Debate rages on talcum baby powder’s association with lung, ovarian cancers

The debate on whether the use of the popular talcum powder causes cancer has refused to go away. Indeed, the use of talcum powder has become a controversial issue as growing evidence suggests that its use may be related to an increased risk of ovarian cancer.

Talcum powder is made from talc, a mineral made up mainly of the elements magnesium, silicon, and oxygen. As a powder, it absorbs moisture well and helps cut down on friction, making it useful for keeping skin dry and helping to prevent rashes. It is widely used in cosmetic products such as baby powder and adult body and facial powders, as well as in a number of other consumer products.

In its natural form, some talc contains asbestos, a substance known to cause cancers in and around the lungs when inhaled.

While mesothelioma is the cancer most often associated with asbestos, there is growing evidence that trace amounts of the mineral in talcum powder could trigger other types of cancer, including ovarian cancer in women.

The Cosmetic, Toiletry, and Fragrances Association, a trade group in the United States that represents manufacturers of these kinds of products, adopted guidelines in 1976 to ensure that talc products would not contain asbestos. The guidelines were voluntary and stated that any asbestos found in natural talc would be removed so that consumer products would not have any detectable levels.

In spite of the guidelines designed to protect consumers from the harm of asbestos found in hygiene and other personal products, studies since the 1970s have found that talcum powder does still often contain the contaminant. One study tested several products and found that many contained asbestos that could easily be inhaled by anyone using them.

In the United States, Johnson & Johnson is being investigated by the US Securities and Exchange Commission after questions surfaced about the safety of the company’s baby powder.

The investigation and subpoenas come on the heels of a Reuter’s report that suggested the company knew for years that its baby powder contained small amounts of asbestos, which is a human carcinogen.

The reason there could be asbestos in baby powder is that one of the primary ingredients is talc: a mineral that is often found and mined near asbestos.

The Guardian investigation revealed that so many talcum powder products are registered by the National Agency for Food and Drug Administration and Control (NAFDAC). The products are in circulation and are used by both the young and the old.

Director General of NAFDAC, Prof. Mojisola Christianah Adeyeye, told The Guardian that the subject of link between talc powder and cancer has been a controversial issue, which continues to divide scientists. “There is no clear scientific evidence on the issue,” she said.

Director General, NAFDAC, Prof. Mojisola Christianah Adeyeye

The pharmacist said evidence showing that talc may be carcinogenic remains inconclusive because a school of thought believes that talc in its natural state contains asbestos (a carcinogen) whereas another school of thought believes it does not. From the foregoing, she said, it is the asbestos component of talc, if truly present, that is capable of causing cancer in talc powder. “Generally, facts hold that there are asbestos-free talc as well as asbestos-containing talc, though the evidence about asbestos free talc is less clear” Adeyeye said.

The NAFDAC DG concluded: “So the simple answer is that talc powder made from asbestos-containing talc is capable of causing cancer whereas talc powder made from asbestos-free talc is not expected to cause cancer.

“For asbestos-containing talc powder which may be ‘yes’ and depending on the site of application (say, pubic area of a woman), the talc powder particles may travel through the private part, the fallopian tubes (oviducts) and eventually enter the ovaries to cause irritation and inflammation from which cancerous cells are able to develop. For asbestos-free talc powder which may be ‘no’, the absence of asbestos (the suspected carcinogen) makes it difficult for cancerous cells to develop.”

Adeyeye said NAFDAC conducts analytical tests before registration of all regulated products including talc powder to ensure their fitness (quality and safety) for use. Also, she said, post marketing surveillance activities are being improved with inclusion of post marketing analysis of regulated products to ensure continuous conformity with the standards and requirements precedent to registration of the products at the outset.

In addition, the NAFDAC DG said if an untoward events or reactions are associated with the use of any product, including talc powder, the product can be banned or withdrawn from the circulation through a process of recall.

What is the implication to the health and lives of Nigerians if talc powder can actually cause cancer? Adeyeye said if any talc powder could actually cause cancer it will not be registered for use in Nigeria because the result of its analysis would have revealed that it contains asbestos-containing talc. “As earlier mentioned, if the product is suspected to contain any carcinogen it would be withdrawn from the circulation and/or banned,” she said.

Adeyeye said the summary is that NAFDAC has the responsibility to safeguard the health of the nation hence a case of untoward health implication is being addressed on daily basis by the Agency.

However, researchers are unanimous that talc or talcum powder can cause cancer.

They said talc that has asbestos is generally accepted as being able to cause cancer if it is inhaled. The evidence about asbestos-free talc is less clear.

“The health implication of using talc that contains asbestos is that it causes cancer,” said a consultant epidemiologist, Dr. Anthony Nwaoney.

The epidemiologist told The Guardian that most concerns about a possible link between talcum powder and cancer have been focused on: whether people who have long-term exposure to talc particles at work, such as talc miners, are at higher risk of lung cancer from breathing them in; and whether women who apply talcum powder regularly in the genital area have an increased risk of ovarian cancer.

The International Agency for Research on Cancer (IARC) is part of the World Health Organization (WHO). Its major goal is to identify causes of cancer.

IARC classifies talc that contains asbestos as “carcinogenic to humans.”

Based on the lack of data from human studies and on limited data in lab animal studies, IARC classifies inhaled talc not containing asbestos as “not classifiable as to carcinogenicity in humans.”

Based on limited evidence from human studies of a link to ovarian cancer, IARC classifies the perineal (genital) use of talc-based body powder as “possibly carcinogenic to humans.”

Director General, the Consumer Protection Council (CPC), Babatunde Irukera, told The Guardian: “We have sent out an advisory on this issue. Although the science behind it is inconclusive, there is need to alert consumers of the possibility of talc powder laden with asbestos causing lung and ovarian cancers. The Nigerian public should be well informed so that they can make choices. They can decide that because of the controversy to use powders made with corn starch.”

The CPC had in early February 2019 alerted the public of a fake Johnson & Johnson’s Baby Talc Powder in circulation.

Babatunde Irukera<br /> Director General<br /> Babatunde Irukera is the Director General/Chief Executive Officer, Consumer Protection Council (CPC).

The agency said in a statement: “The CPC has become aware that credible judicial process recently decided that Johnson & Johnson (J&J) Talc (Baby/Body) powder may be harmful and injurious to users. The product is popularly known as Johnson’s Baby Powder (product of Johnson & Johnson).”

The statement signed by Irukera said specifically, a court in the United States decided the company failed to warn consumers about the potential health risks associated with using its baby and body powder products.

The CPC said the plaintiffs in the case had claimed that asbestos (a known carcinogen, allegedly present in the talc-an ingredient of the products) caused them to develop ovarian cancer.

Although J&J has already indicated its intention to appeal the case, Irukera said the Council considers it important to alert and educate consumers in Nigeria as they make choices with respect to baby and body powders.

The Council noted that regulatory documents filled in the United States reveal that there are more than 9,000 plaintiffs against the company in cases involving their talc body powder.

The CPC noted that scientific findings in support of the decision of the court above are otherwise inconclusive. “Regardless, a consumer advisory in this regard is appropriate. The Council recognizes that the NAFDAC and the Standard Organisation of Nigeria (SON) are relevant and key regulators with respect to food and drug safety and standards. The Council is in communication with both regulators accordingly,” it noted.

The Council encouraged consumers to proceed with an abundance of caution, and to contact NAFDAC, SON or the CPC with any questions while considering alternatives such as face/skin powders containing corn starch instead of talc.

Indeed, over 9,000 consumers have filed baby powder lawsuits against Johnson & Johnson. Most of these consumers are women who have ovarian cancer. According to their claims, they believe that their cancer developed due to using talcum powder on their genitals.

These women back their claims with a variety of studies that have found that long-term use of talcum powder on female genitals may increase the risk of ovarian cancer.

In recent years women who developed ovarian cancer after decades of using baby powder products have been suing the companies responsible, most notably Johnson & Johnson. An important piece of evidence arose during a trial on behalf of Jackie Fox, a woman who died from ovarian cancer. Her family sued Johnson & Johnson and won a jury-awarded settlement of $72 million.

The family’s legal team presented evidence that the company knew there was a link between using baby powder and developing ovarian cancer. An internal memo made it clear the company was aware of the risk but continued selling the product with no warnings to consumers. This was a major win and proof that women like Ms. Fox deserved to be compensated for the damage talcum powder caused.

That case has been followed by many, including a big win for 22 women who together filed a class action lawsuit against Johnson & Johnson. The jury awarded $4.7 billion to the women, which included $4.14 in punitive damages to the company for failing to warn consumers of the risks of ovarian cancer from using their products. Not only did the women and their families in this case get such a big win, but also the company lost a bid to get the award reversed. A judge upheld the jury’s decision.

J&J has said it will appeal the recent verdicts against it. It has maintained in public statements that its talc is safe, as shown for years by the best tests available, and that the information it has been required to divulge in recent litigation shows the care the company takes to ensure its products are asbestos-free. It has blamed its losses on juror confusion, “junk” science, unfair court rules and overzealous lawyers looking for a fresh pool of asbestos plaintiffs.

“Plaintiffs’ attorneys out for personal financial gain are distorting historical documents and intentionally creating confusion in the courtroom and in the media,” Ernie Knewitz, J&J’s vice president of global media relations, wrote in an emailed response to Reuters’ findings. “This is all a calculated attempt to distract from the fact that thousands of independent tests prove our talc does not contain asbestos or cause cancer. Any suggestion that Johnson & Johnson knew or hid information about the safety of talc is false.”

Indeed, there is a very real possibility that talcum powder can increase the risk and even cause the development of ovarian cancer in women who have used it for a long time. The longer the period of use and greater the regularity of use of baby powder, the bigger the risk is. Women need to know about this risk so they can make the right choice for hygiene. Companies like Johnson & Johnson are increasingly being held to account for asbestos and ovarian cancer, but the risk is still real and present.

The issue was first investigated in 1971 when researchers found talc particles in ovarian tumors. A later study in 1982 saw a possible connection between ovarian cancer and using talc on genitals.

More recently, a 2014 study found no link between talc and ovarian cancer. However, research from 2016 found that using talc on the genitals could increase the risk of ovarian cancer by 33 percent in participants. However, the study relied on personal interviews based on participants’ memories, which may not be accurate.

According to a 2018 review, there is a weak but statistically significant association between ovarian cancer and talcum powder used on genitals.

However, given this conflicting evidence, as well as many other risk factors of ovarian cancer, such as older age, long-term hormone therapy, family history, and genetics, scientists are unable to say for sure that talcum powder causes cancer.

Although the overall lifetime risk of developing ovarian cancer is low, it is one of the most deadly gynecological cancers. Therefore it is important to recognize some of the major signs and symptoms of ovarian cancer for early detection and diagnosis.

Signs and symptoms of ovarian cancer include: lower abdominal pain or pressure; weight gain or weight loss; abnormal periods; gas, nausea, or vomiting; and trouble eating or feeling “full” after eating.

While these symptoms may be associated with other benign conditions, it is always important to discuss any questions or concerns you may have with your doctor.

A new study published in the journal Epidemiology, analysed the use of talcum powder in over 4,000 women with and without ovarian cancer. The authors found that use of talcum powder in the genital region may increase a woman’s risk for ovarian cancer by 33 per cent, especially in instances where the powder was used daily.

The researchers insist that more research is necessary to determine how talcum powder causes cancer. In the meantime, the American Cancer Society suggests that it may be prudent to avoid or limit use of products containing talc, if you are concerned about developing ovarian cancer.

One study of note compared talcum powder use and rates of ovarian cancer in over 1,000 women. The study compared the personal hygiene habits of nearly 600 women with ovarian cancer and about 700 women without that diagnosis. The study found that regular use of talcum powder on the genitals increased the risk of developing ovarian cancer by 44 percent. The lifetime risk of ovarian cancer for women who used talcum powder was significantly higher than for those who did not. Another study found similar results after investigating more than 8,000 women.

Also important was a study that investigated how talc could cause ovarian cancer. It may be that talc particles migrate from the external genital area to the interior, all the way to the ovaries. The study found that this is, in fact, possible. Researchers examined tissue from ovarian tumors and found that they contained particles of talc.

A study published in the journal Toxicological and Environmental Chemistry established that cosmetic facial talcum powders marketed in Nigeria contains toxic trace metals such as lead.

The aim of the study was to determine the concentrations of Pb (lead), Cd (cadmium), Co (copper), and Cr (chromium) in cosmetic talcum powders regularly used in Nigeria.

The researchers said the results of the study were generally within regulatory limits and the slightly elevated levels of lead in few samples indicate that the use of certain talcum powder products could constitute trace metal exposure routes to users. “Thus, there is a need for regulation of trace metal levels in cosmetic powders through the establishment of national guidelines,” they said.

According to another study published in American Journal of Industrial Medicine, lead acetate administered orally, cutaneously, or intraperitoneally causes kidney cancer, brain cancer (gliomas), and lung cancer in rodents, and acts synergistically with other carcinogens.

IARC classified lead as a “possible human carcinogen” based on sufficient animal data and insufficient human data in 1987.

According to the United States Centers for Disease Control and Prevention (CDC) repeatedly inhaling talc might harm the lungs.

The United States Food and Drug Administration (FDA) does not have a stand on the issue due to the ongoing scientific debate.

The European Union, however, has banned talc in beauty and health products, so people cannot purchase it in certain European countries.

While talcum powder remains popular, there are no medical reasons to use it. The choice is up to the individual whether they wish to use talcum powder or not.

According to some reports, talcum powder may cause respiratory problems in babies if inhaled.

Alternatives to talc-based baby powders include: cornstarch powders; arrowroot starch powders; tapioca starch powders; oat flour; baking soda; and zinc-based diaper rash creams for infants and toddlers.