On Monday, a jury in Missouri hit Johnson & Johnson with a $55 million verdict in favor of a woman who developed ovarian cancer after decades of using talc baby powder in her vaginal area as part of her normal routine. Younger readers might find this practice unusual, but this was commonly recommended and encouraged through advertisements with slogans like, “just a sprinkle a day keeps odor away.” To this day, Johnson & Johnson still doesn’t warn against use in the vaginal area, and instead continues to encourage adults to use it all over their bodies, because it “gives a cooling sensation, and helps to prevent chafing.”

 

The case was the second such huge verdict this year, following a $72 million verdict in February. But this verdict is in many ways a better indicator of the strength of these lawsuits: this case was selected for trial by the defendants, apparently based on the belief that the woman’s pre-existing endometriosis would absolve Johnson & Johnson. As the defense lawyer told the jury:

 

“The fact is, endometriosis is a recognized, significant risk factor for ovarian cancer,” she said. “It’s highly unlikely [that] Mrs. Ristesund would have had ovarian cancer if she had not had endometriosis. In fact, there’s no proof, none, that she wouldn’t have had ovarian cancer had she not used talc. None.”

 

Afterwards, another of Johnson & Johnson’s lawyers told the press: “The scientific reality is that cosmetic talc does not cause cancer.” This statement isn’t true, but I’ll get to that in a moment.

 

First, let’s take a moment to consider why Johnson & Johnson claims endometriosis is a “recognized, significant risk factor for ovarian cancer.” The leading study on the link between endometriosis and ovarian cancer was published in 2012, and it found, among women who had endometriosis:

 

  • Three times the risk of clear-cell ovarian cancer
  • Two times the risk of low-grade serous ovarian cancer
  • Two times the risk endometrioid invasive ovarian cancer
  • No association with mucinous ovarian cancer
  • No association with high-grade serous ovarian cancer

 

So, this study linked endometriosis to clear-cell, low-grade serous, and endometrioid invasive ovarian cancer, but not to mucinous and high-grade serous ovarian cancer.

 

These differences are important, because research has shown that low-grade and high-grade serous ovarian cancer “are fundamentally different tumor types, and consequently, different diseases.” In fact, “high-grade serous tumors differ from all other ovarian carcinomas in terms of their development, prognosis, pathologic findings, and underlying genetic alterations.” And as the National Cancer Institute says, the most common type of ovarian cancer is high-grade serous cancer, which is not associated with endometriosis.

 

Which makes me wonder: what was Johnson & Johnson trying to say? When it comes to the most common type of ovarian cancer, the high-grade serous cancer, the epidemiological research shows endometriosis doesn’t increase the risk of ovarian cancer. That’s hardly a “recognized, significant risk factor for ovarian cancer,” despite Johnson & Johnson’s assertion.

 

What has been shown to be a significant risk factor for ovarian cancer, however, is talcum powder.

 

Way back in 1982, a case-control study published in Cancer found women who “regularly used talc either as a dusting powder on the perineum or on sanitary napkins” were 1.92 times (or, 92%) more likely to develop ovarian cancer. More than two dozen studies have been performed since then, and virtually all of them showed an elevated risk of ovarian cancer in women using talcum powder. For example, in 1997, a study published in the American Journal of Epidemiology found “women with a history of perineal dusting” were 1.6 times (60%) more likely to develop ovarian cancer. In 2008, a meta-study in the Journal of Epidemiology & Community Health pooled together over 20 studies and found a 35% increase in the risk of ovarian cancer in women who used talc powder.

 

Maybe you’re thinking a 35% increase in the risk isn’t a big deal, that it could somehow be a statistical mirage, the result of pure chance across 20+ scientific studies. Certainly, that’s Johnson & Johnson’s position, considering their lawyer’s claim that “[t]he scientific reality is that cosmetic talc does not cause cancer.” Consider this: second hand smoking around children increases the child’s risk of developing lung cancer by 30%. But few people doubt that link, because your nose tells you that the effects of smoking extend beyond the actual smoker.

 

With baby powder, it’s different. It smells clean and produces a cooling sensation. There’s no obvious sensory indication that will tell you that talc travels through the body to pelvic lymph nodes. There’s no way to notice that talc will reduce anti-MUC1 antibodies, which play a role in fighting MUC1-expressing cancers, like ovarian cancer. But the science is there nonetheless.

 

The question is, when will Johnson & Johnson start listening to the scientists and to the juries?

 

 

 

 

 

  • Colin

    Scientific American had an article on Feb. 26, 2016 that said the studies showing a causal link are less rigorous than the ones showing no link. It also mentioned that the International Agency for Research on Cancer categorizes it as a “possibly carcinogenic to humans,” along with coffee and aloe vera.

    I haven’t read the actual studies, but it seems that the issue is, at the very least, much less definitive than you make it sound.

    • I read the Scientific American article​ when writing my post and I was unimpressed.

      They ignored the 20+ case-control studies and based their entire argument on two cohort studies, which themselves retroactively used data from the Nurses’ Health Study and the Women’s Health Initiative. The article is correct that, when all things are equal, a prospective cohort study provides better answers than a case-control study, but all things aren’t equal here. Neither of those cohort studies were designed to look at a link between talc and ovarian cancer, and so neither collected good data. This problem was already discussed in the Journal of the National Cancer Institute, which said:

      The amount of talc applied or making contact with the ovary may vary substantially by mode of application. Particularly the cohort studies suffer from very limited exposure information: The Nurses’ Health Study which previously reported on talc use collected only information on frequency of talc use per week (11), whereas the Women’s Health Initiative (7) only collected information on duration of use, not on frequency.

      Scientific American didn’t mention that. Yet, despite these limitations, one of those same studies showed an increase in serous ovarian cancer, the most common type, a result Scientific American admits, then pretends doesn’t matter because it was “modest.” When even “very limited exposure information” shows a “modest” link, that’s further confirmation of a problem.

      But the worst error was claiming Dr. Daniel Cramer is “a paid consultant for plaintiffs attorneys in the trial against J&J.” He became an expert witness after decades of publishing peer-reviewed research showing this link. It’s hardly a strike against his credibility that, after years of being the foremost expert on this subject, the plaintiffs paid him to testify about the same conclusions at trial. There’s no other way to get his testimony into the case because there’s no way to subpoena an expert witness, you have to pay them to testify.

      People can quibble about whether they personally think that increasing the risk of cancer by a third is a big deal or not. But that’s their personal choice. The truth is, the link has been established over and over again, and there’s no good reason why Johnson & Johnson hasn’t warned about that link. Their own internal documents show they’ve known about the link since at least 1986.