Re­search, ju­ries at odds over can­cer risk of talc

Daily Freeman (Kingston, NY) - - FRONT PAGE -

TREN­TON, N.J. >> Two law­suits ended in jury ver­dicts worth $127 mil­lion. Two oth­ers were tossed out by a judge who said there wasn’t re­li­able ev­i­dence that the talc in John­son & John­son’s iconic baby pow­der causes ovar­ian can­cer. So who’s right? And is baby pow­der safe?

Most re­search finds no link or a weak one be­tween ovar­ian can­cer and us­ing baby pow­der for fem­i­nine hy­giene, a prac­tice gen­er­a­tions of Amer­i­can moth­ers have passed on to their daugh­ters. Most ma­jor health groups have de­clared talc harm­less. John­son & John­son, whose baby pow­der dom­i­nates the mar­ket, says it’s per­fectly safe.

Yet some 2,000 women have sued, and lawyers are re­view­ing thou­sands of other po­ten­tial cases, most gen­er­ated by ads tout­ing the two big ver-

dicts. Mean­while, jury se­lec­tion in the next trial be­gan Mon­day.

A look at the is­sue:

What is talc?

Talc is a min­eral that is mined from de­posits around the world, in­clud­ing the U.S. The soft­est of min­er­als, it’s crushed into a white pow­der. It’s been widely used in cos­met­ics and other per­sonal care prod­ucts to ab­sorb mois­ture since at least 1894, when John­son & John­son’s Baby Pow­der was launched. But it’s mainly used in a va­ri­ety of other prod­ucts, in­clud­ing paint and plas­tics.

Does it cause ovar­ian can­cer?

Like many ques­tions in sci­ence, there’s no de­fin­i­tive an­swer. Find­ing the cause of can­cer is dif­fi­cult. It would be un­eth­i­cal to do the best kind of study, ask­ing a group of women to use tal­cum pow­der on their gen­i­tals and wait to see if it causes can­cer, while com­par­ing them to a group who didn’t use it.

While ovar­ian can­cer is of­ten fa­tal, it’s rel­a­tively rare. It ac­counts for only about 22,000 of the 1.7 mil­lion new cases of can­cer ex­pected to be di­ag­nosed in the United States this year.

Fac­tors that are known to in­crease a women’s risk of ovar­ian can­cer in­clude age, obe­sity, use of es­tro­gen ther­apy af­ter menopause, not hav­ing any chil­dren, cer­tain ge­netic mu­ta­tions and per­sonal or fam­ily his­tory of breast or ovar­ian can­cer.

What re­search can be done?

Two other kinds of re­search are pos­si­ble. Nei­ther of them, though, can con­clu­sively prove some­thing causes can­cer. One looks back in time, af­ter an ill­ness has oc­curred. It com­pares two groups of peo­ple, one with the ill­ness, one with­out, and asks about past ex­po­sures that might be fac­tors. But peo­ple have trou­ble re­mem­ber­ing de­tails years later.

The sec­ond ap­proach fol­lows a large group of peo­ple. It as­sesses their health at the start and fol­lows them for years, record­ing any ill­nesses while track­ing pos­si­ble in­flu­ences such as diet and use of med­i­ca­tion, al­co­hol or other sub­stances. Sci­en­tists gen­er­ally find these “prospec­tive” stud­ies most re­li­able.

What re­search has shown

The big­gest prospec­tive stud­ies have found no link be­tween tal­cum pow­der ap­plied to the gen­i­tals and ovar­ian can­cer. But about two dozen smaller, look­back stud­ies over three decades have mostly found a mod­est con­nec­tion — a 20 per­cent to 40 per­cent in­creased risk among talc users.

How­ever, that doesn’t mean talc causes can­cer. Sev­eral fac­tors make that un­likely and there’s no proof talc, which doesn’t in­ter­act with chem­i­cals or cells, can travel up the re­pro­duc­tive tract, en­ter the ovaries and then trig­ger can­cer.

One large study pub­lished in June that fol­lowed 51,000 sis­ters of breast can­cer pa­tients found gen­i­tal talc users had a re­duced risk of ovar­ian can­cer, 27 per­cent lower than in nonusers. An anal­y­sis of two huge, long-run­ning U.S. stud­ies, the Women’s Health Ini­tia­tive and the Nurses’ Health Study, showed no in­creased risk of ovar­ian can­cer in talc users.

What ex­perts say

If there were a true link, Dr. Hal C. Lawrence III says large stud­ies that tracked women’s health for years would have ver­i­fied re­sults of the smaller look-back ones.

“Lord knows, with the amount of pow­der that’s been ap­plied to ba­bies’ bot­toms, we would’ve seen some­thing” if talc caused can­cer, said Lawrence, vice pres­i­dent of the Amer­i­can Col­lege of Ob­stet­rics and Gy­ne­col­ogy.

The Na­tional Can­cer In­sti­tute’s Dr. Ni­co­las Wentzensen says the fed­eral agency’s po­si­tion is that there’s not a clear con­nec­tion.

“It is very hard to es­tab­lish causal re­la­tion­ships,” he said, adding, “A lot of ovar­ian cancers oc­cur in women who have never used talc, and many women have used talc and not got­ten ovar­ian can­cer.”

Re­search direc­tor El­iz­a­beth Ward of the Amer­i­can Can­cer So­ci­ety says it is un­usual to have so much dis­crep­ancy be­tween stud­ies. “The risk for any in­di­vid­ual woman, if there is one, is prob­a­bly very small,” Ward said.

What lawyers and courts say

Like the stud­ies, courts have pro­duced mixed re­sults.

In the first trial two years ago, a South Dakota jury found John­son & John­son li­able for one woman’s ovar­ian can­cer but didn’t award any dam­ages. This year, state court ju­ries in St. Louis awarded plain­tiffs $72 mil­lion and $55 mil­lion — ver­dicts the com­pany is ap­peal­ing.

But U.S. Dis­trict Judge Nel­son John­son in At­lantic City threw out the first two of the 400 law­suits in his court. He re­viewed the re­search and tes­ti­mony from two doc­tors who are the plain­tiffs’ key ex­pert wit­nesses and con­cluded the two aren’t re­li­able, not­ing they had pre­vi­ously writ­ten that there was no proof talc causes ovar­ian can­cer. Other courts ap­proved them as ex­perts, noted the plain­tiffs’ at­tor­ney, Ted Mead­ows of Mont­gomery, Alabama.

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