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Perineal Talc Use and Ovarian Cancer: A Systematic Review and Meta-Analysis

Penninkilampi, Ross; Eslick, Guy, D.

doi: 10.1097/EDE.0000000000000745

Background: It has been posited that there is an association between perineal talc use and the incidence of ovarian cancer. To date, this has only been explored in observational studies.

Objectives: To perform a meta-analysis to evaluate the association between perineal talc use and risk of ovarian cancer.

Methods: Studies were identified using six electronic databases. Observational studies involving at least 50 cases of ovarian cancer were eligible for inclusion. We analyzed the association between ovarian cancer, including specific types, and any perineal talc use, long-term (>10 years) use, total lifetime applications, and use on diaphragms or sanitary napkins. A subgroup analysis was performed, stratifying by study design and population.

Results: We identified 24 case–control (13,421 cases) and three cohort studies (890 cases, 181,860 person-years). Any perineal talc use was associated with increased risk of ovarian cancer (OR = 1.31; 95% CI = 1.24, 1.39). More than 3600 lifetime applications (OR = 1.42; 95% CI = 1.25, 1.61) were slightly more associated with ovarian cancer than <3600 (OR = 1.32; 95% CI = 1.15, 1.50). An association with ever use of talc was found in case–control studies (OR = 1.35; 95% CI = 1.27, 1.43), but not cohort studies (OR = 1.06; 95% CI = 0.90, 1.25). However, cohort studies found an association between talc use and invasive serous type ovarian cancer (OR = 1.25; 95% CI = 1.01, 1.55). We found an increased risk of serous and endometrioid, but not mucinous or clear cell subtypes.

Conclusions: In general, there is a consistent association between perineal talc use and ovarian cancer. Some variation in the magnitude of the effect was found when considering study design and ovarian cancer subtype.

From the Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, NSW, Australia.

Submitted July 12, 2017; accepted August 27, 2017.

This manuscript is original, has not been previously published in whole or in part, and is not under consideration for publication elsewhere. Neither animals nor human subjects were used in this research.

All authors have read the manuscript, agree that the work is ready for submission, and accept the contents of the manuscript.

The authors report no conflicts of interest.

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Correspondence: Guy D. Eslick, The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 3, Clinical Building, PO Box 63, Penrith, NSW 2751, Australia. E-mail:

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