A critical review of talc and ovarian cancer

Figures & data

Table 1. Talc and ovarian cancer cohort study characteristics and results.

					Potential Confounders Adjusted								Risk Estimate^a (95% Confidence Interval [CI]) for Mode of Perineal Talc Use				Extent of Perineal Talc Exposure ptrend or Risk Estimate (95% CI)^b		Histological Subtypes of Invasive Ovarian Cancer^c
Study	Cohort	Sample Size	Follow-up (years)	Loss to Follow-up (%)	Age	Obesity	Family History	Parity	OC Use	Tubal Ligation	Hysterectomy	PMH Use	Any	Dusting Powder	Sanitary Napkin	Diaphragm	Frequency	Duration	Serous	Mucinous	Endometrioid	Clear Cell
Gertig et al. (2000)	NHS	78,630	14	2	✓	✓		✓	✓	✓		✓	1.09(0.86, 1.37)		0.89 (0.61, 1.28)		1.12 (0.82, 1.55)^d		1.4 (1.02, 1.91)	0.93 (0.53, 1.66)	0.91 (0.49, 1.87)
Gates et al. (2010)	NHS	108,870	24	4.8–6.4	✓		✓	✓	✓	✓	✓	✓							1.06 (0.84, 1.35)^e	1.50 (0.84, 2.66)^e	1.06 (0.66, 1.69)^e
Houghton et al. (2014)	WHI-OS	61,576	12.4 (average)	NR	✓	✓	✓	✓	✓	✓		✓	1.06 (0.87, 1.28)	1.12 (0.92, 1.36)	0.95 (0.76, 1.20)	0.92 (0.68, 1.23)		0.77	1.13 (0.84, 1.51)	1.03 (0.47, 2.27)	1.29 (0.64, 2.61)
Urban et al. (2015)	WHI-OS	74,786	12.3 (average)	NR	✓													0.97 (0.78, 1.22)^f
Gonzalez et al. (2016)	Sister Study	41,654	6.5 (median)	0.1	✓			✓	✓		✓		0.73 (0.44, 1.2)^g
O’Brien et al. (2020)	Pooled (NHS, NHSII, WHI-OS, Sister Study)	252,745	11.2 (median)	NR		✓		✓	✓	✓	✓	✓	1.08 (0.99, 1.17)				0.20	0.49	1.10 (0.97, 1.25)^h	1.03 (0.69, 1.54)^h	1.15 (0.83, 1.58)^h	1.17 (0.73, 1.89)^h

Notes:

NHS = Nurses’ Health Study; NHSII = Nurses’ Health Study II; OC = Oral Contraceptive; PMH = Postmenopausal Hormones; NR = Not Reported; WHI-OS = Women’s Health Initiative Observational Study.

Bold denotes a statistically significant result.

(a) All studies used hazard ratios as the risk metric, with the exception of the two studies of the NHS cohort, which used relative risks.

(b) P_trend is presented, unless otherwise noted.

(c) Risk estimates for invasive cancers are presented when available.

(d) Relative risk for daily talc use vs. never use.

(e) Relative risk for talc use at least once per week vs. less than once per week.

(f) Hazard ratio for talc use of a duration of more than 10 years vs. less than 10 years.

(g) For any talc use in the 12 months prior to study enrollment.

(h) Hazard ratio for ever use of talc vs. never use.

Table 2. Talc and ovarian cancer case-control study characteristics and results.

			Number		Response Rates		Potential Confounders Adjusted
Study	Location	Control	Cases	Controls	Cases	Controls	Age	Obesity	Family History	Parity	OC Use	Tubal Ligation	Hysterectomy	PMH Use
Cramer et al. (1982)	US	P	215	215	72.4%	48.2%	✓	✓		✓	✓			✓
Hartge et al. (1983)	US	H	135	171	NR	NR	✓
Whittemore et al. (1988)	US	H, P	188	539^d	NR	NR	✓			✓	✓
Booth, Beral, and Smith (1989)	UK	H	235	451	NR	NR	✓
Harlow and Weiss (1989)	US	P	116	158	68.0%	74.0%	✓			✓	✓
Harlow et al. (1992)	US	P	235	239	69.0%	50.5%	✓	✓		✓
Chen et al. (1992)	China	P	112	224	48.7%	93.7%	✓			✓
Rosenblatt, Szklo, and Rosenshein (1992)	US	H	77	46	77.1%	NR		✓		✓		✓
Tzonou et al. (1993)	Greece	H	189	200	90.0%	94.0%	✓	✓		✓
Cramer and Xu (1995)	US	P	450	454	NR	NR
Purdie et al. (1995)	Australia	P	824	860	90.0%	73.0%				✓
Chang and Risch (1997)	Canada	P	450	564	71.3%	64.6%	✓		✓	✓	✓	✓	✓
Cook, Kamb, and Weiss (1997)	US	P	313	422	64.3%	68.0%	✓
Green et al. (1997)	Australia	P	824	855	90.0%	73.0%	✓	✓	✓	✓	✓
Godard et al. (1998)	Canada	P	170	170	87.0%	22.7%	✓					✓
Cramer et al. (1999)	US	P	563	523	64.2%	72.0%	✓	✓	✓	✓	✓	✓
Wong et al. (1999)	US	H	499	755	NR	NR	✓		✓	✓	✓	✓	✓
Ness et al. (2000)	US	P	767	1,367	87.9%	74.0%	✓		✓	✓	✓	✓	✓
Langseth and Kjaerheim (2004)	Norway	N	35	121	76.1%	57.1%	✓		✓	✓
Mills et al. (2004)	US	P	256	1,122	40.3%	57.1%	✓				✓
Jordan et al. (2007)	Australia	P	363	752	84.0%	47.0%	✓			✓	✓		✓
Merritt et al. (2008)	Australia	P	1,576	1,509	74.0%	47.1%	✓			✓	✓
Gates et al. (2008)	US	P	1,175	1,202	71.0%	68.0%	✓	✓		✓	✓	✓		✓
Wu et al. (2009)	US	P	609	688	62.5%	NR	✓		✓	✓	✓	✓
Moorman et al. (2009)^i	US	P	550	533	66.5%	43.9%	✓
Moorman et al. (2009)^j	US	P	83	134			✓
Rosenblatt et al. (2011)	US	P	812	1,313	76.7%	69.0%	✓			✓	✓
Kurta et al. (2012)	US	P	902	1,802	71.0%	46.1%	✓
Terry et al. (2013)	US, Canada, Australia	P	8,525	9,859	NR	NR	✓	✓		✓	✓	✓
Wu et al. (2015)	US	P	1,701	2,391	63.2%	NR	✓	✓	✓	✓	✓	✓		✓
Cramer et al. (2016)	US	P	2,041	2,100	71.5%	56.4%	✓	✓	✓	✓	✓	✓	✓	✓
Schildkraut et al. (2016)	US	P	584	745	50.0%	61.0%	✓	✓	✓	✓	✓	✓
Gabriel et al. (2019)	US	P	2,040	2,100	71.0%	54.0%	✓	✓		✓	✓	✓
	Relative Risk (95% Confidence Interval) for Mode of Perineal Talc Use				Extent of Perineal Talc Exposure ptrend or Risk Estimate (95% CI)^a			Histological Subtypes of Invasive Ovarian Cancer^b
Study	Any	Dusting Powder	Sanitary Napkin or Underwear^c	Diaphragm or Cervical Cap	Frequency	Duration	Total Applications	Serous	Mucinous	Endometrioid	Clear Cell
Cramer et al. (1982)	1.61(1.04, 2.49)
Hartge et al. (1983)	2.5(0.7, 10.0)			0.8(0.4, 1.4)
Whittemore et al. (1988)	1.36(0.91, 2.04)	1.45(0.81, 2.60)	0.62(0.21, 1.80)	1.5(0.63, 3.58)	0.19	0.61
Booth, Beral, and Smith (1989)		1.3^e(0.8, 1.9)		Null	0.05
Harlow and Weiss (1989)	1.1(0.7, 2.1)	1.2(0.6, 2.6)	2.2(0.8, 19.8)	0.5(0.2, 1.4)
Harlow et al. (1992)	1.5(1.0, 2.1)	1.7(1.1, 2.7)	1.1(0.4, 2.8)	1.2(0.6, 2.4)	0.046	0.07	0.015
Chen et al. (1992)		3.9(0.9, 10.6)
Rosenblatt, Szklo, and Rosenshein (1992)	1.0(0.2, 4.0)	1.7(0.7, 3.9)	4.8(1.3, 17.8)	3.0(0.8, 10.8)
Tzonou et al. (1993)		1.05(0.28, 3.98)
Cramer and Xu (1995)	1.6(1.2, 2.1)
Purdie et al. (1995)		1.27(1.04, 1.54)
Chang and Risch (1997)	1.42(1.08, 1.86)	1.31(1.00, 1.73)	1.26(0.81, 1.96)		Null	Null		1.34(0.96, 1.85)	1.59(0.97, 2.58)	1.67(1.00, 2.79)
Cook, Kamb, and Weiss (1997)	1.5(1.1, 2.0)	1.8(1.2, 2.9)	1.5(0.6, 3.6)	0.8(0.4, 1.4)			Null	1.7(1.1, 2.5)	0.7(0.4, 1.4)	1.2(0.6, 2.3)
Green et al. (1997)		1.3(1.1, 1.6)				Null
Godard et al. (1998)		2.49(0.94, 6.58)
Cramer et al. (1999)	1.60(1.18, 2.15)	1.45(0.97, 2.18)	1.45(0.68, 3.09)			0.48	0.68	1.70(1.22, 2.39)	0.79(0.44, 1.40)	1.04 ^f(0.67, 1.61)
Wong et al. (1999)	0.92 (0.24, 3.62)	1.0(0.8, 1.3)	0.9(0.4, 2.0)			Null
Ness et al. (2000)		1.5(1.1, 2.0)	1.7(1.2, 2.4)	0.6(0.3, 1.2)		Null
Langseth and Kjaerheim (2004)	1.15 (0.41, 3.21)
Mills et al. (2004)	1.37(1.02, 1.85)				0.015	0.045	0.051	1.77(1.12, 2.81)	2.56(0.89, 7.39)	1.28(0.62, 2.62)	0.63(0.15, 2.64)
Jordan et al. (2007)		1.10(0.84, 1.45)			0.3 ^g
Merritt et al. (2008)	1.17(1.01, 1.36)					0.021		1.21(1.03, 1.44)	1.10(0.80, 1.52)	1.18(0.81, 1.70)	1.08(0.68, 1.72)
Gates et al. (2008)		1.40(1.15, 1.70)			0.002			1.62(1.26, 2.09)
Wu et al. (2009)		1.53(1.13, 2.09)	1.71(0.99, 2.97)	1.14(0.46, 2.87)	0.032 ^h		0.0004
Moorman et al. (2009)^i	1.04(0.82, 1.33)
Moorman et al. (2009)^j	1.19(0.68, 2.09)
Rosenblatt et al. (2011)		1.27 (0.97, 1.66)	0.82 (0.58,1.16)	0.72 (0.48, 1.10)		Null	Null	1.01 (0.69, 1.47)		1.53 ^f(0.91, 2.57)
Kurta et al. (2012)		1.40(1.16, 1.69)
Terry et al. (2013)		1.24(1.15, 1.33)					0.17	1.20(1.09, 1.32)	1.09(0.84, 1.42)	1.22(1.04, 1.43)	1.24(1.01, 1.52)
Wu et al. (2015)		1.46(1.27, 1.69)				1.14 ^k(1.09, 1.20)
Cramer et al. (2016)	1.32(1.15, 1.53)	1.42(1.04, 1.96)		0.73(0.57, 0.93)	<0.0001	0.002	0.02	1.42(1.19, 1.69)	0.87(0.53, 1.44)	1.38(1.06, 1.80)	1.01(0.65, 1.57)
Schildkraut et al. (2016)	1.44(1.11, 1.86)				<0.01	0.02	0.01
Gabriel et al. (2019)	1.30 (1.13–1.50)				0.0001 ^h			1.39 (1.14–1.69)	0.97 (0.68–1.40)	1.26 (0.94–1.69)	1.08 (0.66–1.78)

Notes:

P = Population-based; H = Hospital-based; N = Nested within the same occupational cohort; NR = Not Reported; OC = Oral Contraceptive; PMH = Postmenopausal Hormones.

Bold denotes a statistically significant result. Results are classified as null if a study reported they were not statistically significant but did not report risk estimates or p-values.

(a) P_trend is presented, unless otherwise noted.

(b) Risk estimates for invasive cancers are presented when available.

(c) If results for sanitary napkins and underwear were reported separately, I present the larger risk estimate of the two.

(d) 280 hospital-based controls, 259 population-based controls.

(e) Daily use.

(f) For endometrioid/clear cell combined.

(g) Frequency for use in the perineal region.

(h) Frequency and duration were evaluated together.

(i) Caucasian women.

(j) African American women.

(k) Relative risk for every five years of talc use.

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