On January 22, 2016, a Missouri jury reached an astounding verdict: awarding $72 million to the family of a woman who died of ovarian cancer, a cancer they claimed was caused by Johnson & Johnson’s baby powder. The verdict is shocking not only for its size, but for the allegations on which it was based. Baby powders, specifically ones that contain a mineral called talc, have long been used as feminine hygiene products. But the idea that they may actually cause ovarian cancer would certainly have women reaching for an alternative. So is it true? Does baby powder cause cancer?
Experts are split on the answer. In fact, it’s been a topic of heated debate for more than 100 years. In reality, the story of baby powder and cancer goes back to the late 19th century.
Talcum Powder, Asbestos & Ovarian Cancer
In 1890, a doctor at Johnson & Johnson began advocating the use of straight talcum powder to alleviate skin irritations. Early customers found another use for the stuff, treating their children’s diaper rash, and demand grew so high that the company created a retail version.
Johnson & Johnson soon discovered a problem, though. Some of the talc used in their Baby Powder had been contaminated with asbestos, a mineral that causes lung cancers.
Once the link between asbestos and mesothelioma was confirmed, everyone stopped using talc straight out of the ground, and switched to one of two alternatives: corn starch or talc that had been screened for asbestos. But questions remained. Scientists theorized that if a woman applied baby powder to her genitals, particles of talc might be able to travel to the ovaries, ultimately irritating the organs and increasing the risk of malignant cell growth.
By the early 1980s, several studies had proposed an association between talc-containing powders and cancer. The first, published in 1971 by the British Journal of Obstetrics and Gynaecology, found that a majority of ovarian and cervical tumors were embedded with talc particles. In 1982, a study in 430 women found that people who regularly applied talcum powder to their genitals were at a 92% increased risk for developing ovarian cancer. Those results were confirmed by several other studies, most of which fell between a 30% to 60% increased risk. But the research has come under considerable fire from other scientists.
Questioning The Link
Most of the studies that look into this issue are “retrospective.” They’re not carefully designed in a laboratory setting, but rely on subjects self-reporting how often they use baby powder and what kind. That opens up numerous pitfalls, not least of which is the fallibility of human memory. Another problem is that some, if not many, of these women may have started out using baby powders that contained asbestos. Thus the link to ovarian cancer may be from asbestos, a known carcinogen, and not talc at all.
In any event, the results haven’t been enough to prove causation. But they’re not so weak that an increased risk is out of the question, either. That’s why most health organizations have been tentative in confirming a link, but haven’t discounted one out of hand. The International Agency for Research on Cancer, for example, says that talcum powders containing asbestos are definitely “carcinogenic to humans,” according to the American Cancer Society. But asbestos-free powders, at least when applied to the genitals, are “possibly carcinogenic to humans.” Where medicine is concerned, you have to hedge your bets.
Researchers, for that matter, are often unwilling to say that a substance can cause a condition until they know how. Before you can demonstrate a clear “mechanism of action,” a causal relationship is speculative at best. Many scientists have been unwilling to accept the inflammation theory we discussed earlier, and that doubt may be preventing them from accepting the research results that show an association between talcum powder and cancer.
Is Fear Driving The Debate?
For Dr. Ahmed Ismail, the debate is really a question of belief, not science. Speaking to UK newspaper The Telegraph, Ismail noted how little we know about ovarian cancer in general. The only reason we even ask whether or not talcum powder could be associated with cancer is “because we’re so desperate to discover why ovarian cancer is caused.” That may be true, but the newly-ended cancer lawsuit raises a separate question altogether: did Johnson & Johnson adequately warn patients of the risks?
Asbestos-free talcum powder may not be conclusively linked to ovarian cancer, but that doesn’t change the fact that more than 20 studies have found the potential for an increased risk. Johnson & Johnson’s bottle, however, makes no mention of that. In fact, beyond a “Safety Tip” to keep the powder out of children’s reach, there’s just a warning about inhaling the stuff. Thus far, juries have found that those minimal warnings, which don’t mention ovarian cancer at all, aren’t enough.
In 2013, the first baby powder lawsuit against Johnson & Johnson went to trial. But similar to the medical experts, the jury was oddly split. While they agreed that Johnson & Johnson should be held liable for not including a cancer warning on the product, they didn’t award the Plaintiff any damages. Myron Levin, an editor at health care watchdog group FairWarning, spoke with one of the jurors afterwards. In an interview with Public Radio International, he said the jury “did not believe the medical evidence was persuasive enough to conclude that [the Plaintiff’s] cancer was actually caused by talc. Still, the jury felt that Johnson & Johnson should have put a warning label on the product.”
Today, Johnson & Johnson controls 19% of the US baby powder market, according to statistics compiled by Statista, and that’s with only one product, the company’s generically-titled “Baby Powder.” Valeant Pharmaceutical’s “Shower to Shower” captures the second-highest spot, with nearly 7% of the market. Shower to Shower, marketed almost exclusively to women as a deodorizer, was originally sold by Johnson & Johnson. Valeant purchased the product in 2012, but it’s likely that Johnson & Johnson will bear the brunt of the growing baby powder litigation. The company already faces over one thousand similar lawsuits, and more are expected in the coming months.
Update March 7, 2016 – New Study Adds Weight To Talcum Powder-Cancer Link
A new study, conducted by researchers at Boston’s Brigham and Women’s Hospital, has added more evidence to the debate surrounding talcum powder, finding the product’s use linked to an increased risk of ovarian cancer. The study, which will soon publish in the peer-reviewed journal Epidemiology, was led by Dr. Daniel Cramer. Cramer has been studying talcum powder’s association with cancer since the early 1980s, and has vigorously advocated for strengthened warning labels on the product.
In the new study, researchers asked 2,041 women who had been diagnosed with epithelial ovarian cancer, a form of the disease that begins in cells covering the ovary, about their use of talcum powder. Turning to women who didn’t have ovarian cancer, the study found that patients who regularly applied talcum-containing baby powders to their genital area were 33% more likely to have been diagnosed with ovarian cancer.
Notably, the study’s results were confined to premenopausal women and postmenopausal women who used hormone therapies. These groups, along with African American women and women with no family history of breast cancer, were at risks that far exceeded those for other women.
Speaking to Reuters on March 3, Nicolas Wentzensen, MD, head of the National Cancer Institute’s clinical epidemiology division, said “the recent paper in Epidemiology has provided additional support for an association between talc use and ovarian cancer from a case-control study.” But Wentzensen isn’t totally on board yet. He noted the study’s relatively weak design, and suggested additional research to “confirm” the paper’s findings.