Last week, a 63-year-old California woman won a massive lawsuit against Johnson & Johnson. The woman, Eva Echeverria, had been using the company's Baby Powder on her nether regions since she was 11 years old, and she claimed the product was to blame for her 2007 ovarian cancer diagnosis. The jury agreed; Echeverria was awarded a record $417 million in damages for the company failing to adequately warn customers of the potential cancer risk.
Echeverria's case is the latest of a handful of multi-million dollar verdicts so far; Bloomberg reports that the company faces 5,500 additional lawsuits around the country regarding its Baby Powder and Shower to Shower products, though Reuters puts the number of claims at 4,800. And while Echeverria's case seems settled (although the company is appealing this and other verdicts), the science linking baby powder and ovarian cancer isn't quite so straightforward.
One of the main ingredients in baby powder is talc, a mineral which absorbs moisture and can help prevent skin irritation and rashes. That's why you might have heard it called talcum powder in the past. In its naturally occurring form, some talc contains asbestos—a known carcinogen. Though, since the 1970s, no talc products sold in the United States have contained asbestos, because of the lung cancer risk; and that includes Johnson & Johnson brand Baby Powder.
Still, the International Agency for Research on Cancer, a branch of the World Health Organization, listed talcum powder used in the female genital area as a possible carcinogen in 2006 and again in 2010, but the IARC noted that bias in the studies couldn't be ruled out. But no federal agencies have moved to take talc off the market or add warning labels. In fact, the FDA denied a request to add a warning label to talc products in 2014, saying there was no conclusive evidence to establish that talc causes cancer though it's possible that "may elicit a foreign-body-type reaction and inflammatory response that, in some exposed women, may progress to epithelial cancers."
Since the 1980s, studies have pointed to the possible negative health effects of using talcum powder for feminine hygiene. But it's really tough to draw definitive conclusions from those findings. "I think part of the difficulty is that the data is not consistent either for or against the association," Don Dizon, the clinical co-director of gynecologic oncology at Massachusetts General Hospital Cancer Center, tells Tonic.
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Part of the reason is simply how those studies have to be done. Normally, to determine if a substance like a drug does the thing scientists think it does, researchers take a big group of people and randomly decide if they will be exposed to the drug or be in the placebo (control) group. A study like that for asbestos-free talcum powder—having a large group of women use the powder while another uses a placebo, then following them for much of their lives to see if they develop ovarian cancer—would never be done, Dizon points out, because it's not ethical. If a substance has already been shown in some lab studies to be associated with cancer, like asbestos-free talc has, you don't want to use humans as test subjects.
So researchers are limited to studies on cells in petri dishes and animals in the lab, or by observing groups of people over long periods of time and analyzing their habits. But there are caveats that complicate the conclusions we can draw from those studies.
In observational studies, factors known to affect a woman's chances of developing ovarian cancer, such as having a genetic predisposition to the disease or taking birth control pills (which lowers the risk), weren't even included in the earlier studies and are hard to parse out. That's further complicated by the fact that the components in baby powder have changed over time (using it before the 1970s, when it contained asbestos, would probably have a different effect than using it today) and the ingredients vary between countries.
What's more, women may not accurately recall how often or how much baby powder they used, especially if they'd been diagnosed with ovarian cancer. Many seek to discover a reason why they developed cancer, and that can push some patients to overestimate how much baby powder they really used. "Everyone asks after they are diagnosed, 'why did this happen to me?'" Dizon says. "Many women say, 'I did everything [right]. I never even used talc.' But talc is really not a risk factor in my mind."
Hypothetically, Dizon could see how particles of baby powder sprinkled on the perineum or in underwear could float up through the vagina, then make their way through the uterus and fallopian tubes to the ovaries, where they can cause inflammation that could make cancer more likely. (Johnson & Johnson does say on its Baby Powder label that the product is for external use only and warns against inhalation; it also sells multiple cornstarch-only formulas.) It's a bit mysterious why the powder hasn't also been associated with higher rates of endometrial cancers, which occur in the lining of the uterus, but Dizon says the mechanism has been compared to the relationship between asbestos and mesothelioma—the substance doesn't cause cancer in the lung, but only in the lung lining after lodging itself there and causing inflammation for years.
The risk, it seems, is small, if it exists at all. The American Cancer Society has a page explaining the alleged connection between talcum powder and ovarian cancer, which concludes that two prospective studies, which follow people as they age rather than look backward for patterns, haven't found an increased risk. If there is any risk, it's probably very small since ovarian cancer itself isn't terribly common: the lifetime risk of developing it is about 1 in 75, or 1.3 percent, versus 1 in 8 for breast cancer, or 12 percent. And an increase of a small risk is still a small risk.
If the science is still up in the air, how could a legal case be decided? Experts can't say for sure that there isn't any link between talcum powder and ovarian cancer, and it's pretty complicated to explain the nuances of study design to a jury, Dizon notes, so there's enough ambiguity for prosecutors to use to their advantage. "There's a tendency to assign blame," he says, and it's not tempting to contradict a woman who is dying from ovarian cancer; Echeverria was too ill to testify in court and gave a videotaped deposition. Still, a New Jersey judge dismissed two similar cases because the plaintiff's lawyers didn't present reliable evidence linking talc to ovarian cancer.
Johnson & Johnson spokesperson Carol Goodrich told Tonic in a statement:
Ovarian cancer is a devastating diagnosis and we deeply sympathize with the women and families impacted by this disease. We will appeal [the] verdict because we are guided by the science, which supports the safety of Johnson's Baby Powder. In April, the National Cancer Institute's Physician Data Query Editorial Board wrote, 'The weight of evidence does not support an association between perineal talc exposure and an increased risk of ovarian cancer.' We are preparing for additional trials in the US and we will continue to defend the safety of Johnson's Baby Powder.
Dizon doesn't think the association between talcum powder and ovarian cancer will be resolved anytime soon, if ever. "The best we can hope for is a consensus opinion," he says—a judgment from an organization such as the American Cancer Society or the International Agency for Research on Cancer made after weighing all the evidence with its caveats.
In the meantime, women shouldn't be too worried about the link between talcum powder and ovarian cancer. "Life is too short to deal with excessive worry. If you are worried about using talcum powder in your private areas, then don't do it," Dizon says. But in general, women would be better off paying more attention to proven risk factors, such as family history of the disease and genetic mutations like BRCA1 and BRCA2.