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Evidence on talc cancer risk differs for jurors

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researchers
Compiled by
By Julie Steenhuysen
Reuters

MELJUN CORTES

February 25, 2016

View A bottle of Johnson's Baby Powder is seen in a photo illustration taken in New York
A bottle of Johnson and Johnson Baby Powder is seen in a photo illustration taken in New York, February
24, 2016. REUTERS/Mike Segar/Illustration

By Julie Steenhuysen
CHICAGO (Reuters) - A U.S. jury verdict linking regular use of Johnson & Johnson talcum
powder to a woman's death from ovarian cancer has spurred new concern from consumers,
but scientists say the evidence of real danger is inconclusive at best.
Jurors in St. Louis on Monday ordered Johnson & Johnson to pay $72 million in damages to
the family of a woman who had used the company's talc-based Baby Powder and Shower
to Shower for several decades. The company maintains that the safety of cosmetic talc "is
supported by decades of scientific evidence."Talcum powders are made of talc, a mineral
comprised of bits of magnesium, silicon and oxygen that absorbs moisture. In its natural
form, some talc contains asbestos, a known carcinogen. But all commercial products sold in
the United States have been asbestos-free since the 1970s.
Even so, the association stuck, said Dr. Ranit Mishori, a professor of family medicine at
Georgetown University.
"That initial idea that talcum has some asbestos in it put that on the radar of certain
researchers and public health experts years and years ago," she said.
Scientists have explored various ways talc might cause cancers in different parts of the body.
Most of the concern has focused on whether long-term exposure to talc fibers might cause
lung cancer among talc miners, and whether women who routinely applied talcum powder
on their genitals had an increased risk of ovarian cancer, according to the American Cancer
Society's website.
Studies in talc miners exposed to talc containing asbestos have been mixed, but there is no
increased lung cancer risk from asbestos-free talc products, the group says.

That leaves the question of ovarian cancer.
Experts believe it is possible in theory for talc to reach the ovaries by traveling up the vagina,
through the uterus and Fallopian tubes and into the ovaries, where it causes inflammation.
Dr. Adetunji Toriola, a Washington University epidemiologist at Siteman Cancer Center in
St. Louis, said such an association is scientifically plausible.
"We know that inflammation increases ovarian cancer risk. We know talcum powder causes
inflammation. The question is, does talc cause cancer by causing inflammation in the
ovaries?" he said.
Dr. Daniel Cramer, a Harvard University epidemiologist, first reported on a potential link
between talc and ovarian cancer in 1982. He has published several studies since, and his
work suggests that talc exposure increases the risk of ovarian cancer, a rare disease, by 30
percent overall.
LEVEL OF PROOF
Cramer, a paid consultant for plaintiff attorneys in the trial against J&J, demonstrated that
increased risk in case-controlled studies, which compared past talcum use in women who
developed ovarian cancer to women who did not.
Experts said these sorts of studies are less rigorous and prone to bias as women struggle to
recall how much or how often they used talcum powder. Results from other, similar studies
have been mixed. Some showed an association between talc and ovarian cancers, and
some did not.
Two studies using a more rigorous design called prospective cohort studies, however, failed
to show any association overall between talc use and increased risk of ovarian cancers.
"We know cohort studies provide much more definitive answers," Toriola said.
In these studies, researchers identify people who are already using a substance in question
and follow them over several years, comparing their results to another cohort of people not
using the substance in question.
One study published in 2000 in the Journal of the National Cancer Institute, in which Cramer
was a co-author, concluded there was "little support for any substantial association between
perineal talc use and ovarian cancer risk overall."
They did, however, show a "modest" increase in serous ovarian cancer, the most common
form.
Based on studies such as these, the International Agency for Research on Cancer, part of
the World Health Organization, classified the use of talc-based body powder on the genitals
as "possibly carcinogenic to humans," a category that includes other commonly used
consumer products such as coffee and aloe vera.

To prove conclusively that talc causes ovarian cancer would require a randomized clinical
trial - the gold standard of scientific proof. But that is not possible because of ethical
concerns, Cramer said.
Such a trial would need to deliberately expose women to a product thought to cause cancer
and wait to see if they developed ovarian cancer at higher rates than women not using the
product.
Mishori said she does not believe there is any proof through "rigorously conducted, highquality studies that there is a causation or even an association" between talc and ovarian
cancer.
As a doctor, she is pragmatic, noting that talc-based powder is not a must-have product.
"If you are concerned, just don't use it," she said.
(Editing by Matthew Lewis and Bill Trott)