Ovarian cancer and talc: a case-control study

Our plain-English summary of Ovarian cancer and talc: a case-control study, by D.W. Cramer, W.R. Welch, R.E. Scully, et al (Cancer, 1982).

The study

• Authors: D.W. Cramer, W.R. Welch, R.E. Scully, C.A. Wojciechowski
• Journal: Cancer
• Published: 1982;50(2):372-6
• Cited by: 176 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001772).

Abstract

Opportunities for genital exposure to talc were assessed in 215 white females with epithelial ovarian cancers and in 215 control women from the general population matched by age, race, and residence. Ninety-two (42.8%) cases regularly used talc either as a dusting powder on the perineum or on sanitary napkins compared with 61 (28.4%) controls. Adjusted for parity and menopausal status, this difference yielded a relative risk of 1.92 (P less than 0.003) for ovarian cancer associated with these practices. Women who had regularly engaged in both practices had an adjusted relative risk of 3.28 (P less than 0.001) compared to women with neither exposure. This provides some support for an association between talc and ovarian cancer hypothesized because of the similarity of ovarian cancer to mesotheliomas and the chemical relation of talc to asbestos, a known cause of mesotheliomas. The authors also investigated opportunities for potential talc exposure from rubber products such as condoms or diaphragms or from pelvic surgery. No significant differences were noted between cases and controls in these exposures, although the intensity of talc exposure from these sources was likely affected by variables not assessed in this study.

In plain English

This case-control study compared 215 white women with epithelial ovarian cancer, diagnosed 1978 to 1981 at twelve Greater Boston hospitals, with 215 general-population women matched by age, race and precinct of residence. Women were interviewed about possible genital talc exposure. Regular use of talc as a dusting powder on the perineum or on sanitary napkins was reported by 92 (42.8%) of the cases and 61 (28.4%) of the controls. This gave an adjusted relative risk of 1.92 (95% confidence limits 1.27 to 2.89). Using talc both ways gave an adjusted relative risk of 3.28 (1.68 to 6.42) compared with neither. No significant differences were found for pelvic surgery, condom or diaphragm use, or dusting diaphragms with talc, but the authors noted that exposure intensity from these sources was likely affected by variables not assessed. The authors said the results gave some support for a link between talc and ovarian cancer. That link had been suggested partly because talc is chemically related to asbestos. The authors noted that the high refusal rate among controls may have introduced selection bias.

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-control study
• Who was studied: 215 white women with epithelial ovarian cancer, 39 of them with tumors of borderline malignancy. Cases were diagnosed November 1978 to September 1981 and identified at twelve hospitals in the Greater Boston area. All were English-speaking Massachusetts residents aged 18 to 80. The 215 controls were drawn from the Massachusetts Town Books and matched by precinct of residence, race and age within two years.
• Exposure: Regular use of talc as a dusting powder on the perineum or on sanitary napkins. The study also looked at possible talc exposure from condoms, from diaphragms (including dusting the diaphragm with talc for storage) and from pelvic surgery (talc on surgical gloves). The asbestos content of talc was not measured; talc's chemical relation to asbestos is the background to the hypothesis.
• Main results:
  • Any perineal talc use (dusting powder, napkins, or both) was reported by 92 (42.8%) of 215 cases and 61 (28.4%) of 215 controls.
  • For any perineal talc use compared with none, the relative risk adjusted for parity and menopausal status was 1.92 (P less than 0.003), with 95% confidence limits of 1.27 to 2.89.
  • Using talc in only one of the two ways was reported by 60 (27.9%) of cases and 48 (22.3%) of controls. This gave an adjusted relative risk of 1.55, which the authors called of borderline significance (P = 0.06).
  • Using talc both on the perineum and on napkins was reported by 32 (14.9%) of cases and 13 (6.0%) of controls. Compared with neither exposure, the adjusted relative risk was 3.28 (P less than .001), with 95% confidence limits of 1.68 to 6.42.
  • After adjusting at the same time for religion, marital status, education, ponderal index, age at menarche, exact parity, hormone use and smoking, the relative risk for any perineal talc use was 1.61 (P = 0.03), with 95% confidence limits of 1.04 to 2.49.
  • Excluding women with pelvic surgery, the adjusted relative risk for talc use both on the perineum and on napkins was 2.79 (P less than 0.003), compared with 3.28 in the whole group.
  • In the 121 cases matched without any control refusal, the adjusted relative risk was 2.44 (P less than 0.05) for women described as having used talc 'both in dusting and on the perineum'.
  • There were no significant differences between cases and controls for possible talc exposure from rubber products or pelvic surgery. Pelvic surgery: 78 (36.3%) of 215 cases vs 75 (34.9%) of 215 controls, adjusted relative risk 1.17 (0.76 to 1.79). Condom use, among women ever married: 19 (11.2%) of 169 cases vs 30 (15.7%) of 191 controls, adjusted relative risk 0.77 (0.41 to 1.44). Diaphragm use, among women ever married: 37 (21.9%) of 169 cases vs 35 (18.3%) of 191 controls, adjusted relative risk 1.19 (0.69 to 2.05). The authors added that exposure intensity from these sources was likely affected by variables not assessed.
  • Among diaphragm users, 22 (55.0%) of 40 cases and 19 (47.5%) of 40 controls dusted the diaphragm with talc for storage. The adjusted relative risk was 1.56 (0.62 to 3.88), which was not a significant excess.
  • Tumor types among cases with perineal talc exposure did not differ significantly from those among cases without it. Tumors of borderline malignancy made up 18% of both groups: 22 of 123 cases without exposure and 17 of 92 with exposure.
• The authors' conclusion: The authors concluded that the findings provide some support for an association between talc and ovarian cancer. That association had been hypothesized because ovarian cancer resembles mesothelioma and because talc is chemically related to asbestos, a known cause of mesothelioma.
• Limitations the authors state:
  • The high refusal rate among potential controls may have introduced selection bias: 155 (33%) of 475 refused.
  • The intensity of talc exposure from rubber products and surgery was likely affected by variables the study did not assess.
  • Details on the specific brands of condoms used were not obtained.
  • Assessing the risk from talc used on diaphragms would need more detail, such as frequency of use and whether the powder was washed off before use.
  • Women's reports of pelvic operations could not always be checked against hospital records.

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: Ovarian Cancer, Talc, Case-Control Study, Relative Risk, Mesothelioma, Diaphragm.

Related studies

• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California — P.K. Mills, D.G. Riordan, et al. (2004)
• Perineal talc use and ovarian cancer: a critical review — J.E. Muscat, M.S. Huncharek (2008)
• A review of perineal talc exposure and risk of ovarian cancer — B.L. Harlow, P.A. Hartge (1995)
• Perineal use of talc and risk of ovarian cancer — H. Langseth, S.E. Hankinson, et al. (2008)
• 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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