Talc, Asbestos, and Epidemiology: Corporate Influence and Scientific Incognizance

Our plain-English summary of Talc, Asbestos, and Epidemiology: Corporate Influence and Scientific Incognizance, by T.H. Tran, J.E. Steffen, K.M. Clancy, et al (Epidemiology, 2019).

The study

• Authors: T.H. Tran, J.E. Steffen, K.M. Clancy, T. Bird, D.S. Egilman
• Journal: Epidemiology
• Published: 2019;30(6):783-788
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Summary of the article

In this commentary, the authors described how talc mining and manufacturing companies and their trade association, the Cosmetic, Toiletry, and Fragrance Association, influenced research and regulation on asbestos in cosmetic talc and on talc and ovarian cancer. They drew on company documents and testimony produced in litigation. They reported that the association's 1976 test method (J4-1) had a detection limit above 0.5% for tremolite asbestos and did not test for chrysotile or fibrous talc. They also reported that 686 of 1032 tests produced in litigation found asbestos in talcs used in cosmetics from 1948 to 2017. Of 32 epidemiologic studies of talc and ovarian cancer, they stated that 12 incorporated the claim that cosmetic talc had been asbestos-free since 1976, only one considered confounding by occupational or other asbestos exposure, and only 2 considered nonperineal exposure routes. They argued that the resulting misclassification likely drove risk estimates toward the null. Eighteen of the 32 studies reported an elevated risk. The authors described the association's "fatal flaw" argument and the withdrawal of talc from the National Toxicology Program's Report on Carcinogens after scientific panels voted to list it. They also described undisclosed conflicts of interest in IARC talc reviews. They urged epidemiologists to work with other professionals, verify industry information and use litigation documents, and concluded that talc should not be sold. The authors disclosed that one of them serves as an expert witness in talc and asbestos litigation and that the others work for him.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a commentary, not an original study. The authors argued that talc mining and manufacturing companies and their trade group, the Cosmetic, Toiletry, and Fragrance Association, influenced research and regulation on talc and ovarian cancer. They drew on company documents produced in litigation and on at least 32 published epidemiologic studies of talcum powder use and ovarian cancer. By the authors' count, 12 of the 32 studies incorporated the trade group's claim that cosmetic talc had been asbestos-free since 1976. Only 2 considered exposure by routes other than perineal use, and only one considered confounding by occupational or other asbestos exposure. Eighteen reported an elevated ovarian cancer risk among talc users compared with nonusers. The authors wrote that the trade group's J4-1 method did not test for chrysotile asbestos or fibrous talc. They cited work by some of the same authors reporting asbestos in 686 of 1032 tests of cosmetic talcs produced in litigation. The authors argued that unrecorded exposures likely drove study results toward the null, and concluded that talc should not be sold. One author serves as an expert witness for people claiming injury from talcum powders.

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: Commentary (an argument piece discussing published epidemiologic studies and corporate and regulatory documents); not an original study
• Who was studied: No study population. The authors discussed at least 32 published epidemiologic studies of talcum powder use and ovarian cancer, together with company, trade association and regulatory documents, many produced in litigation.
• Exposure: Talc used in cosmetics and baby powder, through perineal use and inhalation, and the asbestos (tremolite, tremolite-actinolite, chrysotile) and fibrous talc the authors say it contained. For example, Johnson & Johnson cosmetic talc came from 1965 to 2003 from a Vermont mine that the authors say contained 10%–20% fibrous talc and accessory tremolite-actinolite.
• Main results:
  • The authors presented talc as an example of corporate influence on research and regulation.
  • By the authors' count, 12 of the 32 epidemiologic studies of talc and ovarian cancer incorporated the trade association's claim that cosmetic talc had been free of asbestos since 1976.
  • Only 2 of the 32 studies considered exposure by routes other than perineal use, according to the authors.
  • Only one study (Rosenblatt et al.) considered confounding by occupational or other asbestos exposure, according to the authors.
  • According to the authors, 18 of the 32 studies reported an elevated risk of ovarian cancer among talc users compared with nonusers.
  • The authors argued that unrecorded exposures caused misclassification and likely drove the studies' rate and odds ratios toward the null.
  • The authors noted that three studies planned as prospective cohort studies evaluated talc exposure only once.
  • The authors cited a Nurses' Health Study update by Gates et al. That update compared two groups of talc users (more than 1 week versus less than 1 week) and found a rate ratio for ovarian cancer of 1.06 (95% CI = 0.89, 1.28).
  • The authors wrote that the trade association's J4-1 test method could detect tremolite asbestos only above 0.5% and did not test for chrysotile asbestos or fibrous talc.
  • The authors cited earlier work by Steffen et al. (some of the same authors) reporting that 686 of 1032 tests produced in litigation showed asbestos in talcs used in cosmetics from 1948 to 2017.
  • The authors reported that talc was the only one of 21 substances nominated for the US National Toxicology Program's Report on Carcinogens that the program withdrew.
• The authors' conclusion: The authors concluded that talc safety has been questioned and that talc should not be sold. They also set out lessons for epidemiologists, including working with toxicologists and industrial hygienists and verifying information supplied by industry.
• Limitations the authors state:
  • The authors disclosed that one author serves as an expert witness at the request of people claiming injury from talcum powders, and that publication of the commentary will advance that author's credibility as an expert and may be used in litigation.

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, Epidemiology, Cosmetic Talc, Ovarian Cancer, Tremolite, Chrysotile, Confounding, Asbestos Exposure.

Related studies

• A Review of the Talc Industry's Influence on Federal Regulation and Scientific Standards for Asbestos in Talc — T. Bird, J.E. Steffen, et al. (2021)
• 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)
• Perineal talc use and ovarian cancer risk: a case study of scientific standards in environmental epidemiology — M. Huncharek, J. Muscat (2011)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• Cosmetic talc and ovarian cancer — D.L. Longo, R.C. Young (1979)
• 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)

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