Sep 13, 2018
Can talcum powder cause ovarian cancer? Dr. Louis Dainty discusses why he recommends women not use the product on their genital area.
Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.
Host: Thanks for joining us today. We’re talking to Dr. Louis Dainty, Regional Director of Gynecologic Oncology at MedStar Washington Hospital Center. Welcome, Dr. Dainty.
Dr. Dainty: Thank you. It’s great to be here.
Host: Why don’t we begin by telling us a little bit about yourself. Why did you go into medicine, and how did you come to be at MedStar Washington Hospital Center?
Dr. Dainty: My interest in medicine began as a, as a kid. I knew I wanted to be a doctor and going the long way to get there, I went in the military, went to medical school after spending some time in infantry and just retired from the military a physician after 26 years just last year.
Host: What led you into women’s health and women’s oncology?
Dr. Dainty: I fell in love with women’s health as soon as I rotated on my OBGYN rotation as a medical student. Initially I thought I was going to be interested in orthopedics but then it was much easier working with women—they were a lot tougher than men.
Host: Today we are talking about ovarian cancer and talcum powder, or baby powder. So, a jury in August 2017 awarded a woman $417 million in a case against Johnson and Johnson. The woman claimed that her terminal ovarian cancer was caused by the company’s baby powder, which she said she’d used for decades. And this isn’t the first time that talcum powder has been blamed for causing ovarian cancer. So, Dr. Dainty, what does science say about whether baby powder can cause ovarian cancer?
Dr. Dainty: The first concern about the possible link between the use of talcum powder and ovarian cancer dates back to 1960s, and that sprung from the initial contamination of talcum powder with asbestos. For some time now, there hasn’t been any asbestos in talcum powder, but still the question remained whether or not there was an association between the use of talcum powder on a female perineum and risk of developing ovarian cancer. The data has been studied, mostly not in a prospective manner but in an observation manner, and the data is mixed—most studies showing that there is no association between the use of talcum powder and ovarian cancer, and others showing that there is a small increased risk of ovarian cancer with the use of talcum powder. When scientists have gone back and looked at the data in total, it seems that statistically there is a very small increased risk of ovarian cancer with the use of talcum powder on the perineum, with specifically a single type of ovarian cancer, and that’s the most common type which is papillary serous carcinoma of the ovary.
Host: What do the studies suggest about a woman’s risk for developing ovarian cancer if she’s used talcum powder?
Dr. Dainty: Your lifetime risk of developing ovarian cancer is about 1.6 percent of all women, so slightly less than two women out of 100 will get ovarian cancer during their life. And the majority of women die from that cancer because it usually doesn’t present until it’s very advanced. Some of the studies suggest slight increase of a risk of ovarian cancer where, if the baseline risk was 1.6 percent, some studies have shown that it might be as high as 1.8 percent. Now that doesn’t sound like it’s a lot, but instead of 14 women out of a thousand, 16 women out of a thousand would develop ovarian cancer. So those two additional women would certainly not feel that that’s not a significant increased risk from talcum powder. So, while statistically it seems like a very small increase, anything we can try to do to try to decrease your risk of developing ovarian cancer, especially something as simple as not applying talcum powder to your bottom, is worth the effort.
Host: So, would it be fair to say that you do recommend that women who use talcum powder stop doing so, or use it less frequently?
Dr. Dainty: Yeah, I would recommend that they don’t apply it directly to their perineum because the vagina is interesting in that there is a communication, obviously, physiologic communication, between the outside world and the inside of your body by means of the vagina and the cervix. And so, in theory, talcum powder could be transported from outside of your body into your vagina and up through your cervix because that’s where sperm travel. Talcum powder certainly also could be transported that way, physiologically. So, yes, I’m recommending that if you’re going to use talcum powder that you use it sparingly around your bottom and not apply it directly to your perineum or your vagina. Cornstarch, without any other additives, seems to do some of the same functions as talcum powder without, the, any obvious risks or any clear association between risk and, so if you have to use something, maybe a more natural subject like cornstarch would do. But again, so just avoid using talcum powder.
Host: Why do women use talc in these areas, and are there certain groups of women who use it more often?
Dr. Dainty: Historically, generations past, I think that a lot of women were taught to put a sanitary pad on, and prior to application of the sanitary pad on their vaginas, they would put talcum powder just to absorb moisture and to also combat bad smell. I think a lot of women, especially older women, grew up doing that. I think younger women, there’s very few women that do that anymore. And so, that’s why people started using talcum powder in the first place.
Host: And when you say that it affects the perineum of the woman, could you explain what that body part is, for individuals who might not know.
Dr. Dainty: So, the perineum is anything, the vagina, the labia, external genitalia basically, between your thighs, from your pubic bone down to your anus.
Host: Are there other products a woman may use, internally or externally, such as petroleum jelly, that may raise her risk for ovarian cancer?
Dr. Dainty: Yeah, that’s an interesting question and the bottom line is there is no evidence to date that there is any increased risk with those, at least not that I am aware of, but you bring up a good point—any petroleum-based product that’s applied to your perineum could have, theoretically have, a risk. The bottom line is what I tell most of my patients is when people ask me, you know, “should I use douching or anything like that,” I say “no” and basically that God designed the vagina just the way it’s supposed to be and you shouldn’t mess with that—mess with it as little as possible. So, I don’t recommend using any foreign products, that are artificial products, that you don’t have to. Obviously, people that need artificial lubricant in order have comfortable intercourse, the products with the least number of additives, either color or perfumes or anything like that, are, are, going to be the safest.
Host: Is it safe to use baby powder on a baby’s bottom?
Dr. Dainty: We don’t know what that risk is, but certainly the use of baby powder for babies is pretty common, and we don’t know whether or not that increases risk. It’d be hard—it’s hard to design a study where you take a hundred babies and expose half of them to talcum powder and the other half you hold back, so all you’re left with is recollection of whether or not a mother said that she used talcum powder on her baby’s bottom or not. So, it’s difficult to get at those kind of exposures through scientific investigation. If I had babies again, I would probably not use talcum powder on their bottoms.
Host: If you have a woman who’s used talcum powder for years or for decades, should she be concerned, or should she see her doctor more frequently?
Dr. Dainty: No. There is no—there’s no call for alarm and there’s no call for increased testing or surveillance. There is no current routine screening that is recommended for the prevention or diagnosis of ovarian cancer in people that are at baseline risk. That means a lifetime risk of 1.6 percent, perhaps, in the United States. So, no, I wouldn’t say that anybody who has used talcum powder in the past should do anything different except maybe stop using talcum powder.
Host: When you’re talking about screening for ovarian cancer, there is really no great test, like mammography for breast cancer or pap smears for cervical cancer. What does screening look like, then, for ovarian cancer?
Dr. Dainty: There is no routine screening. As you just said, there is no routine screening for baseline risk, women at baseline risk for ovarian cancer. There are some screenings that we recommend for women who fall into the category of familial or hereditary ovarian cancer, which is a different topic altogether. But for the baseline-risk, general population, there is no routine screening. The only thing that, as an individual and/or a provider, that you may ask a patient to look for are symptoms. So, early satiety, bloating, increased abdominal girth, abdominal pain that occur more days than not—if that’s a new finding, that’s something you need to bring up to your OB GYN. And so that’s really the only screening that I would recommend for all folks.
Host: So, you alluded to this a little bit before. What are those main risk factors for ovarian cancer?
Dr. Dainty: Probably the biggest is age. So, the average age for ovarian cancer is about 63. So, the older you get, the higher risk you are of developing ovarian cancer. Obesity is the number one modifiable risk factor. If you are 25 pounds overweight, which we all are, you are at 400 percent risk of having endometrial cancer. So, we talk about talcum powder because it increases your risk by 20 percent, and being overweight by 25 pounds, you increase your risk by 400 percent. If you are 50 pounds or more overweight, the risk goes up to 10 times the baseline risk. Certainly—and let’s not even talk about smoking, right? So, yes, talcum powder is real, but it’s not, the data is not so strong. Certainly, the most common talked about risk of ovarian cancer is familial risk. Now, right now, familial risk accounts for maybe 15 or 20 percent of all ovarian cancers. So, most are sporadic or just happen spontaneously. Family history is certainly, though, very important. So, if you have other family members who have breast or ovarian cancers, especially those that have had those cancers prior to age 50, those are folks that may need to be referred to a geneticist for testing.
Host: Does that include both sides of your family—so my mother’s side of the family or my father’s—or does that run more prevalently in one or the other?
Dr. Dainty: No, it includes both sides. That’s an excellent point. It’s all first-degree relatives. So, if your father’s sister had ovarian cancer early or your father had breast cancer, that would be something that would be very concerning and something that would possibly warrant referral to see a geneticist.
Host: This has been very insightful and eye-opening so thank you again, Dr. Dainty, for joining us to discuss this very delicate but also very important women's health topic.
Dr. Dainty: I appreciate the invitation. Thank you.
Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.