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Does talcum powder cause ovarian cancer?

Talcum Powder

Based on prevailing research, the science is hardly decided on whether the regular use of talcum powder causes ovarian cancer. But at least two juries in St. Louis, Missouri, would beg to differ after awarding a total of $127 million in cases involving two women who said they got ovarian cancer from using Johnson & Johnson® talcum powder. One jury ordered the pharmaceutical giant to pay $55 million to Gloria Ristesund, who was diagnosed in 2011. The other awarded $72 million to the family of Jacqueline Fox, three years after she died of ovarian cancer at the age of 59. Johnson & Johnson says it will appeal the decisions.

Johnson & Johnson, which faces more than 1,000 other talc-related lawsuits, says the most recent verdict "goes against 30 years of studies by medical experts around the world that continue to support the safety of cosmetic talc." Some oncologists agree. Despite the hand wringing the verdicts have caused among consumers, experts say not to read too much into the juries’ decisions, and instead focus on the science.

Talc, or magnesium silicate, is a soft mineral made of magnesium, silicon and oxygen. It's mined worldwide and used in a variety of everyday products, from cosmetics and crayons to paper and plastics. Talcum powder has been a flagship product for Johnson & Johnson for decades, sold under such staples as Johnson's Baby Powder® and Shower to Shower® body powder. But some researchers say those talcum sprinkles, when applied to a woman's genitals or sanitary napkins, may travel up the vagina and through the uterus and fallopian tubes, settling into the ovaries and causing inflammation. Over time, the inflammation allows cancer cells to develop, or so the theory goes.

British researchers in the early 1970s first raised cancer risk concerns around talcum powder when they discovered talc crystals in the ovaries of 10 of 13 cancer victims. Ten years later, Dr. Daniel W. Cramer, an obstetrician and gynecologist at Brigham and Women's Hospital in Boston, conducted the first of several studies linking talcum powder use to cancer. His 1982 study and several since concluded that women whose genitals were exposed to talcum powder were three times more likely to develop ovarian cancer. Dr. Cramer often appears on behalf of defendants in talc lawsuits.

Most health agencies have not declared talc a risk factor for ovarian cancer, although in 2010, the World Health Organization’s International Agency for Research on Cancer concluded that “perineal use of talc-based body powder is possibly carcinogenic to humans.”

Dr. John Farley, Chief of the Division of Gynecological Oncology at our hospital near Phoenix, says it is important to put these studies into perspective and consider how they were conducted. Some relied on women to remember their behavior from years earlier. Did they use talc? If so, how much did they use? Did they take birth control pills, which may reduce ovarian cancer risk? Dr. Cramer used such surveys, known as case control or retrospective studies and considered by some to be flawed. "The case control studies, because they are retrospective, are subject to recall bias," Dr. Farley says. "So a patient who has ovarian cancer might say they remember using talcum powder, while a patient who does not have cancer might not recall that."

Other studies, called prospective studies, tracked women's behavior after they enrolled in the trials, collecting more reliable data. "When they look at talcum powder exposure in those studies, they don’t find any relationship between the exposure to talcum powder and ovarian cancer," Dr. Farley says.

Other questions about the talc-cancer link include:

If talc is a carcinogen, why would it only cause ovarian cancer and not anal or vaginal cancer? "You would think it would cause additional lower-extremity cancers," says Dr. Farley. "But it doesn't."

Why isn't talcum powder linked to lung cancer? Studies on the workers who mine and mill talc show mixed results, according to the American Cancer Society. But there are no studies showing a lung cancer link to the use of talcum powder. Surgeons even use talc during some lung procedures in a therapy called pleurodesis, used to remove fluid from the space between the lungs and the chest wall. The talc is applied directly to the outside of the lungs, but the practice has not been linked to an increased risk of cancers in the chest, Dr. Farley says.

Does the cosmetic use of talc increase cancer risk? Talc is used in eye shadows and other makeup products, but there have been no increases in cancer risk associated with the use of those products.

All the questions, jury verdicts and conflicting studies aside, the use of talcum powder should be a "personal preference,” Dr. Farley says. “The risk factor is very small in the general population." If you still want to sprinkle but avoid the talc, look for a powder made with cornstarch, since there is no evidence at this time linking cornstarch powders with any form of cancer, according to the American Cancer Society.

Learn about the risk factors for ovarian cancer.