and frequency and nature of use (daily, during certain seasons of
the year, only while menstruating). Another important ques-
tion is whether the use of body powder was before or after tubal
ligation or hysterectomy.
Individuals’ answers to questions about use of brand names
over time may be unreliable, and therefore, in future studies,
investigators should try to ascertain, either from government or
industry sources, the composition of the powders used in
different time periods by different brand names and, in
particular, to ascertain whether the exposure may have included
some contamination by asbestos and also whether the exposure
was to talc or a non-talc product. Statistical analyses should
attempt to assess risk separately for the categories of powders:
talc containing asbestos, talc not containing asbestos, non-talc
product. Further, exposure metrics should take into account the
age, duration and intensity of exposure. As well as analyses for
all ovarian tumours combined, there should, if possible, be
analyses by histological subtype and by invasiveness of the
While it would not be reasonable to envisage establishing a
costly long-term prospective cohort study just to study this
association, any long-term cohort study that is being set up to
study cancer among women should collect information about
talc use if the study is being conducted in a country where such
use has been widespread.
In summary, future studies should focus on seeking evidence
in talc-exposed female populations worldwide, collecting reli-
able information on age at initial use of body powder, exposure
assessments and dose response associations.
Acknowledgements: The work reported in this paper was initiated while SH, JS and
EW were part of an IARC Monographs Working Group of the International Agency for
Research on Cancer, Lyon, France.
Funding: This study was financed by the Cancer Registry of Norway.
Competing interests: None.
1. Lux MP, Fasching PA, Beckmann MW. Hereditary breast and ovarian cancer: review
and future perspectives. J Mol Med 2006;84:16–28.
2. Persson I. Estrogens in the causation of breast, endometrial and ovarian cancers—
evidence and hypotheses from epidemiological findings. J Steroid Biochem Mol Biol
3. International Agency for Research on Cancer. IARC monographs on the
evaluation of carcinogenic risks to human, Vol 93, Carbon black, titanium dioxide, and
non-asbestiform talc. Geneva: WHO (in press).
4. Heller DS, Gordon RE, Westhoff C, et al. Asbestos exposure and ovarian fiber
burden. Am J Ind Med 1996;29:435–9.
5. Langseth H, Johansen BV, Nesland JM, et al. Asbestos fibers in ovarian tissue from
Norwegian pulp and paper workers. Int J Gynecol Cancer 2007;17:44–9.
6. Venter PF. Ovarian epithelial cancer and chemical carcinogenesis. Gynecol Oncol
7. Olive DL, Schwartz LB. Endometriosis. N Engl J Med 1993;328:1759–69.
8. Rosenblatt KA, Thomas DB. Reduced risk of ovarian cancer in women with a tubal
ligation or hysterectomy. the World Health Organization Collaborative Study of
Neoplasia and Steroid Contraceptives. Cancer Epidemiol Biomarkers Prev
9. Tortolero-Luna G, Mitchell MF. The epidemiology of ovarian cancer. J Cell Biochem
10. Gertig DM, Hunter DJ, Cramer DW, et al. Prospective study of talc use and ovarian
cancer. J Natl Cancer Inst 2000;92:249–52.
11. Cramer DW, Welch WR, Scully RE, et al. Ovarian cancer and talc: a case-control
study. Cancer 1982;50:372–6.
12. Hartge P, Hoover R, Lesher LP, et al. Talc and ovarian cancer. JAMA
13. Whittemore AS, Wu ML, Paffenbarger RS Jr, et al. Personal and environmental
characteristics related to epithelial ovarian cancer. II. Exposures to talcum powder,
tobacco, alcohol, and coffee. Am J Epidemiol 1988;128:1228–40.
14. Booth M, Beral V, Smith P. Risk factors for ovarian cancer: a case-control study.
Br J Cancer 1989;60:592–8.
15. Harlow BL, Weiss NS. A case-control study of borderline ovarian tumors: the
influence of perineal exposure to talc. Am J Epidemiol 1989;130:390–4.
16. Harlow BL, Cramer DW, Bell DA, et al. Perineal exposure to talc and ovarian cancer
risk. Obstet Gynecol 1992;80:19–26.
17. Chen Y, Wu PC, Lang JH, et al. Risk factors for epithelial ovarian cancer in Beijing,
China. Int J Epidemiol 1992;21:23–9.
18. Rosenblatt KA, Szklo M, Rosenshein NB. Mineral fiber exposure and the
development of ovarian cancer. Gynecol Oncol 1992;45:20–5.
19. Tzonou A, Polychronopoulou A, Hsieh CC, et al. Hair dyes, analgesics, tranquilizers
and perineal talc application as risk factors for ovarian cancer. Int J Cancer
20. Cramer DW, Xu H. Epidemiologic evidence for uterine growth factors in the
pathogenesis of ovarian cancer. Ann Epidemiol 1995;5:310–4.
21. Purdie D, Green A, Bain C, et al. Reproductive and other factors and risk of epithelial
ovarian cancer: an Australian case-control study. Survey of Women’s Health Study
Group. Int J Cancer 1995;62:678–84.
22. Chang S, Risch HA. Perineal talc exposure and risk of ovarian carcinoma. Cancer
23. Cook LS, Kamb ML, Weiss NS. Perineal powder exposure and the risk of ovarian
cancer. Am J Epidemiol 1997;145:459–65.
24. Green A, Purdie D, Bain C, et al. Tubal sterilisation, hysterectomy and decreased risk
of ovarian cancer. Survey of Women’s Health Study Group. Int J Cancer
25. Godard B, Foulkes WD, Provencher D, et al. Risk factors for familial and sporadic
ovarian cancer among French Canadians: a case-control study. Am J Obstet Gynecol
26. Cramer DW. Perineal talc exposure and subsequent epithelial ovarian cancer: a
case-control study. Obstet Gynecol 1999;94:160–1.
27. Wong C, Hempling RE, Piver MS, et al. Perineal talc exposure and subsequent
epithelial ovarian cancer: a case-control study. Obstet Gynecol 1999;93:372–6.
28. Ness RB, Grisso JA, Cottreau C, et al. Factors related to inflammation of the ovarian
epithelium and risk of ovarian cancer. Epidemiology 2000;11:111–7.
29. Mills PK, Riordan DG, Cress RD, et al. Perineal talc exposure and epithelial ovarian
cancer risk in the Central Valley of California. Int J Cancer 2004;112:458–64.
30. Jordan SJ, Green AC, Whiteman DC, et al. Risk factors for benign serous and
mucinous epithelial ovarian tumors. Obstet Gynecol 2007;109:647–54.
31. Harlow BL, Hartge PA. A review of perineal talc exposure and risk of ovarian cancer.
Regul Toxicol Pharmacol 1995;21:254–60.
32. Ness RB, Cottreau C. Possible role of ovarian epithelial inflammation in ovarian
cancer. J Natl Cancer Inst 1999;91:1459–67.
33. International Agency for Research on Cancer. Preamble to the IARC
monographs on the evaluation of carcinogenic risks to humans. 93. Lyon: IARC
34. Baan R, Straif K, Grosse Y, et al. Carcinogenicity of carbon black, titanium dioxide,
and talc. Lancet Oncol 2006;7:295–6.
What this study adds
c Epidemiological evidence suggests that use of cosmetic talc in
the perineal area may be associated with ovarian cancer risk.
The IARC has classified this use of talc as possibly
carcinogenic to human beings (group 2B).
c The mechanism of carcinogenicity may be related to
inflammation. This paper focus on the high degree of
consistency in the studies accomplished so far, and what
should be the focus in future studies.
360 J Epidemiol Community Health 2008;62:358–360. doi:10.1136/jech.2006.047894