Serous Ovarian Cancer Caused by Exposure to Asbestos and Fibrous Talc in Cosmetic Talc Powders-A Case Series

Our plain-English summary of Serous Ovarian Cancer Caused by Exposure to Asbestos and Fibrous Talc in Cosmetic Talc Powders-A Case Series, by J.E. Steffen, T. Tran, M. Yimam, et al (Journal of Occupational and Environmental Medicine, 2020).

The study

• Authors: J.E. Steffen, T. Tran, M. Yimam, K.M. Clancy, T.B. Bird, M. Rigler, W. Longo, D.S. Egilman
• Journal: Journal of Occupational and Environmental Medicine
• Published: 2020;62(2):e65-e77
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Asbestos is a known cause of ovarian cancer. We report 10 cases of serous ovarian cancer among users of Johnson & Johnson (J&J) asbestos-containing "cosmetic" talc products.

Methods: We conducted an asbestos exposure assessment during talc application and analyzed surgical tissues and talc containers for asbestos and talc.

Results: Talc was found in all cases and tremolite and/or anthophyllite asbestos was found in 8/10 cases. The asbestos fibers found in the "cosmetic" talc containers matched those found in tissues. We estimated inhaled asbestos dose ranged from 0.38 to 5.18 fiber years.

Conclusion: We provide evidence that the inhaled dose of asbestos/fibrous talc from "cosmetic" talc use causes ovarian cancer. The unique combination of the types of asbestiform minerals detected in cancerous tissue and "cosmetic" talc is a fingerprint for exposure to asbestos-containing talc.

In plain English

This case series described ten women with serous ovarian cancer who had used Johnson & Johnson cosmetic talc products. They were drawn from 22 plaintiffs in a lawsuit against the company. The ten were those whose tissue had been examined by electron microscopy. One researcher simulated perineal (genital-area) powdering with a container of Johnson's Baby Powder that the authors dated to the 1950s. Breathing-zone air samples averaged 2.57 asbestos fibers per cc over five minutes, and all of the asbestos was tremolite. Using this and earlier published measurements, the authors estimated each woman's inhaled asbestos dose at 0.38 to 5.18 fiber years. A model adapted from EPA mesothelioma estimates put each woman's ovarian cancer risk at 2.3 to 31.1 times baseline. Talc was found in tissue from all ten women. The authors reported asbestos, mainly tremolite and anthophyllite, in 8 of 10, although the case table listed asbestos in 7. The authors concluded that these cases provided more evidence of a causal link between asbestos, talc and ovarian cancer. They noted that their doses may under- or overestimate exposure, and that latency and fibrous talc were left out of the risk model.

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 series, combined with a simulated talc-application air sampling test, individual dose calculations and a modeled dose-response risk estimate
• Who was studied: 10 women with pathologically confirmed serous ovarian cancer, selected from 22 plaintiffs in the lawsuit Ingham et al. vs. Johnson & Johnson et al. for whom tissue analysis had been done. Eight were living; for the two who had died, exposure histories came from relatives. Age at diagnosis was 41 to 78 years (mean 51.1, median 50).
• Exposure: Use of J&J cosmetic talc products (Johnson's Baby Powder, Shower to Shower, STS Shimmer). The authors modeled inhaled asbestos from four uses: perineal application (10 of 10 women), upper body powdering (9 of 10), diapering others as an adult (8 of 10) and being diapered as an infant (7 of 10). Asbestos types considered were mainly tremolite and anthophyllite; fibrous talc was also measured.
• Main results:
  • In the simulated perineal application by one researcher (4.05 g of talc, 5-minute sampling), the researcher's personal breathing-zone samples averaged 2.57 f/cc asbestos. Area samples averaged 0.2 f/cc asbestos.
  • All asbestos found in the air samples of the simulation was tremolite. No fibers were found in background samples or field blanks.
  • Estimated total inhaled asbestos dose across the ten cases ranged from 2,774,000,000 to 37,742,501,440 fibers (0.38 to 5.18 fiber years). The average was 9,308,551,008 fibers (1.28 fiber years).
  • Based on the authors' model adapted from EPA dose-response estimates, ovarian cancer risk from inhaled asbestos was calculated at 2.3 to 31.1 times baseline in these cases, averaging 7.7-fold. These are modeled estimates, not observed rates.
  • In the women's tissue (ovaries, fallopian tubes, pelvic lymph nodes):
• platy talc was found in 9 of 10 cases;
• fibrous talc in 8 of 10;
• tremolite asbestos in 6 of 10;
• anthophyllite asbestos in 4 of 10;
• ferro-anthophyllite in 2;
• winchite and richterite in 1;
• crocidolite in 1.
  • The authors stated that all ten cases had talc and eight had asbestos in their tissue. The case-by-case table lists asbestos for seven cases (Cases 1 to 6 and 8).
  • Tremolite asbestos was found both in a bottle of Johnson's Baby Powder bought by Case 3 in 2014 and in that woman's right pelvic lymph node.
  • Seven of the 10 women tested negative for BRCA mutations, 2 were never tested, and 1 tested positive for a BRCA2 variant.
  • No other known asbestos exposure was identified for any of the ten women.
• The authors' conclusion: The authors concluded that these cases provide more evidence of a causal link between asbestos, talc and ovarian cancer. They also concluded that asbestos is present in consumer talc at levels sufficient to cause disease, and that tremolite and anthophyllite in tissue are a fingerprint for asbestos-containing talc.
• Limitations the authors state:
  • The dose estimates may underestimate or overestimate the women's total exposure.
  • Latency (time since exposure) was not adjusted for.
  • Fibrous talc was left out of the risk assessment because dose-response data were lacking.
  • Many reported talc uses (for example, on sheets and pillows) were excluded from the dose calculations for lack of exposure data. Brief use of unidentified products could not be calculated.
  • The diapering exposure figures came from a 1972 study. That study did not capture exposure after the sampling time and did not distinguish asbestos from fibrous talc.
  • Asbestos is unevenly distributed in talc, so sampling cannot fully represent exposure.
  • For the two deceased women, exposure histories were only rough accounts from relatives.
  • Asbestos concentrations in tissue were about ten times lower than in earlier studies. The authors attributed this possibly to differences in method.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Ovarian cancer, Talc and vermiculite, Tremolite.

Medical terms in this study, explained in our Lexicon: Ovarian Cancer, Talc, Cosmetic Talc, Asbestos Exposure, Tremolite, Anthophyllite, Fiber Year, Asbestiform.

Related studies

• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• Letter concerning: Burns AM, Barlow CA, Banducci AM, Unice KM, Sahmel J. Potential Airborne Asbestos Exposure and Risk Associated with the Historical Use of Cosmetic Talcum Powder Products — M.M. Finkelstein (2019)
• Talc, Asbestos, and Epidemiology: Corporate Influence and Scientific Incognizance — T.H. Tran, J.E. Steffen, et al. (2019)
• Amphibole content of cosmetic and pharmaceutical talcs — A.M. Blount (1991)
• Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women — R. Lee, D. Van Orden (2015)

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