Study Does Not Find Link Between Ovarian Cancer and Genital Powder Use

The largest study to date did not find a significant link overall between using powder in the genital area and ovarian cancer in women. However, because of the rarity of ovarian cancer, the study still may not have been large enough to detect a possible small increase in risk, according to the study authors.

For the study, published January 7, 2020 in the Journal of the American Medical Association, researchers from several major cancer institutes in the US looked at data from more than 250,000 women in 4 large, prospective studies: the Nurses’ Health Study, Nurses’ Health Study II, Sister Study, and Women’s Health Initiative Observational Study. The average age of the women was 57. Overall, 38% of the women reported using powder in the genital area, with long-term use (at least 20 years) in 10% and frequent use (at least once a week) in 22%.

During an average follow-up period of about 11 years, 2,168 women developed ovarian cancer, which translated to 58 cases per 100,000 person-years. There were 61 cases per 100,000 person-years among women who had ever used powder compared with 55 cases among women who had never used it. The researchers estimated the difference in ovarian cancer risk to be just 0.09% by age 70, which was not statistically significant. The researchers also found no significant differences between women who used powder frequently or long-term compared to women who didn’t use powder.

The researchers concluded, “In this analysis of pooled data from women in four US cohorts, there was not a statistically significant association between self-reported use of powder in the genital area and incident ovarian cancer. However, the study may have been underpowered to identify a small increase in risk.”

What are the concerns about talcum powder?

Most powder products used in the genital area contain the mineral talc. In its natural form some talc contains asbestos, which is known to cause lung cancer when inhaled. In 1976, the cosmetic and personal care products industry issued voluntary guidelines recommending that all talc used in cosmetic products in the US should be free from detectable amounts of asbestos, as measured by industry standards.

However, concerns have remained about a possible link between talcum powder used in the genital area and ovarian cancer. It has been suggested that the particles could travel through the vagina, uterus, and fallopian tubes to the ovaries, where it could cause inflammation that might lead to cancer.

Many studies have tried to determine whether there is a link between genital powder use and ovarian cancer. Findings have been mixed, with some studies reporting a slightly increased risk and some reporting no increase. The reliability of some of these studies has been called into question because they relied on women’s memories of using powder many years earlier. 

A word from our expert

Susan Gapstur, MPH, PhD, American Cancer Society Senior Vice President, Behavioral and Epidemiology Research, says the new study provides insight into the link between genital powder use and ovarian cancer risk, but it does not provide definitive evidence. She points out that while results showed no evidence of a statistically significant risk overall, some of the subgroup findings do suggest a possible link.

She says, “For example, among women who reported no history of tubal ligation or hysterectomy [that is, women who had an intact reproductive tract], ever-use was linked with a 13% higher risk compared to never-use. The risk was slightly stronger (19%) for women who used powder frequently. However, there was no increased risk of ovarian cancer associated with powder use for women without an intact reproductive tract, and the authors found that the associations between powder use and ovarian cancer risk did not differ statistically between these two subgroups of women. But this lack of statistical significance should be interpreted cautiously. It may be due to limited sample size to detect small differences in associations by subgroups.”

Gapstur also points out that the finding of a link between powder use and ovarian cancer risk among women with an intact reproductive system is consistent with the hypothesis that ovarian (and fallopian tube) cancer might be caused by particles that travel through the reproductive system, resulting in inflammation, oxidative stress, and DNA damage.

She concludes, “Unfortunately, it is unclear if there are forthcoming data from prospective studies to more adequately assess this link between genital powder use and ovarian cancer risk,” suggesting that new and ongoing studies should ask participants about body powder use to help close this information gap.