Response to letters regarding "Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology"

Our plain-English summary of Response to letters regarding "Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology", by B.L. Finley, S.M. Benson, G.M. Marsh (Inhalation Toxicology, 2018).

The study

• Authors: B.L. Finley, S.M. Benson, G.M. Marsh
• Journal: Inhalation Toxicology
• Published: 2018;30(1):1-4
• Type of article: Letter, Comment
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This is a letter to the editor. It reports no new cohort study, though it includes an updated pooled calculation. The authors replied to letters by Finkelstein and Mirabelli criticizing their 2017 pooled analysis of mesothelioma in cosmetic talc miners and millers in Italy, Norway, Austria and France. They stood by their statements that no credible analyses showed detectable asbestos in the Italian talc and that the Italian cohorts had no confirmed mesotheliomas, disputing a registry case Mirabelli raised. They defended using Piedmont regional rather than national rates, citing non-occupational asbestos exposure in the region, and called Finkelstein's hypothetical 'thought experiment' deeply flawed. They drew on updated Italian and Norwegian cohort studies by other researchers, which reported no pleural cancers, plus earlier French and Austrian data. From these, the authors calculated that 3.0 pleural cancers or mesotheliomas would be expected, a figure they called a lower limit. They reported 79% power to detect a three-fold or greater increase and 62% power for a 2.5-fold or greater increase. Seven or more cases would have been needed to reject no association at the 0.05 level.

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 (authors' reply to critical letters). It reports no new primary cohort study but includes an updated pooled power calculation based on published cohort studies.
• Who was studied: Pooled cosmetic talc miner and miller cohorts. Italy (Pira et al. 2017a): 1166 miners and 556 millers, 59,339 person-years. Norway (Wergeland et al. 2017): 94 miners and 296 millers, 15,687 person-years. France (Wild et al. 2002): 1070 miners and millers, 28,849 person-years. Austria (Wild et al. 2002): 542 miners and millers, 9,469 person-years.
• Exposure: Employment as a cosmetic talc miner or miller. The authors state the talc lacked measurable asbestos fibers. The letter writers cited analyses reporting anthophyllite, tremolite and chrysotile asbestos, which the authors disputed.
• Main results:
  • The updated Italian and Norwegian cohort studies (by other researchers) added 14,322 person-years and reported that no study subjects developed a pleural cancer of any type.
  • Across the pooled updated cohorts, the authors calculated 3.0 expected pleural cancers or mesotheliomas.
  • The pooled data gave 79% power to detect a three-fold or greater increase in pleural cancers.
  • The pooled data gave 62% power to detect a 2.5-fold or greater increase in pleural cancers.
  • Seven or more pleural cancers (an SMR of 2.33 or greater) would have needed to be observed across the three pooled cohort studies to reject, at the 0.05 level, the hypothesis of no association.
  • According to Pira et al. (2017b), a registry case raised by Mirabelli showed no evidence of ever having been employed at the Italian talc mines.
  • The authors called Finkelstein's hypothetical 'thought experiment' deeply flawed.
• The authors' conclusion: The authors stood by their statement that there are no confirmed mesotheliomas in the Italian cosmetic talc miner and miller cohorts. They held that their use of Piedmont regional rates followed standard practice and was the proper choice.
• Limitations the authors state:
  • The authors note that the pooled expected number of 3.0 is a lower limit, because Wild et al. (2002) reported expected counts only for mesothelioma, a subcategory of pleural cancers.

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: Cosmetic Talc, Pleural Mesothelioma, Epidemiology.

Related studies

• Letter on: "Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology" — D. Mirabelli (2017)
• 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)
• Re: Brent L. Finley, Stacey M. Benson & Gary M. Marsh (2017): Cosmetic talc as a risk factor for pleural mesothelioma: a weight of evidence evaluation of the epidemiology, Inhalation Toxicology, DOI: 10.1080/08958378.2017.1336187 — M.M. Finkelstein (2017)
• A quantitative weight of evidence assessment of Hill's guidelines for causal inference for cosmetic talc as a cause of mesothelioma — A.M. Ierardi, A. Urban, et al. (2021)
• Letter concerning: Occupational exposures to cosmetic talc and risk of mesothelioma: an updated pooled cohort and statistical power analysis with consideration of latency period by Gary M. Marsh et al. (Inhal Toxicol. 2019 Aug 5:1-11. doi:10.1080/08958378.2019.1645768) — M.M. Finkelstein (2019)
• Authors' Response to "Evidence Does Not Support Exposure to Cosmetic Talc as a Cause of Malignant Mesothelioma" — J. Moline, K. Bevilacqua, et al. (2020)

Browse more research in Inhalation Toxicology, or return to medical research.