Over the last 40 years, a growing body of researchers have found evidence to suggest that the genital use of talcum powder increases the risk for ovarian cancer.

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Approximately 20,000 women and their families have filed talcum powder lawsuits, accusing Johnson & Johnson, along with many of the firm’s talc suppliers, of concealing a link between talc, a naturally-occurring mineral, and ovarian cancer.

Investigating The Link Between Talcum Powder & Ovarian Cancer

In their product liability lawsuits, plaintiffs rely upon a large and growing body of medical evidence that talcum powder, when applied to the genitals, can increase the risk for ovarian cancer. At first blush, the allegations in these lawsuits seem outrageous. How could a product considered safe, something we use routinely on babies, actually be the cause of cancer? But it’s not as crazy as it sounds. In fact, it may very well be true, so long as we consider the wealth of medical evidence establishing the link between talc and ovarian cancer.

Talcum powder has been used in a variety of products for over a century. Johnson & Johnson has been at the center of this market from the beginning, introducing Johnson’s Baby Powder to the consumer public in 1893. First cited as a powerful prophylactic against diaper rash in infants, the soft, delicate powder soon came into wider use as an essential element of feminine hygiene, as women across the country began to apply the powder directly to the perineum or sprinkled in their underwear. Talcum powder remains a part of many women’s daily ritual to this day.

1971: Researchers Outline Theory Behind Ovarian Cancer Association

It began as a theory. In the early 1970s, medical researchers developed a hypothesis. If powder was applied directly to the genitals, they thought, particles from the powder could conceivably travel up through the reproductive organs, ultimately reaching the ovaries. Could these particles irritate ovarian tissue and cause cancer?

In 1971, nearly 50 years ago, a team of researchers from the United Kingdom found concrete evidence that particles of talc, released from talcum powder, could travel directly to the ovaries.

Publishing their research in the Journal of Obstetrics and Gynaecology of the British Commonwealth, W.J. Henderson and his colleagues described what happened when they removed 13 ovarian and cervical cancer tumors from living patients. As Henderson explained in his study, talcum particles were found embedded in 10 of the 13 tumors, leading researchers to speculate that genital application of talc could be the cause of some ovarian cancers.

1982: Dr. Cramer Reports 92% Increased Risk In Talcum Powder Users

It would take another 11 years, however, for firmer evidence of the association to the surface. In 1982, hoping to study the connection between talc and cancer further, a group of researchers at Brigham and Women’s Hospital, an affiliate of Harvard University, decided to compare talcum powder usage between two groups of women: those who had been diagnosed with ovarian cancer and those who had not. Surveying 430 women total, the study came to a surprising result. Women with ovarian cancer were substantially more likely to have used talcum powder.

The study, published in the journal Cancer, reported, over 42% of the cancer patients were frequent talcum powder users. The rate among non-cancer patients was much lower, at 28%. From these initial results, Dr. Daniel Cramer, an epidemiologist who has done more to further this debate than almost anyone else, concluded that women who used talcum powder on the genital area were about 92% more likely to develop ovarian cancer than their peers.

But Dr. Cramer’s additional results were even more troubling. Women who used talcum powder in two different ways, dusting the perineum directly and adding the powder to sanitary napkins, were around 300% more likely to develop cancer.

1998 – 1992: International Research Substantiates Link

Dr. Cramer’s surprising results set off a flurry of additional research, as scientists across the world endeavored to investigate the newly-published and controversial link between talcum powder and ovarian cancer.

1992: 50% Increased Risk In Women Who Use Talc

Meanwhile, Dr. Daniel Cramer was still investigating the possibility of a link between ovarian cancer and talcum powder back in Cambridge.

Along with his colleagues at Harvard Medical School, Dr. Cramer interviewed 474 women about their use of talcum powder. 235 of the women had been diagnosed with ovarian cancer. As it turned out, these cancer patients were also far more likely to be regular talcum powder users. Almost half of the female ovarian cancer patients interviewed told Cramer and his colleagues that they used talc-based body powders on a regular basis. The rate of talcum powder usage in cancer-free women was much lower, at 39%.

In their paper, published by the journal Obstetrics and Gynecology in 1992, Dr. Cramer and his team estimated that any form of talcum powder use increased the risk for ovarian cancer by 50%, while applying the substance daily increased the risk by 80%. Women who used the product on a daily basis for decades, Dr. Cramer concluded, appeared to be at a 280% increased risk.

1995: Australian Researchers Find Increased Risk

In 1995, a group of Australian researchers published their own results in the International Journal of Cancer. In the largest case-control study ever conducted on ovarian cancer risk factors, the team compared 824 women diagnosed with ovarian cancer (the “case” group) to 860 women without cancer (the “control” group).

The study’s results confirmed many previous findings on the topic. The study concluded that ovarian cancer risk was decreased in women who took oral contraceptives, along with those who had multiple pregnancies. Increased risks were identified in women who smoked and those who used talcum powder “in the abdominal or perineal region.”

1997: 50% – 80% Increased Risk In Washington Women

In 1997, researchers at Seattle’s Fred Hutchinson Cancer Research Center performed yet another case-control study on the link between talcum powder and ovarian cancer. Led by Dr. Linda S. Cook, the group interviewed 313 women who had been diagnosed with ovarian cancer, then compared their survey results with those taken from 422 women who did not have cancer. Again, a clear increased cancer risk was observed in women who reported using talcum powder on their genitals.

Women who used talcum powder, the researchers concluded, were 50% more likely to develop ovarian cancer. That increased risk rose to 80% if the woman applied talc directly to her perineum, rather than sprinkling the powder on sanitary napkins or underwear. The study was published by the American Journal of Epidemiology.

1997: Yale Team Observes 42% Increased Risk

Researchers at Yale University published the results from their own case-control study in 1997, publishing their findings in an edition of the journal Cancer. Conducting a standardized interview with 450 ovarian cancer patients, along with 564 cancer-free women, the researchers found that use of talcum powder was significantly associated with ovarian cancer, increasing the risk for the disease by 42%.

Industry Leaders, J&J Strike Back With Funded Research

By the late 1990s, the growing body of medical evidence associating talcum powder to ovarian cancer had come under attack. Industry-funded groups, including the Cosmetic, Toiletry and Fragrance Association were on the move, publishing their own data sets that appeared to show no link between the common household product and ovarian cancer.

The Cosmetic, Toiletry and Fragrance Association even created the Talc Interested Party Task Force, a committee funded almost exclusively by Johnson & Johnson, with the explicit goal of “develop[ing] talking points and find[ing] experts to rebut studies linking talc to ovarian cancer,” FairWarning.org reports.

The debate around talc was becoming more contentious, as major industry players found one of their greatest cash-cows, talc-based body powders, threatened by an increasingly vocal group of researchers who reported troubling results on the mineral’s link to ovarian cancer.

Cramer, Co-Authors Call For “Formal Public Health Warnings”

In 1999, Dr. Daniel Cramer struck back, publishing yet another case-control study on the link. Cramer’s newest study, published in the International Journal of Cancer, interviewed 1,086 women about their use of genital talc. 563 of the survey recipients had been diagnosed with ovarian cancer, while 523 of the women were cancer-free. Again, Cramer’s work yielded a significant result. Women who reported using talcum powder as a feminine hygiene product were 60% more likely to have developed ovarian cancer.

But this time, Cramer took a vocal stand in support of public health. Noting the wealth of similar studies, all of which had found a clear and significant link between talc and ovarian cancer, Dr. Cramer called for “more formal public health warnings” in the conclusion of his report.

As we now know, no formal public health warnings of the sort advocated by Cramer would ever be announced. To this day, Johnson & Johnson has never issued a warning to consumers. In fact, the company has consistently denied that any link exists between ovarian cancer and the genital use of talc. Despite the wealth of medical evidence, Johnson & Johnson continues to maintain that its product is safe, gentle and free of ovarian cancer risk.

2000: 70% Increased Risk, Penn Researchers Report

It’s often said that the research around ovarian cancer and talc is inconclusive. It’s strange, then, that a group of researchers from the University of Pennsylvania wrote in 2000 that “previous epidemiologic observations consistently suggest […] that perineal talc use increases the risk” for ovarian cancer. In their own study, the team interviewed 767 ovarian cancer patients and compared them to 1,367 women without cancer.

Their goal was to investigate medical conditions that increase inflammation in the ovaries, including endometriosis, pelvic inflammatory disease and thyroid disease. Talcum powder was also included as a possible source of ovarian inflammation. In so doing, the researchers informally tested the theory, introduced by W.J. Henderson in 1971, that talc particles can irritate ovarian cells, increasing the likelihood for cancer as a result.

All of the inflammatory conditions included in the study were observed to increase the risk for ovarian cancer. When applied to a woman’s underwear, talc-based body powders were found to have increased the risk for ovarian cancer by 70%. A 50% increased risk was deduced for women who applied talcum powder directly to the genitals.

2013: Meta-Analysis Finds Statistically-Significant Risk

Noting that, while many previous research studies had found a link between talcum powder and ovarian cancer, several studies had proven inconclusive, a team of researchers at Boston’s Brigham and Women’s Hospital set out to find solid results in 2013, by conducting a large meta-analysis of data derived from eight previous studies. The results were published in Cancer Prevention Research.

After pooling data from the eight studies, the researchers were left with information on 8,525 ovarian cancer patients and 9,859 women without cancer. After applying a complex statistical analysis, the data uncovered a “modest increased risk” for ovarian cancer. Women who reported genital talcum powder use were 24% more likely to develop epithelial ovarian cancer and clear cell tumors. A 46% increased risk was observed for borderline serous tumors, while a 20% increased risk was seen for invasive serous tumors.

Does Alleged Risk Outweigh Cosmetic Benefits?

Importantly, however, the researchers noted that talcum powders are used for purely cosmetic reasons. Talcum powder does not treat or cure any disease. It is not, in the final analysis, necessary, especially considering that many manufacturers, including Johnson & Johnson, manufacture corn starch alternatives that have never been associated with ovarian cancer.

If talcum powder truly increases the risk for ovarian cancer, this is an exposure that women have every ability to avoid. In thousands of product liability lawsuits, ovarian cancer patients say they were never given an opportunity to choose, because Johnson & Johnson, they claim, failed to warn of talc’s alleged link to ovarian cancer.