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The Science Connecting Talcum Powder and Ovarian Cancer

A jury in Missouri hit Johnson & Johnson with a $55 million verdict in favor of a woman who developed ovarian cancer after decades of using talc baby powder in her vaginal area as part of her normal routine. Younger readers might find this practice unusual, but this was commonly recommended and encouraged through advertisements with slogans like, “just a sprinkle a day keeps odor away.” To this day, Johnson & Johnson still doesn’t warn against use in the vaginal area, and instead continues to encourage adults to use it all over their bodies, because it “gives a cooling sensation, and helps to prevent chafing.”

The case was the second such huge verdict this year, following a $72 million verdict. But this verdict is in many ways a better indicator of the strength of these lawsuits: this case was selected for trial by the defendants, apparently based on the belief that the woman’s pre-existing endometriosis would absolve Johnson & Johnson. As the defense lawyer told the jury:

“The fact is, endometriosis is a recognized, significant risk factor for ovarian cancer,” she said. “It’s highly unlikely [that] Mrs. Ristesund would have had ovarian cancer if she had not had endometriosis. In fact, there’s no proof, none, that she wouldn’t have had ovarian cancer had she not used talc. None.”

Afterwards, another of Johnson & Johnson’s lawyers told the press: “The scientific reality is that cosmetic talc does not cause cancer.” This statement isn’t true.

First, let’s take a moment to consider why Johnson & Johnson claims endometriosis is a “recognized, significant risk factor for ovarian cancer.” The leading study on the link between endometriosis and ovarian cancer was published in 2012, and it found, among women who had endometriosis:

Three times the risk of clear-cell ovarian cancer
Two times the risk of low-grade serous ovarian cancer
Two times the risk endometrioid invasive ovarian cancer
No association with mucinous ovarian cancer
No association with high-grade serous ovarian cancer
So, this study linked endometriosis to clear-cell, low-grade serous, and endometrioid invasive ovarian cancer, but not to mucinous and high-grade serous ovarian cancer.

These differences are important, because research has shown that low-grade and high-grade serous ovarian cancer “are fundamentally different tumor types, and consequently, different diseases.” In fact, “high-grade serous tumors differ from all other ovarian carcinomas in terms of their development, prognosis, pathologic findings, and underlying genetic alterations.” And as the National Cancer Institute says, the most common type of ovarian cancer is high-grade serous cancer, which is not associated with endometriosis.

What was Johnson & Johnson trying to say? When it comes to the most common type of ovarian cancer, the high-grade serous cancer, the epidemiological research shows endometriosis doesn’t increase the risk of ovarian cancer. That’s hardly a “recognized, significant risk factor for ovarian cancer,” despite Johnson & Johnson’s assertion.

What has been shown to be a significant risk factor for ovarian cancer, however, is talcum powder.

Back in 1982, a case-control study published in Cancer found women who “regularly used talc either as a dusting powder on the perineum or on sanitary napkins” were 1.92 times (or, 92%) more likely to develop ovarian cancer. More than two dozen studies have been performed since then, and virtually all of them showed an elevated risk of ovarian cancer in women using talcum powder. For example, in 1997, a study published in the American Journal of Epidemiology found “women with a history of perineal dusting” were 1.6 times (60%) more likely to develop ovarian cancer. In 2008, a meta-study in the Journal of Epidemiology & Community Health pooled together over 20 studies and found a 35% increase in the risk of ovarian cancer in women who used talc powder.

Some might say that a 35% increase in the risk isn’t a big deal, that it could somehow be a statistical mirage, the result of pure chance across 20+ scientific studies. That’s Johnson & Johnson’s position, considering their lawyer’s claim that “[t]he scientific reality is that cosmetic talc does not cause cancer.” However, it is important to note that second hand smoking around children increases the child’s risk of developing lung cancer by 30%. Few people doubt that link, because their nose tells them that the effects of smoking extend beyond the actual smoke.

With baby powder, it’s different. It smells clean and produces a cooling sensation. There’s no obvious sensory indication that will tell you that talc travels through the body to pelvic lymph nodes. There’s no way to notice that talc will reduce anti-MUC1 antibodies, which play a role in fighting MUC1-expressing cancers, like ovarian cancer. But the science is there nonetheless.

In the history of American jurisprudence, before the dam broke that resulted in dangerous products being pulled from the marketplace, manufacturers have almost always initially asserted that the product was not dangerous and that there was a lack of scientific and medical proof of its dangerous propensities. Unfortunately, that pattern is being repeated here.