Recently a Missouri jury has awarded $72 million to the
family of an Alabama woman who died from ovarian cancer in October 2015, which
she said was caused by using Johnson & Johnson's baby powder and other
products containing talcum powder.
The jury found Johnson & Johnson guilty of negligence,
and conspiring to hide facts by not issuing a warning on the product used.
The general public has spoken in favor of the women but,
does evidence linking use of the talcum powder as feminine hygiene product and
development of ovarian cancer exist in studies and clinical research?
Talcum powder is made from talc, a mineral made up mainly of
the elements magnesium, silicon, and oxygen. As a powder, it absorbs moisture
well and helps cut down on friction, making it useful for keeping skin dry and
helping to prevent rashes.
Since early 1980s, a few studies have found that women who
regularly used talc powder for feminine hygiene had higher than average rates
of ovarian cancer. Yet the evidence–which fell short of proving causation–was
mostly confined to medical journals, and not known to general public.
According to an article published in Journal of Toxicology and Environmental Health 1976 Nov;2(2):255-84, researchers at Mount Sinai Hospital in
New York published test results on 20 talc-based consumer products,
including baby and facial powders. All the formulations were before 1973. Of
the 20 products 10 contained detectable amounts of tremolite and anthophyllite,
principally asbestiform, while some also contained fragmented forms of these
minerals They found two types of asbestos, tremolite and anthophyllite,
in 10 of the 20 products.
Before the 1970s, talcum powder was often contaminated with
asbestos fibres which are known to cause cancer. But since then, all home
products containing talcum powder are legally obliged to be asbestos-free.
J &J claims that all its talcum products are free of talc and are manufactured according to strict US pharmacopoeia standard.
Dr. Daniel Cramer, MD, ScD, an obstetrician/gynecologist at
Brigham and Women's Hospital and Harvard
Medical School
in Boston and a
prominent researcher in this field opines that talc does cause ovarian cancer.
He was the first to link talc with ovarian cancer in his pilot study published
in 1982.
He has recently published a paper in Epidemiology journal December 2015 issue, citing over 20 well executed case-control studies that
support this association. In this article he has established a dose –response
relationship with the trend increasing as number of years of talc use accrues.
According to him “Subtypes of ovarian cancer more likely to be associated with
talc included invasive serous and endometrioid tumors and borderline serous and
mucinous tumors”.
Many other control studies have documented a 30% increase in
risk of ovarian cancer, but the single cohort study done has not documented
causation.
Due to this inconclusive research evidence, talcum powder is
classified by the InternationalAgency for Research on Cancer (IARC) aspossibly carcinogenic
(cancer causing) to humans when applied to the genital area. IARC is
a part of the World Health Organisation which convenes international expert
working groups to evaluate the evidence of the carcinogenicity of specific
exposures.
While the American Cancer Society says “It is not clear if
consumer products containing talcum powder increase cancer risk”.
Many research papers and epidemiology studies have
specifically evaluated talc and perineal use and these studies have found talc
to be safe. For example, the Nurses’ Health Study (2010)2 and the Women’s
Health Initiative Observational Cohort (2014)3 are two large-scale prospective
studies looking at talc and ovarian cancer. Both found no causal relationship
between talc and ovarian cancer.” Both these studies were criticized insufficient
exposure to the talc powder.
Meanwhile the J& J spokesperson Carol Goodrich said,
"We sympathize with the plaintiff's family but firmly believe the safety
of cosmetic talc is supported by decades of scientific evidence." The
company is expected to appeal the ruling.
The possible mechanism of cancer causation by the talc is chronic
inflammation. Very small particles of talc migrate from vagina to the upper
genital tract. In fact, Jackie Fox, whose ovarian cancer prompted the court
case in St Louis,
had talc found in her surgically removed ovaries, according to news reports.
The American Cancer Society advises the consumers to use
corn starch based products, until a definite answer to the role played by talcum
powder in ovarian cancer causation is found.
The US
National Toxicology Program (NTP) is formed from parts of several
different government agencies, including the National Institutes of Health
(NIH), the Centers for Disease Control and Prevention (CDC), and the Food and
Drug Administration (FDA). The NTP has not fully reviewed talc (with or without
asbestos) as a possible carcinogen.
Further research is needed to determine whether and how
talcum powder might increase the risk of ovarian cancer.
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