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The Association Between Talc Use and Ovarian Cancer: A Retrospective Case–Control Study in Two US States

Cramer, Daniel W.; Vitonis, Allison F.; Terry, Kathryn L.; Welch, William R.; Titus, Linda J.

doi: 10.1097/EDE.0000000000000434

Background: Multiple studies of ovarian cancer and genital talc use have led only to consensus about possible carcinogenicity. Seeking greater clarity, we examined this association in 2,041 cases with epithelial ovarian cancer and 2,100 age- and-residence-matched controls.

Methods: We defined genital talc use as regular application to the genital/rectal area directly, on sanitary napkins, tampons, or underwear. To estimate “talc-years,” we multiplied applications per year by years used. Unconditional logistic regression, Wald statistics, likelihood-ratio tests, and polytomous logistic regression were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI), trends, effect-modification, and heterogeneity by ovarian cancer histologic subtype.

Results: Overall, genital talc use was associated with an OR (95% CI) of 1.33 (1.16, 1.52), with a trend for increasing risk by talc-years. Women who used talc were more likely to be older, heavier, asthma sufferers, and regular analgesic users—none of which was a confounder. Dose–responses were more apparent for premenopausal women, especially nonsmokers and those heavier or postmenopausal users of menopausal hormones (hormone therapy [HT]). Subtypes of ovarian cancer more likely to be associated with talc included invasive serous and endometrioid tumors and borderline serous and mucinous tumors. Premenopausal women and postmenopausal HT users with these subtypes who had accumulated >24 talc-years had ORs (95% CI) of 2.33 (1.32, 4.12) and 2.57 (1.51, 4.36), respectively.

Conclusion: Risks for epithelial ovarian cancer from genital talc use vary by histologic subtype, menopausal status at diagnosis, HT use, weight, and smoking. These observations suggest that estrogen and/or prolactin may play a role via macrophage activity and inflammatory response to talc.

Supplemental Digital Content is available in the text.

From the aObstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA; bDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; cDepartment of Pathology, Brigham and Women’s Hospital, Boston, MA; and dDepartment of Community & Family Medicine, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH.

Submitted 12 June 2015; accepted 17 December 2015.

Supported by the National Institutes of Health (Grant Numbers R01CA054419, P50CA105009, R01CA67272), the Department of Defense Congressionally Directed Medical Research Programs (W81XWH-10-1-0280), and the Department of Obstetrics and Gynecology, Brigham and Women’s Hospital.

Dr. Cramer reports being paid for expert testimony in litigation related to ovarian cancer. Ms. Vitonis reports being paid for programming work related to the same litigation. The other authors have no conflicts to report.

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Correspondence: Daniel W. Cramer, 221 Longwood Ave, RFB365, Boston, MA 02115. E-mail:

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