×
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT

Talc and cancer

Last Updated 30 May 2016, 18:32 IST

Deane Berg thought she was going to die, and she wanted to know why. She was 49, way too young, she thought, to have advanced cancer in her ovaries. As she scrolled through websites that listed possible causes of ovarian cancer, one jumped out at her: talcum powder. She did not have risk factors like infertility or endometriosis, but she had dusted baby powder between her legs every day for 30 years. “I went into the bathroom, I grabbed my Johnson’s Baby Powder and threw it in the wastebasket,” recalled Deane, now 59, a physician assistant in Sioux Falls, South Dakota. “I said, ‘What else could it be?’”

Deane was the first of thousands of women with ovarian cancer to file a lawsuit against the consumer products giant Johnson & Johnson, claiming that Baby Powder caused their disease and pointing to a long trail of studies linking talc to the cancer. The research dates to 1971, when scientists in Wales discovered particles of talc embedded in ovarian and cervical tumours. Since then, numerous studies have linked genital talc use to ovarian cancer, including a report earlier this month that among African-American women, genital use of powder is linked with a 44% increased risk for invasive epithelial ovarian cancer.

Johnson & Johnson says its trademark Baby Powder is safe, and it plans to appeal 2 multimillion-dollar jury awards, including $55 million in damages awarded to a cancer survivor earlier this month and a $72 million award in February.

The International Agency for Research on Cancer in 2006 classified talcum powder as a possible human carcinogen if used in the female genital area. But the agency, part of the World Health Organization, has also said pickled vegetables and coffee are possible carcinogens and that hot dogs cause cancer.

Johnson & Johnson says research implicating talcum powder is flawed and points to studies that absolve talc of any cancer risk. “We have children ourselves,” said Tara Glasgow, the research and development lead for the company’s baby products franchise worldwide. “We would never sell a product we didn’t believe was safe.”

So did the juries get it right or wrong? Is it plausible that Johnson’s Baby Powder — that clean-smelling soft stuff that’s a medicine cabinet staple, packaged in milky-white containers and supposedly mild enough for babies’ bottom — can cause cancer? It’s not an easy question to answer.

Difficult to blame
“There is no way we’re ever going to know for certain that any exposure is necessarily causal to a disease,” said Shelley Tworoger, an associate professor of medicine and epidemiology at Brigham and Women’s Hospital at Harvard. “We might be 99% sure,” in some cases, she said, “but there’s usually no way to guarantee that what you see is actually the truth.”

Cancer is hard to study because it develops over a long period of time and is influenced by many factors, including genes, behaviours and environmental exposures. The best we can do, Shelley said, “is look at the preponderance of the evidence.” Talc is a naturally occurring clay mineral composed of magnesium and silicon. Known for its softness, it is used in cosmetic products like blush because it absorbs moisture and prevents caking. It is also an additive in tablets, chewing gum and some rice. It’s often mined in proximity to asbestos, a known carcinogen, and manufacturers have to take steps to avoid contamination.

Many women use the powder on their inner thighs to prevent chafing, while others sprinkle it on their perineum, sanitary pads or underwear to stay “fresh” and dry. A 1980s ad campaign for a once-popular powder promised with a catchy jingle that “a sprinkle a day helps keep odour away.” There has never been an experiment to see what happens when you deliberately expose women to talcum powder — for practical and ethical reasons, there never will be — so scientists must rely on observational studies that can link an exposure to a disease but cannot determine a cause-and-effect relationship.

In 1982, Daniel W Cramer, a Harvard professor, and his colleagues compared 215 women with ovarian cancer and 215 healthy women who served as a control group. Compared with non-users, women who used talcum powder were at nearly twice the risk for having ovarian cancer, and those who used it regularly on their genitals and sanitary pads were at more than 3 times the relative risk. At least 10 subsequent studies echoed the results, with varying degrees of increased risk. But a small number of studies did not find a heightened risk for talc users.

When researchers pooled the results of similar studies involving nearly 20,000 women, they found powder use was associated with a 24% increased risk for ovarian cancer, an uncommon disease but one that is often fatal. If the finding is true, it means that for every 5 or 6 talcum powder users who develop ovarian cancer, one may be a result of talcum powder use, Steven A Narod, an expert in cancer genetics from Toronto, said.

Why talc use might lead to cancer is not clear. Studies have shown that talc crystals can move up the genital-urinary tract into the peritoneal cavity, where the ovaries are.

Indeed, a pathology report on Berg’s tumour found talc particles embedded in the tissue.There is also a plausible mechanism, Tworoger said, because talc particles can set off inflammation, and inflammation is believed to play an important role in the development of ovarian cancer.

Although Johnson & Johnson’s talc supplier added warning labels in 2006, J&J did not add similar warnings to its products, according to litigation documents. Baby powder does carry a warning to keep it out of the reach of children and many pediatricians discourage its use on babies, who can become ill or die after breathing in the particles. Inhalation studies in female rats demonstrated carcinogenicity, according to the National Toxicology Program. Condom and surgical glove makers have stopped dusting their products with talc.

“Talcum powder is an interesting case, because it’s not something that’s necessary,” said Dr Anne McTiernan, an epidemiologist with the Fred Hutchinson Cancer Research Center in Seattle. “If there’s any doubt, why should anyone use it?”As for Berg — the Sioux Falls woman with advanced ovarian cancer — she won her lawsuit against Johnson & Johnson, but the jury did not award damages. She hopes other talc lawsuits will raise awareness.“I knew nothing about this before,” she said. “I figured baby powder is for babies, it must be safe.”

ADVERTISEMENT
(Published 30 May 2016, 17:17 IST)

Follow us on

ADVERTISEMENT
ADVERTISEMENT