Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California

Our plain-English summary of Perineal talc exposure and epithelial ovarian cancer risk in the Central Valley of California, by P.K. Mills, D.G. Riordan, R.D. Cress, et al (International Journal of Cancer, 2004).

The study

• Authors: P.K. Mills, D.G. Riordan, R.D. Cress, H.A. Young
• Journal: International Journal of Cancer
• Published: 2004;112(3):458-64
• Cited by: 51 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Perineal talc use has been suggested as a possible risk factor for ovarian cancer based on its structural similarity to asbestos, a known human carcinogen. A population-based epidemiologic case-control study of epithelial ovarian cancer (EOC) was conducted in 22 counties of Central California that comprise the reporting area for 2 regional cancer registries. Telephone interviews were conducted with 256 cases diagnosed in the years 2000-2001 and 1,122 controls frequency-matched on age and ethnicity. The interview obtained information on demographic factors, menstrual and reproductive experience, exogenous hormone use, surgical history and family history of cancer. Questions on perineal talc use included frequency of use, duration of use and specific years when talc was used. Multivariate-adjusted odds ratio (OR) and 95% confidence intervals (CI) were derived from unconditional logistic regression. The OR for ever use of talc was 1.37 (CI = 1.02-1.85) compared to never users. However, no dose response association was found. Tubal ligation (TL) modified the effect of talc on EOC such that women with TL had an OR of 0.88 (CI = 0.46-1.68) associated with perineal talc use, whereas women with no TL had an OR of 1.54 (CI = 1.10-2.16). Talc use and EOC risk was highest in women with serous invasive tumors (OR = 1.77; CI = 1.12-2.81). This study provides some support for the hypothesis that perineal talc use is associated with an increased risk of EOC.

In plain English

This population-based case-control study asked whether women who used talcum powder in the genital (perineal) area were more likely to develop epithelial ovarian cancer. In 22 counties of California's Central Valley, researchers interviewed by telephone 256 women diagnosed in 2000 to 2001 and 1,122 comparison women without the disease. Women who had ever used talc had an odds ratio of 1.37 (95% CI 1.02 to 1.85) compared with never users. The estimates did not rise steadily with longer duration or greater cumulative use. Serous invasive tumors had a statistically significant odds ratio of 1.77 (1.12 to 2.81). Mucinous invasive tumors (16 cases) had a higher but not significant 2.56 (0.89 to 7.39). For borderline tumors it was 1.09 (0.65 to 1.83), which was not statistically significant. Among women without a tubal ligation the odds ratio was 1.54 (1.10 to 2.16), compared with 0.88 (0.46 to 1.68) among women with one. The formal interaction test was not statistically significant. The authors described talc's role as suggestive though uncertain. They noted a small sample, low response rates, possible recall bias, and inability to distinguish powder formulations.

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: population-based case-control study using telephone interviews, analysed with unconditional logistic regression
• Who was studied: 256 women with newly diagnosed epithelial ovarian cancer (diagnosed 1 January 2000 to 31 December 2001) and 1,122 controls selected by random digit dialing, frequency-matched on age and race/ethnicity, living in 22 counties of California's Central Valley; the response fraction was 40% among all identified cases and 57% among eligible controls
• Exposure: self-reported adult use of talcum powder in the genital (perineal) area, including calendar years of use, frequency and total duration; frequency and duration were combined into a cumulative-use measure
• Main results:
  • Ever use of perineal talc was reported by 42.6% of cases and 37.1% of controls; compared with never users, ever users had a multivariate-adjusted odds ratio of 1.37 (95% CI 1.02–1.85)
  • Women using talc 4–7 times per week had an odds ratio of 1.74 (1.14–2.64), p for trend 0.015, but the trend was not steady: the estimate fell from 1.34 in the lowest frequency group to 1.16 in the 1–3 times per week group
  • There was no clear dose response for duration or cumulative use. For duration, the estimate peaked at 4–12 years (OR 1.86; 1.16–2.98) and was 1.22 (0.72–2.08) for more than 30 years. For cumulative use, the highest quartile had an OR of 1.06 (0.62–1.83)
  • By tumor type, the odds ratio was 1.51 (1.07–2.12) for all invasive tumors and 1.77 (1.12–2.81) for serous invasive tumors. It was 2.56 (0.89–7.39) for mucinous invasive tumors (16 cases), which was not statistically significant, and 1.09 (0.65–1.83) for all borderline tumors
  • Women without a tubal ligation had a talc-associated odds ratio of 1.54 (1.10–2.16), compared with 0.88 (0.46–1.68) among women with a tubal ligation; the interaction coefficient was not statistically significant
  • Risk was not increased with first use on or before 1975 (OR 1.22; 0.84–1.77). It was increased with first use after 1975 (OR 1.92; 1.27–2.91), which the authors said may relate to recency of use. Women who last used talc 1–2 years before interview had an OR of 2.40 (1.43–4.05), while women whose last use was in the more distant past did not show altered risk
• The authors' conclusion: The authors concluded that the study provides some support for the hypothesis that perineal talc use is associated with increased epithelial ovarian cancer risk. They called the role of talc suggestive though uncertain and noted that research has provided little biologic or experimental evidence. Because of this, they invoked the precautionary principle.
• Limitations the authors state:
  • Relatively small sample size and a lower than ideal response fraction
  • Possible recall bias
  • Could not exclude use during non-ovulatory periods or use after tubal ligation or hysterectomy, and could not tell apart different powder formulations (including talc versus cornstarch)
  • Could not measure the actual amount of talc used per application

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: Talc, Ovarian Cancer, Case-Control Study, Odds Ratio, confidence interval.

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• 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)
• Ovarian Cancer and "Tainted Talc": What Treating Physicians Need to Know — R. Casey, T.P. Larkin (2019)
• Ovarian cancer and talc: a case-control study — D.W. Cramer, W.R. Welch, et al. (1982)

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