26.5%), other potential or documented exposures were also described.
  • For the 44 cases, potential or documented alternate exposures were described and ranked by certainty: 7 possible, 17 likely, 20 definite. Twenty-two women (17.8%) and fifteen men (35.7%) had likely or definite alternate exposure.
  • Twenty-two women (17.8%) and fifteen men (35.7%) had likely or definite alternate exposure in addition to talc use.
  • Of the 166 cases, 124 were female and 42 male.
  • Average age at diagnosis for all 166 cases was 63.3 years (range 26 to 94).
  • Average duration of cosmetic talc use was 40.8 years (range 5 to 76).
  • Average latency from the start of talc use to diagnosis was 52.4 years (range 20 to 83).
  • Tumor site among the 166 cases: 109 pleural (65.7%), 52 peritoneal (31.3%), 4 in both pleura and peritoneum, and 1 pericardial.
  • Peritoneal mesothelioma made up 29.8% of cases in women and 35.7% in men. The authors called the high proportion of peritoneal tumors unusual and said it deserves further investigation.
  • 125 of the 166 cases (75.3%) were of the epithelial (epithelioid) subtype.
  • Twelve teachers (7.2% of cases) were in the series. The authors also described five hairdressers/barbers as having documented occupational exposure to asbestos-containing talcum powder.
• The authors' conclusion: The authors concluded that 122 cases would have had no identified source of asbestos if a history of cosmetic talc use had not been taken.
• Limitations the authors state:
  • The series may reflect the biases that affect all studies using cases in litigation.
  • There may have been additional, unknown sources of asbestos exposure.
  • No tissue sampling data were included; the authors relied on patient history.
  • Few individuals in the series were tested for the BAP-1 gene.

Topics

Medical terms in this study, explained in our Lexicon: Cosmetic Talc, Mesothelioma, Asbestos Exposure, Latency, Cumulative Exposure.

Related studies

• Mesothelioma Associated With the Use of Cosmetic Talc — J. Moline, K. Bevilacqua, et al. (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)
• 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)
• 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. (2017)
• Serous Ovarian Cancer Caused by Exposure to Asbestos and Fibrous Talc in Cosmetic Talc Powders-A Case Series — J.E. Steffen, T. Tran, et al. (2020)

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