New Information on Talc and Mesothelioma

Our plain-English summary of New Information on Talc and Mesothelioma, by J.B. Shrager (The Annals of Thoracic Surgery, 2020).

The study

• Author: J.B. Shrager
• Journal: The Annals of Thoracic Surgery
• Published: 2020;110(3):1099
• Type of article: Letter, Comment
• Read it: PubMed · Publisher

In plain English

This letter to the editor, reporting no new data, updated the author's 2020 review of talc pleurodesis. That review stated it identified no reports of talc causing malignant mesothelioma. The author had since identified an earlier published case: a woman with mesothelioma, no known asbestos exposure besides cosmetic talc, and asbestos fibers in lung and lymph nodes. The letter cited Moline and colleagues' series of 33 cosmetic talc users with mesothelioma and no other known asbestos exposures. It cited Finley and associates' systematic review, which found no mesothelioma cases in talc miners and millers, with 67% statistical power to observe a 2.5-fold increase in mesothelioma mortality. It noted at least 900 legal cases claiming talc caused mesothelioma. Citing uncertainty that purification removes all asbestos fibers, the author concluded graded, purified talc should likely remain the preferred sclerosant for malignant pleural effusion in patients with limited life expectancy. For young people with benign problems and long life expectancies, such as spontaneous pneumothorax, the author concluded talc's pros and cons should be carefully weighed against other options before recommending it.

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 (correspondence) updating the author's earlier review article on talc pleurodesis; no original study
• Who was studied: Not applicable: no patients or groups were studied; the letter comments on published literature
• Exposure: Talc, both cosmetic talc and graded, purified talc used for pleurodesis, and the possibility that it contains asbestos fibers mined with it
• Main results:
  • The author's correction to the earlier review: an earlier published case (Gordon and colleagues, 2014) had since been identified. It described mesothelioma in a woman with no known asbestos exposure other than cosmetic talc who had asbestos fibers in her lung and lymph nodes.
  • The letter cites a series by Moline and colleagues (not this author's work) of 33 cosmetic talc users who developed mesothelioma without other known asbestos exposures. The series includes lung and/or intrathoracic lymph node analyses from 4 of these patients showing asbestos fiber types reported to be found in talc.
  • The author noted that at least 900 legal cases had been filed claiming mesotheliomas were caused by talc preparations.
  • The letter cites a systematic review by Finley and associates (not this author's work) of mesothelioma incidence in talc miners and millers. That review identified no cases, with a 67% statistical power to observe a 2.5-fold increase in mesothelioma mortality.
• The authors' conclusion: The author concluded that the review's conclusions should be modified. Graded, purified talc should likely remain the preferred sclerosant for patients with malignant pleural effusion who have a limited life expectancy. In young individuals with benign problems and long life expectancies, such as spontaneous pneumothorax, the pros and cons of talc should be carefully weighed against other options before it is recommended.

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: Talc, Mesothelioma.

Related studies

• Talc Pleurodesis: A Medical, Medicolegal, and Socioeconomic Review — I. Baiu, E. Yevudza, et al. (2020)
• Talc slurry pleurodesis. Pleural fluid and histologic analysis — L. Kennedy, R.A. Harley, et al. (1995)
• Medical thoracoscopic talc pleurodesis for chylothorax due to lymphoma: a case series — D.C. Mares, P.N. Mathur (1998)
• Intrapleural talc for the prevention of recurrent pneumothorax — J.R. Milanez, F.S. Vargas, et al. (1994)
• A randomized controlled trial of the efficacy of cosmetic talc compared with iodopovidone for chemical pleurodesis — R. Agarwal, A.S. Paul, et al. (2011)
• Survival in patients with malignant pleural effusion undergoing talc pleurodesis — M. Hassan, R.M. Mercer, et al. (2019)

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