Perineal talc use and ovarian cancer: a critical review

Our plain-English summary of Perineal talc use and ovarian cancer: a critical review, by J.E. Muscat, M.S. Huncharek (European Journal of Cancer Prevention, 2008).

The study

• Authors: J.E. Muscat, M.S. Huncharek
• Journal: European Journal of Cancer Prevention
• Published: 2008;17(2):139-46
• Type of article: Review
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Talc, like asbestos, is a silicate that has been studied in relation to cancer risk. Several studies conducted over the past 25 years found an association between perineal talc powders and ovarian cancer. The summary relative risk is about 1.3 (95% confidence intervals 1.2-1.5) and these data have been interpreted as supporting a causal role. In this review article, we discuss the chemical and morphological features of talc and asbestos, and explain why despite their similar chemical classification talc does not possess asbestos-like carcinogenic properties. The heterogeneity in the perineal dusting studies has raised important concerns over the validity of the exposure measurements, and the lack of a consistent dose-response effect limits making causal inferences. Perhaps more importantly, whereas it is unknown whether external talc dust enters the female reproductive tract, measures of internal talc exposure such as talc-dusted diaphragms and latex condoms show no relationship with ovarian cancer risk. In addition, the therapeutic use of high dose cosmetic grade talc for pleurodesis has not been shown to cause cancer in patients receiving these treatment modalities. Talc is not genotoxic. Mechanistic, pathology and animal model studies have not found evidence for a carcinogenic effect. In summary, these data collectively do not indicate that cosmetic talc causes ovarian cancer.

In plain English

This review, not a new study, discussed published research on perineal (genital-area) talc use and ovarian cancer, talc versus asbestos, talc on diaphragms and condoms, and talc treatment in the chest (pleurodesis). Earlier meta-analyses of the dusting studies (16 case–control studies and the Nurses' Health Study, excluding one 2004 study) gave a summary relative risk of 1.33 (95% confidence interval 1.16 to 1.45). A meta-analysis of nine studies of talc-dusted diaphragms gave a summary odds ratio of 1.03 (0.80 to 1.33); none of seven condom studies found increased risk. Few dusting studies found risk rising with greater use. No mesothelioma developed by 1985 among 99 patients given asbestos-free talc for collapsed lung in 1954 to 1964, and none was reported after 15 to 40 years among 210 patients given talc or kaolin, mainly for collapsed lung. Some 1970s baby powders contained small amounts of tremolite or quartz, the authors noted. The authors concluded that the data did not indicate that cosmetic talc causes ovarian cancer, though the validity of reported talc use had not been determined.

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: Critical review of published literature, with no new data collected. It covered the mineralogy of talc and asbestos, the epidemiologic studies of perineal talc use, diaphragm and condom data, pathology studies, therapeutic talc use and animal studies.
• Who was studied: Published studies, not a new group of people: 16 case–control studies of perineal talc dusting and ovarian cancer plus the Nurses' Health Study; a meta-analysis of nine case–control studies of talc-dusted diaphragms; seven studies with data on condom use; clinical studies of patients given talc pleurodesis; and animal and laboratory studies.
• Exposure: Cosmetic talc applied to the perineum (dusting powders). Also talc on contraceptive diaphragms and latex condoms, and therapeutic cosmetic-grade talc placed in the pleural space (pleurodesis). The authors also discussed possible contamination of some 1970s baby powders with tremolite or quartz silica.
• Main results:
  • Earlier meta-analyses (Gross and Berg, 1995; Huncharek et al., 2003) of the perineal dusting studies, excluding Mills et al., 2004, gave a summary relative risk of 1.33 (95% CI 1.16–1.45).
  • In the dusting studies, the summary odds ratio for hospital-based studies was 1.19 (95% CI: 0.99–1.41).
  • In the dusting studies, the summary odds ratio for population-based studies was 1.38 (95% CI: 1.25–1.52).
  • The proportion of controls who dusted with talc powder was the same, 32%, in hospital-based and population-based studies.
  • A meta-analysis of nine case–control studies of talc-dusted contraceptive diaphragms (Huncharek et al., 2007) found a summary odds ratio of 1.03 (95% CI: 0.80–1.33).
  • None of seven studies with information on condom use, including the Nurses' Health Study, found an increased risk of ovarian cancer. Crude relative risks in Table 1 ranged from 0.49 to 1.0.
  • Many dusting studies collected information on duration, frequency and cumulative use. Few found a positive dose–response relationship, and some found an inverse relationship.
  • A study of normal ovarian tissue (Heller et al., 1996b) found that some samples with no measurable talc came from women reporting regular talc dusting, while some samples with high concentrations came from women reporting no genital talc use.
  • Of 99 patients given asbestos-free talc pleurodesis for spontaneous pneumothorax between 1954 and 1964, none developed malignant mesothelioma as of 1985.
  • Of 210 patients treated with talc (or kaolin), mainly for pneumothorax, between 1956 and 1960, no cases of mesothelioma were reported after 15–40 years of follow-up.
  • The authors stated that cosmetic grade talc has been asbestos-free for several decades, but that some baby powders made in the 1970s contained small amounts of tremolite or quartz silica (Rohl et al., 1976).
  • In lifetime whole-body exposure experiments in female laboratory rats (Boorman and Seely, 1995), ovarian tissue was not contaminated with talc and ovarian tumor incidence was not increased.
• The authors' conclusion: The authors concluded that, taken together, the data do not indicate that cosmetic talc causes ovarian cancer. They argued that the null findings for talc-dusted diaphragms and condoms are more convincing than the dusting associations.
• Limitations the authors state:
  • The authors stated that the validity of the diaphragm data, like that of the talc dusting data, had not been determined.
  • The condom studies did not collect information on frequency and duration of use.
  • No published data exist on the treatments given to study participants, so the authors' proposed biases cannot be confirmed or measured.
  • The ovarian tissue pathology studies had small sample sizes and limited exposure assessment.
  • The authors said they could only speculate about the reasons for the decline in talc sales.

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, Silicate, Relative Risk, confidence interval, Carcinogenic, Dose-response relationship, Diaphragm.

Related studies

• Perineal use of talc and risk of ovarian cancer — H. Langseth, S.E. Hankinson, et al. (2008)
• 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 risk: a case study of scientific standards in environmental epidemiology — M. Huncharek, J. Muscat (2011)
• A review of perineal talc exposure and risk of ovarian cancer — B.L. Harlow, P.A. Hartge (1995)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• 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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