Diana Zuckerman, PhD, and Danielle Shapiro, MD, MPH Cancer Prevention & Treatment Fund
A growing body of evidence suggests that using talcum powder (also called talc) in the genital area can increase a woman’s chances of developing ovarian cancer. The more years she uses talc, the more likely she is to develop ovarian cancer. Talc is an ingredient in many baby powders. If you have 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.
About 1.3% of women in the United States will be diagnosed with ovarian cancer in her lifetime. Although this is much lower than the lifetime risk for developing breast cancer, there is no recommended test to screen for ovarian cancer, so unlike breast cancer, ovarian cancer is rarely diagnosed early. When ovarian cancer is found early, a woman has nearly a 93% chance of surviving at least 5 years after she is diagnosed. Those chances drop off significantly to about 30% if the cancer is found after it has spread to other parts of her body. According to the American Cancer Society, over 21,000 women are estimated to receive a new diagnosis of ovarian cancer in 2021, and almost 14,000 women are estimated to die from it.
Based on many research studies involving thousands of women, those who have used talcum powder are about 30% more likely to be diagnosed with ovarian cancer than women who have not.[6,7] 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 for any individual woman, but if 1 million women use talcum powder, approximately 4,000 more of those women will develop ovarian cancer, compared to the number that would 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 a 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 of 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 using talcum powder 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.
It is possible that there is a bias in women’s responses. Women with ovarian cancer might inaccurately recall having used more talc in the genital area than they actually did, leading to a false association between genital use of talc and ovarian cancer. However, it does not seem likely that these results are due to biased answers or faulty memory. While there is never a guarantee that memories are 100% accurate, many women are very sure about whether or not they regularly used talcum powder in the genital area. The International Agency for Research on Cancer (IARC), a well-respected agency within the World Health Organization (WHO), concluded that there was an “unusually consistent” increased chance of developing ovarian cancer among women who reported using talcum powder in the genital area. In addition, the results are consistent for one particular type of epithelial ovarian cancer, called serous carcinoma. If the association between genital talc use and developing ovarian cancer were due to faulty memory or biased responses, we would see an association between it and all forms of ovarian cancer. The fact that it is consistently associated with one type of ovarian cancer means it is more likely that these findings are accurate.
Some of the most convincing evidence comes from two case-control studies published in 2016: the African American Cancer Epidemiology Study (AACES) and the New England study.[10,1]
The AACES study compared 584 African American women who had been diagnosed with ovarian cancer to 745 African American women who did not have ovarian cancer. The women in the study came from 11 different geographic regions of the United States, and women with ovarian cancer were compared to women of the same ages and from the same geographic regions. In this study, talc use was common – about 63% of women with ovarian cancer and 53% of the healthy women said they had used talc.
The study found that the women who had only used talc in the genital area, as well as women who used talc only in non-genital areas, or who used it in both, were significantly more likely to have been diagnosed with epithelial ovarian cancer than women who did not use talc. Those who used talc in the genital area had a more than 40% increased risk of cancer, whereas those who used talc only in non-genital areas had an increased risk of over 30%. Instead of having a 1.3% lifetime risk, the women who used talc in the genital area would have over a 1.8% risk. Johnson & Johnson has been shown to target African American women in their marketing of talc, and African American women are more likely to use the product than other women, so it is important to understand the risks for this population.
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, compared to women who did not have a respiratory condition. The researchers believe that talcum powder causes the body to develop inflammation, which is known to potentially cause the growth of cancer cells. 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 talc.
The New England ovarian cancer study also suggests that the body develops cancer as a result of inflammation caused by talcum powder. The researchers 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. They reported that the women who used talc in the genital area, whether or not they used it elsewhere in their bodies, were significantly more likely to be diagnosed with epithelial ovarian cancer. Most reported using Johnson & Johnson Baby Powder or Shower to Shower brand powder. Many body powders are now made with cornstarch instead of talc, but women who used powders made with cornstarch were not considered talc users in the study.
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 increased their lifetime risk to about 1.7%. However, some women were more at risk than others. Women who used talc and were sterilized prior to menopause (underwent a tubal ligation or hysterectomy) or who took hormone therapy for menopausal symptoms were even more likely to develop ovarian cancer compared to other talc users. The researchers believe that the hormone estrogen may make women less vulnerable to the risk of talc.
One study published in 2020 reports that there are no consistent findings of a relationship between talc exposure and developing ovarian cancer. However, it is important to note that the study was funded by the Cosmetics Alliance Canada and Industrial Minerals Association-North America. Since the researchers were funded by companies that profit off of talc use, that could have biased their results. Another study published in 2020 also found no statistically significant association between genital application of talc and ovarian cancer across 4 studies. However, the researchers warn that their study may have been underpowered and could have missed a small increase in risk due to talc use. This is especially likely because there are some shortcomings in the research, such as inconsistency with how talc use was measured and no information about the amount of talc in the powders women reported using.
How Could Talc Cause Ovarian Cancer?
Talc is often found in the same places in the earth as asbestos, so asbestos may be contaminating talc when it is mined. Asbestos is known to cause cancer in humans. In 2019, the U.S. Food and Drug Administration (FDA) found that a bottle of Johnson & Johnson baby powder tested positive for asbestos. The FDA gathered a team of experts from 8 different federal agencies, and these experts developed recommendations for standardizing testing talc products for asbestos.[15,16]
However, this team of experts said that it is “irrelevant” whether the products contain asbestos because both asbestos and similar minerals (such as talc) are suspected of causing “similar pathological outcomes.” In fact, microscopic photos of talc show that it can look very similar to asbestos, regardless of whether it is contaminated with asbestos. The team of experts asserted that talc, even without any asbestos present, is suspected to cause health problems. One reason that researchers believe genital application of talc can cause ovarian cancer is that talc can enter the ovaries and cause inflammation, and inflammation can cause cancer.[17,18]
Lawsuits Over Talc and Cancer
Since 2014, Johnson & Johnson has defended its talcum powder in lawsuits brought by families of women who had used their talcum powder products and died from ovarian cancer. In February 2016, the courts ruled in favor of the family of a woman who died of ovarian cancer at 62 years old. Particles of talc were found in her ovaries, which were removed after her cancer diagnosis. The courts overturned the ruling just a few months later based on jurisdictional issues that were not related to the science. In another matter, a California woman with ovarian cancer won a $70 million dollar against Johnson & Johnson. 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.”
There is some evidence that men may also be harmed by talc. For example, the courts ruled in favor of a New Jersey man because the powder had caused an asbestos-related lung cancer known as mesothelioma. In this case, the talcum powder was likely contaminated with asbestos. 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.
A 2018 investigation by Reuters examined Johnson & Johnson’s internal reports, company memos, and confidential documents from 1971 to the early 2000s. According to the documents, as early as 1971, researchers from Mount Sinai Medical Center had told Johnson & Johnson that they had found traces of asbestos in the company’s baby powder made with talc. The documents suggest that Johnson & Johnson claimed that the tiny amount of asbestos found in some samples of its powders was too small to cause health problems, and the company lobbied the Food and Drug Administration to agree with that assessment.
Currently, Johnson & Johnson is facing over 15,000 lawsuits from people who believe that their cancers were caused by talc products sold by the company. In one lawsuit, a group of 22 women who developed ovarian cancer sued the company and were awarded $2 billion. The company tried to appeal the case before the Supreme Court, but in June 2021, the Supreme Court rejected the appeal, which means that the $2 billion award still stands.
In May 2020, Johnson & Johnson announced that they would stop selling talc-based baby powders in the U.S. and Canada. Nevertheless, the company denies any claims that their product is associated with cancer. Instead, they claim that they are no longer selling the talc-based powder due to low demand and “misinformation around the safety of the product and a constant barrage of litigation advertising.” The company will still sell baby powders that are cornstarch-based, rather than talc-based.
The Bottom Line
While the scientific evidence has shown a consistent link between talcum powder and ovarian cancer and possibly other health risks, 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.
The National Center for Health Research is a nonprofit, nonpartisan research, education and advocacy organization that analyzes and explains the latest medical research and speaks out on policies and programs. We do not accept funding from pharmaceutical companies or medical device manufacturers. Find out how you can support us here.
- Cramer DW, Vitonis AF, Terry KL, et al. The association between talc use and ovarian cancer: A retrospective case–control study in two US states. Epidemiology. 2016;27(3): 334-346.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/
- Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, Gaudet MM, Jemal A, Siegel RL. Ovarian cancer statistics, 2018. CA: A Cancer Journal for Clinicians. 2018 Jul;68(4):284-96.
- National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. Seer.cancer.gov. https://seer.cancer.gov/statfacts/html/breast.html. 2020.
- U.S. Preventive Services Task Force. Final Recommendation Statement: Ovarian Cancer: Screening. Rockville, MD:U.S. Preventive Services Task Force. 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/ovarian-cancer-screening1\
- American Cancer Society. Key Statistics for Ovarian Cancer. Cancer.org. https://www.cancer.org/cancer/ovarian-cancer/about/key-statistics.html. Updated 2021.
- Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention. 2018; 27(3):248-57.
- Terry KL, Karageorgi S, Shvetsov YB, Merritt MA, Lurie G, Thompson PJ, Carney ME, Weber RP, Akushevich L, Lo-Ciganic WH, Cushing-Haugen K. Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls. Cancer Prevention Research. 2013; 6(8):811-21.
- International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 93 Carbon Black, Titanium Dioxide, and Talc; 2010. http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8F.pdf
- Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: a meta-analysis. European Journal of Cancer Prevention. 2018; 27(3):248-57.
- 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. 2016;25(10):1411-1417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050086/
- Cohen R. Talc linked to ovarian cancer risk in African-American women. Reuters Health News. June 6, 2016. https://www.reuters.com/article/us-health-talc-ovarian-cancer/talc-linked-to-ovarian-cancer-risk-in-african-american-women-idUSKCN0YO2T7
- Goodman JE, Kerper LE, Prueitt RL, Marsh CM. A critical review of talc and ovarian cancer. Journal of Toxicology and Environmental Health, Part B. 2020; 15:1-31.
- O’Brien KM, Tworoger SS, Harris HR, Anderson GL, Weinberg CR, Trabert B, Kaunitz AM, D’Aloisio AA, Sandler DP, Wentzensen N. Association of powder use in the genital area with risk of ovarian cancer. JAMA. 2020; 323(1):49-59.
- U.S. Food and Drug Administration. Talc. Fda.gov. https://www.fda.gov/cosmetics/cosmetic-ingredients/talc. Updated March 2020.
- The Mesothelioma Center. FDA Panel Recommends Standardized Talc Testing for Asbestos. Asbestos.com. https://www.asbestos.com/news/2020/01/21/standardized-talc-testing-asbestos/. January 2020.
- Reuters. Government experts urge new talc testing standards amid asbestos worries. Reuters.com. https://www.reuters.com/article/us-usa-fda-talc-testing/government-experts-urge-new-talc-testing-standards-amid-asbestos-worries-idUSKBN1Z92I4. January 2020.
- Trabert B. Body powder and ovarian cancer risk–what is the role of recall bias?. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2016; 25(10):1369.
- Penninkilampi R, Eslick GD. Perineal Talc Use and Ovarian Cancer: A Systematic Review and Meta-Analysis. Epidemiology. 2018; 29(1):41‐49. doi:10.1097/EDE.0000000000000745
- Taylor J. Missourinet. Johnson & Johnson case from St. Louis gets heard in Missouri Supreme Court. Missourinet. March 5, 2018. https://www.missourinet.com/2018/03/05/johnson-johnson-case-from-st-louis-gets-heard-in-missouri-supreme-court/
- DailyMed. LABEL: ASSURED MEDICATED BODY POWDER- menthol powder. Dailymed.nlm.nih.gov. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c8dad6e4-748f-41c1-98d6-1afa836967ce. Updated November 2017.
- Bellon T. J&J, Imerys unit must pay $117 million in N.J. asbestos cancer case. Reuters. April 11, 2018. https://www.reuters.com/article/us-johnson-johnson-cancer-lawsuit/jj-imerys-unit-must-pay-117-million-in-n-j-asbestos-cancer-case-idUSKBN1HI2ZD
- Girion L, Wood M. Johnson & Johnson knew for decades that asbestos lurked in its Baby Powder. Reuters. December 14th 2018, https://www.reuters.com/investigates/special-report/johnsonandjohnson-cancer/#johnson-research-sidebar
- National Public Radio. Supreme Court Says A $2 Billion Verdict In A Baby Powder Cancer Case Should Remain. Npr.org. https://www.npr.org/2021/06/01/1002149828/supreme-court-johnson-johnson-talc-verdict-ovarian-cancer. June 2021.
- National Public Radio. Johnson & Johnson Stops Selling Talc-Based Baby Powder In U.S. And Canada. Npr.org. https://www.npr.org/2020/05/19/859182015/johnson-johnson-stops-selling-talc-based-baby-powder-in-u-s-and-canada. May 2020.