Diana Zuckerman, PhD and Danielle Shapiro, MD, MPH, National Center for Health Research
A growing body of evidence suggests that using talc in the genital area can increase a woman’s chances of developing ovarian cancer. The more years she uses talc, the more likely she is to develop ovarian cancer. If you have ever used talcum powder or “baby powder” or if you are still using it on yourself or your baby, here’s what you need to know.
On average, one in every 75 women will develop ovarian cancer in her lifetime. This is just over 1%, and much lower than the 12% lifetime risk of developing breast cancer. But, unlike breast cancer, there is no recommended test to screen for ovarian cancer, so it is rarely diagnosed early. In 2017, there were over 20,000 new cases of ovarian cancer and over 14,000 deaths. When ovarian cancer is found early, a woman has nearly a 93% chance of surviving at least 5 years after she is diagnosed. Those chances drop off significantly to about 30% if the cancer is found after it has spread to other parts of her body.
Based on dozens of research studies involving thousands of women, women who have used talcum powder are about 30% more likely to be diagnosed with ovarian cancer than women who have not.[2,3] This means that over her lifetime, a woman who uses talcum powder increases her chances of developing ovarian cancer from 1.3% to 1.7%. That is still a low risk for any woman, but if that if one million women use talcum powder, 4,000 more of those women will develop ovarian cancer, compared to the number that would have developed ovarian cancer if they hadn’t used talcum powder.
How Good Is the Evidence?
Most of the evidence comes from a type of study known as a case-control study. For these studies, researchers recruit two groups of women – women with ovarian cancer (called “cases”) and women without ovarian cancer(called “controls”). All the women are asked to recall whether they used talcum powder in the past, and if so, how often and how it was used. These studies cannot tell us for sure that talcum powder use causes ovarian cancer, but they can tell us if women who report using the powder in the genital area are more likely to develop ovarian cancer. Although, there is never a guarantee that memories are 100% accurate, many women are very sure about whether or not they regularly used talcum powder in the genital area. And, the consistent results since most of the case-control studies of talcum powder in the U.S. and in other countries show similar increases in ovarian cancer among the talc users, this adds a great deal to those studies’ credibility. In fact, The International Agency for Research on Cancer (IARC), a well-respected agency within the World Health Organization (WHO), concluded that there was an “unusually consistent” increased chance of developing ovarian cancer among women who reported using talcum powder in the genital area.
Some of the most convincing evidence comes from two case-control studies published in 2016: the African American Cancer Epidemiology Study (AACES) and the New England study.[5,6]
The AACES study compared 584 African American women who had been diagnosed with ovarian cancer in 11 different geographic regions of the U.S to 745 women without ovarian cancer of the same age and geographic.  In this study, talcum powder use was common – about 63% of women with ovarian cancer and 53% of the healthy women said they had used talc. The study found that the women who had used talc anywhere in their body, used talc on their genitals and elsewhere, or had used talc only in the genital area, were significantly more likely to have been diagnosed with epithelial ovarian cancer. The women who reported using talc in the genital area, whether or not they used it anywhere else, were about 44% more likely to have been diagnosed with ovarian cancer. Instead of having a 1.3% lifetime risk, the women who used talc would have almost a 2% risk. The main author of the study believes that this study was important because African American women are more likely to have used powder, making it easier to determine a strong link between talcum powder and ovarian cancer.
In that study of African American women, the women who had a respiratory condition, such as asthma, were slightly more likely to develop ovarian cancer if they used talc, compared to women who did not have a respiratory condition. The authors believe that talcum powder causes the body to develop inflammation, which is known to potentially cause the growth of cancer cells. It makes sense those women who are more likely to develop inflammation, such as those who have an underlying respiratory condition, may be at a slightly higher risk of developing ovarian cancer from talcum powder.
The New England ovarian cancer study also suggests that the body develops cancer as a result of inflammation caused by talcum powder. The authors of the study are from the prestigious Brigham and Women’s Hospital in Boston, and their study was supported by a grant from the National Institutes of Health. They compared approximately 2,041 women living in Massachusetts and New Hampshire who had been diagnosed with ovarian cancer, with 1,578 women of the same age and geographic location who did not have cancer. They reported that the women who used talc in the genital area, whether or not they used it elsewhere in their bodies, were significantly more likely to be diagnosed with epithelial ovarian cancer. Most reported using Johnson & Johnson Baby Powder or Shower to Shower powder. Many body powders are now made with cornstarch instead of talc. Women who used those same brand name powders made with cornstarch were not considered talc users in the study.
Overall, the women using talc were about 33% more likely to develop ovarian cancer. Instead of having a 1.3% lifetime risk, a woman who used talc increased their lifetime risk to about 1.7%. However, some women were more at risk than others. Women who used talc and were sterilized prior to menopause (underwent a tubal ligation or hysterectomy) or who took hormone therapy for menopausal symptoms, were even more likely to develop ovarian cancer compared to other talcum powder users. The researchers believe that the hormone estrogen may make women less vulnerable to the risk of talc.
One possible reason for the risks of talc is that talc may contain small amounts of asbestos. In 2009, the U.S. FDA conducted a small survey of talc-containing cosmetics including baby powder, concluding that none of the products they tested contained asbestos. They stated that while “these results [are] informative, they do not prove that most or all talc or talc-containing cosmetic products currently marketed in the United States are likely to be free of asbestos contamination.” Because the FDA does not require companies to provide information on safety to them, consumers must rely on the companies to follow through on their duty to warn. As the debate continues, the bottom line is, if you can, avoid using these products for your health and your family’s health.
In December 2018, Health Canada, an agency of the Canadian government, evaluated the association between talc containing body products and various health concerns. They have issued a draft report concluding that using talc powder on the genital area increased the risk for ovarian cancer. Additionally, they are considering warning labels and other mitigation strategies.
What Have the Courts Decided?
Since 2014, Johnson & Johnson has defended its talcum powder in lawsuits brought by families of women who had used their talcum powder products and died from ovarian cancer. In February 2016, the courts ruled in favor of the family of a woman who died of ovarian cancer at the age of 62 years. Particles of talc were found in her ovaries, which were removed after her cancer diagnosis. The courts overturned the ruling just a few months later based on jurisdictional issues not related to the science. In another matter, a California woman with ovarian cancer won a $70 million dollar against Johnson & Johnson. She continues to fight for fair warning labels on the products it sells. A powder sold by the brand Assured already carries such a warning: “Frequent application of talcum powder in the female genital area may increase the risk of ovarian cancer.” However, Johnson & Johnson’s official position is that such a warning would do more harm than good because it is not backed by scientific evidence.
There is some evidence that men may also be harmed by talc. For example, the courts ruled in favor of a man in New Jersey because the powder had caused an asbestos-related lung cancer known as mesothelioma. In this case, the talcum powder was likely contaminated with asbestos, a chemical that is known to cause cancer in humans. Despite the jury’s decision, Johnson & Johnson continues to deny claims that their product contains asbestos or that it causes cancer. However, the court held that exposure to asbestos from another source was not a likely cause of his cancer.
A 2018 investigation by Reuters examined Johnson & Johnson’s internal reports, company memos, and confidential documents from 1971 to early 2000’s. According to the documents, as early as 1971, researchers from Mount Sinai had told Johnson & Johnson that they had found traces of asbestos in Johnson & Johnson Baby Powder made with talc. The documents suggest that Johnson & Johnson claimed that the tiny amounts of asbestos found in some samples of its powders was too small to cause health problems, and lobbied the Food and Drug Administration to agree with that assessment. Currently, there have been over 11,700 plaintiffs with cases against Johnson & Johnson due to talcum powder-associated cancers such as mesothelioma, lung cancer, and ovarian cancer.
The Bottom Line
While the scientific evidence has shown a consistent link between talcum powder and ovarian cancer and possibly other health risks, many questions remain. The bottom line question is: why take the risk?
- U.S. Preventive Services Task Force. Final Recommendation Statement: Ovarian Cancer: Screening. Rockville, MD:U.S. Preventive Services Task Force. 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/ovarian-cancer-screening1\
- Berge W, Mundt K, Luu H, Boffetta P. Genital use of talc and risk of ovarian cancer: A meta-analysis. 2017. http://cdn.cnn.com/cnn/2017/images/11/15/genital_use_of_talc_and_risk_of_ovarian_cancer___a.99354.2017.july.meta.pdf
- Terry KL, Karageorgi S, Shvetsov YB, et al. Genital powder use and risk of ovarian cancer: A pooled analysis of 8,525 cases and 9,859 controls. Cancer Prevention Research (Philadelphia, PA). 2013;6(8):811-821. https://www.ncbi.nlm.nih.gov/pubmed/23761272
- International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Volume 93 Carbon Black, Titanium Dioxide, and Talc; 2010. http://monographs.iarc.fr/ENG/Monographs/vol93/mono93-8F.pdf
- Schildkraut JM, Abbott SE, Alberg AJ, et al. Association between body powder use and ovarian cancer: The African American Cancer Epidemiology Study (AACES). Cancer Epidemiology, Biomarkers & Prevention. 2016;25(10):1411-1417. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050086/
- Cohen R. Talc linked to ovarian cancer risk in African-American women. Reuters Health News. June 6, 2016. https://www.reuters.com/article/us-health-talc-ovarian-cancer/talc-linked-to-ovarian-cancer-risk-in-african-american-women-idUSKCN0YO2T7
- Cramer DW, Vitonis AF, Terry KL, et al. The association between talc use and ovarian cancer: A retrospective case–control study in two US states. Epidemiology. 2016;27(3): 334-346.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820665/
- Cosmetics Products and Ingredients: Talc. FDA.gov. updated March 12, 2018. https://www.fda.gov/Cosmetics/ProductsIngredients/Ingredients/ucm293184.htm
- Environment and Climate Change Canada, Health Canada. Draft Screening Assessment Talc. Canada. 2018. https://www.canada.ca/content/dam/eccc/documents/pdf/pded/talc/Draft-screening-assessment-talc.pdf
- Taylor J. Missourinet. Johnson & Johnson case from St. Louis gets heard in Missouri Supreme Court. Missourinet. March 5, 2018. https://www.missourinet.com/2018/03/05/johnson-johnson-case-from-st-louis-gets-heard-in-missouri-supreme-court/
- Jen Christensen. Does talcum powder cause cancer? A legal and scientific battle rages. CNN. April 11, 2018. https://www.cnn.com/2018/04/11/health/talc-ovarian-cancer-cases/index.html
- Bellon T. J&J, Imerys unit must pay $117 million in N.J. asbestos cancer case. Reuters. April 11, 2018. https://www.reuters.com/article/us-johnson-johnson-cancer-lawsuit/jj-imerys-unit-must-pay-117-million-in-n-j-asbestos-cancer-case-idUSKBN1HI2ZD
- Girion L, Wood M. Johnson & Johnson knew for decades that asbestos lurked in its Baby Powder. Reuters. December 14th 2018, https://www.reuters.com/investigates/special-report/johnsonandjohnson-cancer/#johnson-research-sidebar