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Douching, Talc Use, and Risk of Ovarian Cancer

Gonzalez, Nicole L.; O’Brien, Katie M.; D’Aloisio, Aimee A.; Sandler, Dale P.; Weinberg, Clarice R.

doi: 10.1097/EDE.0000000000000528
Cancer Epidemiology

Background: Douching was recently reported to be associated with elevated levels of urinary metabolites of endocrine disrupting phthalates, but there is no literature on douching in relation to ovarian cancer. Numerous case–control studies of genital talc use have reported an increased risk of ovarian cancer, but prospective cohort studies have not uniformly confirmed this association. Behavioral correlation between talc use and douching could produce confounding.

Methods: The Sister Study (2003–2009) enrolled and followed 50,884 women in the US and Puerto Rico who had a sister diagnosed with breast cancer. At baseline, participants were asked about douching and talc use during the previous 12 months. During follow-up (median of 6.6 years), 154 participants reported a diagnosis of ovarian cancer. We computed adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for ovarian cancer risk using the Cox proportional hazards model.

Results: There was little association between baseline perineal talc use and subsequent ovarian cancer (HR: 0.73, CI: 0.44, 1.2). Douching was more common among talc users (odds ratio: 2.1, CI: 2.0, 2.3), and douching at baseline was associated with increased subsequent risk of ovarian cancer (HR: 1.8, CI: 1.2, 2.8).

Conclusions: Douching but not talc use was associated with increased risk of ovarian cancer in the Sister Study.

From the aBiostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research triangle Park, NC; bSocial & Scientific Systems, Inc., Durham, NC; and cEpidemiology Branch, National Institute of Environmental Health Sciences, Research triangle Park, NC.

Submitted 18 April 2016; accepted 15 June 2016.

Supported by the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (Project Z01-ES044005 to DPS).

Dale P. Sandler and Clarice R. Weinberg are joint senior authors.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (

Correspondence: Clarice R. Weinberg, 111 TW Alexander Dr, Research triangle Park, NC 27709. E-mail:

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.