Which talcum powder is best for women

Can talcum powder cause ovarian cancer?

Los Angeles - A court in California has reportedly awarded $ 417 million in damages to a longtime user of talcum powder in the genital area with ovarian cancer. Whether the mineral powder is actually carcinogenic is controversial both in research and in dishes.

Talc is a metamorphic mineral made of magnesium silicate that can bind water. Finely ground it has a pleasant consistency as a powder. It was widely used as "baby powder" before absorbent diapers were developed. In medicine it is used for pleurodesis. Talc may be added to foods as 553b and tablets. Condoms and diaphragms are also easier to use thanks to talcum powder. A broad area of ​​application is cosmetics. This area also includes talcum powder for the genital area of ​​women.

The minerals that talc is made from often contain asbestos. In the past, talcum powder could contain a significant amount of asbestos, depending on the deposit. Today there are regulations designed to prevent this. In Germany, the Ordinance on Hazardous Substances (GefStoffV) limits the maximum concentration to 0.1 percent. Asbestos is now classified as clearly carcinogenic. Talcum powder was also suspected early on. However, the relationship is not clear. A detailed monograph by the International Agency for Research on Cancer (IARC) classified the perineal use of talc in 2006 as “possibly carcinogenic” for humans (Group 2B).

The evidence was mainly based on the results of case-control studies, in which a slightly increased risk was found. According to the IARC monograph, however, the consistency of the results was noticeable. However, it cannot be ruled out that distortions (“bias”) and other common causes (“confounders”) are responsible for the associations.

Recent studies have also failed to provide clarity. An analysis by the Women's Health Initiative (JNCI 2014; 106; dju2089), which observed 61,576 postmenopausal women for a mean of 12.4 years, found a hazard ratio of 1.06, which with a 95 percent confidence interval of 0.87 to 1.28 was not significant. Previously, the Nurses' Health Study had found no association between perineal talc use and ovarian cancer disease. The relative risk was 1.09 (0.86-1.37). In a more recent analysis of the Nurses' Health Study, however, a significant increase in the relative risk (1.21; 1.02-1.44) was found (Cancer Epidemiol Biomarkers Prev; 2010; 19: 1269-75).

Epidemiological studies find it difficult to prove a connection because ovarian carcinomas are generally rare. In the Women's Health Initiative, too, there were only 429 diseases. Since talcum powder is freely available as a cosmetic article (and is not prescribed by prescription), its use is difficult to check. The researchers are dependent on the information from the users who used the powder in different amounts. The talc content of the powder can also vary. One or the other user may have used a powder that does not contain any talc.

The US National Cancer Institute concludes that the current evidence does not support an association between perineal talc exposure and an increased risk of ovarian cancer. The American Cancer Society and the British Cancer Research UK Foundation come to similar conclusions.

However, a connection cannot be completely dismissed. The fine talcum powder is quite capable of penetrating the genital tract into the ovaries. Harvard doctors have clearly proven the mineral in a serous ovarian cancer. The woman became ill at the age of 68 after using talcum powder daily for over 30 years (Obstet Gynecol 2007; 110: 498-501).

The stronger association with serous ovarian carcinoma compared to other types is also striking. Serous carcinomas are often carcinomas of the fallopian tubes, which are more likely to be exposed to talc than the ovary itself, in which the other forms of cancer develop. A current meta-analysis based on 24 case-control studies and three cohort studies also found a significant association only for serous ovarian cancer (relative risk 1.24; 1.15-1.34; European Journal of Cancer Prevention 2017; doi: 10.1097 / CEJ.0000000000000340).

Hormones could also play a role. In a recent case-control study, premenopausal women had a risk of serous or endometrial cancer that was 2.33 times higher (1.32-4.12). In postmenopausal women who had received hormone replacement therapy, the odds ratio was even 2.57 (1.5-4.36) (Epidemiology 2016; 27: 334-346).

So far it has not been possible to induce endometrial cancer in animal experiments by exposure to talc. This means that an important link is missing in the chain of evidence. And in the epidemiological studies no clear dose-effect relationship has been found so far, which is a strong argument for a causal relationship.

Incidentally, the US courts do not agree in their ruling either. According to research by the New York Times, a Virginia woman was awarded $ 110 million in damages in May. A year earlier, the Missouri courts had granted two women $ 55 million and $ 72 million (one had died of cancer before the verdict). In Tennessee, a lawsuit was dismissed in March and two plaintiffs in New Jersey were left empty-handed. The manufacturer has therefore gone into revision in the current case.

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