Talcum Powder and Ovarian Cancer

Diana Zuckerman, PhD, and Danielle Shapiro, MD, MPH Cancer Prevention & Treatment Fund

A growing body of evidence suggests that using talc in the genital area can increase a woman’s chances of developing ovarian cancer. And the more years she uses talc, the more likely she is to develop ovarian cancer.  If you ever used talcum powder or “baby powder” or if you are still using it on yourself or your baby, here’s what you need to know.

On average, one in every 75 women will develop ovarian cancer in their lifetime. This is just over 1%, and much lower than the 12% lifetime risk of developing breast cancer.  But, unlike breast cancer, there is no recommended test to screen for ovarian cancer, so it is rarely diagnosed early. In 2017, there were over 20,000 new cases of ovarian cancer and over 14,000 deaths. When ovarian cancer is found early, a woman has nearly a 93% chance of surviving at least 5 years after she is diagnosed, but those chances drop off significantly to about 30% if the cancer is found so late that it has spread to other parts of her body.[1]

Based on dozens of research studies in thousands of women, women who use talcum powder are about 30% more likely to be diagnosed with ovarian cancer than women who did not use talcum powder.[2,3] This means that over her lifetime, a woman who uses talcum powder increases her chances of developing ovarian cancer from 1.3% to 1.7%.  That is still a low risk, but if that if one million women used the powder, 4,000 more of them will develop ovarian cancer – women who wouldn’t have developed ovarian cancer if they hadn’t used talcum powder.

How Good Is the Evidence?

Most of the evidence comes from a type of study known as the case-control study.  For these studies, researchers recruit two groups of women– women with ovarian cancer (called “cases”) and women without ovarian cancer (called “controls”).  All the women are asked to recall whether they used talcum powder in the past, and if so, how often and how it was used. These studies cannot tell us for sure that talcum powder use causes ovarian cancer, but they can tell us if women who report using the powder in the genital area are more likely to develop ovarian cancer. Of course, there is no guarantee that the women’s memories are 100% accurate.  However, using talcum powder is a somewhat memorable experience, and many women are very sure of whether they did or not.  Since most of the case-control studies of talcum powder in the U.S. and in other countries show similar increases in ovarian cancer among the powder users, this adds a great deal to their credibility.

The International Agency for Research on Cancer (IARC), is a well-respected agency within the World Health Organization (WHO). IARC concluded that there was an “unusually consistent” increased chance of developing ovarian cancer among women who reported using talcum powder in the genital area.[4]

Some of the most convincing evidence comes from two studies published in 2016, the African American Cancer Epidemiology Study (AACES) and the New England study.[5,7] 

The AACES study compared 584 African American women in 11 different geographic regions in the U.S who had been diagnosed with ovarian cancer to 745 women of the same age and geographic location.[5] In this study, talcum powder use was common: About 63% of women with ovarian cancer said they had used talc and 53% of the healthy women said they had used it. The study found that the women who used talc anywhere in their body, used talc on their genitals and elsewhere, or had used talc only in the genital area, were significantly more likely to have been diagnosed with epithelial ovarian cancer.  The women who reported using talc in the genital area, whether or not they used it anywhere else, were about 44% more likely to have been diagnosed with ovarian cancer. Instead of having a 1.3% lifetime risk, the women who used talc would have almost a 2% risk. The main author of the study believes that this study was important because African American women are more likely to have used powder, making it easier to determine a strong link between talcum powder and ovarian cancer. [6]

In that study of African American women, the women who had a respiratory condition, such as asthma, were slightly more likely to develop ovarian cancer if they used talc, than women who did not have a respiratory condition.[5] The authors believe that talcum powder causes the body to develop inflammation, which is known to potentially cause the growth of cancer cells. It makes sense that women who are more likely to develop inflammation, such as those who have an underlying respiratory condition, may be at a slightly higher risk of developing ovarian cancer from talcum powder.

The New England ovarian cancer study also suggests that the body develops cancer as a result of inflammation caused by the talcum powder.[7] The authors of the study are from the prestigious Brigham and Women’s Hospital in Boston, and their study was supported by a grant from the National Institutes of Health.  They compared approximately 2,041 women living in Massachusetts and New Hampshire who had been diagnosed with ovarian cancer, with 1,578 women of the same age and geographic location who did not have cancer.

The study found that the women who used talc in the genital area, whether or not they used it elsewhere in their body, were significantly more likely to have been diagnosed with epithelial ovarian cancer. Most reported using Johnson & Johnson Baby powder or Shower to Shower powder. Many body powders are now made with cornstarch instead of talc.  Women who used those same brand name powders made with cornstarch were not considered talc users.

Overall, the women using talc were about 33% more likely to develop ovarian cancer. Instead of having a 1.3% lifetime risk, a woman who used talc would have about a 1.7% risk. However, some women were more at risk than others. Women who were sterilized prior to menopause (underwent a tubal ligation or hysterectomy) or who took hormone therapy for menopausal symptoms and who used talc were even more likely to develop ovarian cancer compared to other talcum powder users. The researchers believe that the hormone estrogen may make women less vulnerable to the risk of talc.[7]

What Have the Courts Decided?

Since 2014, Johnson & Johnson has defended its talcum powder in law suits brought by families of women who have died from ovarian cancer and had used talcum powder. In February 2016, the courts ruled in favor of the family of a woman who died of ovarian cancer at the age of 62 years. Particles of talc were found in her ovaries, which she had to have removed after her cancer diagnosis.The courts overturned the ruling just a few months later due to jurisdictional issues, not the science.[8] A woman in California won a $70 million dollar against the company. She continues to fight for fair warning labels on the products it sells. A powder sold by the brand Assured already carries such a warning: “Frequent application of talcum powder in the female genital area may increase the risk of ovarian cancer.” However, Johnson & Johnson believes such a warning would do more harm than good because it is not backed by scientific evidence.[9]

In a related line of lawsuits, the courts rules in favor of a man in New Jersey because the powder had caused an asbestos-related lung cancer known as mesothelioma. In this case, the talcum powder was likely contaminated with asbestos, a chemical that is known to cause cancer in humans. Despite the jury’s decision, Johnson & Johnson continues to deny claims that their product contains asbestos or that it causes cancer. However, the court held that exposure to asbestos from another source was not a likely cause of his cancer.[10] In 2009, the U.S. FDA conducted a small survey of talc-containing cosmetics including baby powder, concluding that none of the products they tested contained asbestos; however, while “these results [are] informative, they do not prove that most or all talc or talc-containing cosmetic products currently marketed in the United States are likely to be free of asbestos contamination.”[11] Because the FDA does not require companies to provide information on safety to them, consumers must rely on the companies to follow through on their duty to warn. As the debate continues, the bottom line is, if you can, avoid using these products for your health and your family’s health.

The Bottom Line

While the scientific evidence has shown a consistent link between talcum powder and ovarian cancer, many questions remain. The bottom line question is: why take the risk?

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

Footnotes:

  1. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/ovarian-cancer-screening1\
  2. Berge W. et al. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention 2017. available online :http://cdn.cnn.com/cnn/2017/images/11/15/genital_use_of_talc_and_risk_of_ovarian_cancer___a.99354.2017.july.meta.pdf
  3. Terry KL, Karageorgi S, Shvetsov YB, et al. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer prevention research (Philadelphia, Pa). 2013;6(8):811-821. doi:10.1158/1940-6207.CAPR-13-0037.
  4. IARC Monographs Volume 93, p. 412. http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8F.pdf
  5. Schildkraut JM, Abbott SE, Alberg AJ, et al. Association between Body Powder Use and Ovarian Cancer: the African American Cancer Epidemiology Study (AACES).Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016;25(10):1411-1417. doi:10.1158/1055-9965.EPI-15-1281.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050086/
  6. Cohen R. Reuters Health News. Talc linked to ovarian cancer risk in African-American women. June 6, 2016. Available online: https://www.reuters.com/article/us-health-talc-ovarian-cancer/talc-linked-to-ovarian-cancer-risk-in-african-american-women-idUSKCN0YO2T7
  7. Cramer, DW, Vitonis, AF, Terry, KL, Welch, WR,Titus, LJ. “The Association Between Talc Use and Ovarian Cancer: A Retrospective Case–Control Study in Two US States.” Epidemiology May 2016. 27(3): 334-346.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/
  8. Taylor J. Missourinet. Johnson & Johnson case from St. Louis gets heard in Missouri Supreme Court. March 5, 2018. Available online:https://www.missourinet.com/2018/03/05/johnson-johnson-case-from-st-louis-gets-heard-in-missouri-supreme-court/
  9. Jen Christensen. CNN. “Does talcum powder cause cancer? A legal and scientific battle rages” April 11, 2018. Available online: https://www.cnn.com/2018/04/11/health/talc-ovarian-cancer-cases/index.html
  10. Tina Bellon. Reuters. Health News. “J&J, Imerys unit must pay $117 million in N.J. asbestos cancer case” April 11, 2018. avialable online: https://www.reuters.com/article/us-johnson-johnson-cancer-lawsuit/jj-imerys-unit-must-pay-117-million-in-n-j-asbestos-cancer-case-idUSKBN1HI2ZD
  11. U.S. FDA. Cosmetics Products and Ingredients: Talc. updated March 12, 2018. available online. https://www.fda.gov/Cosmetics/ProductsIngredients/Ingredients/ucm293184.htm