The use of intimate care products, particularly those containing talc, like genital powders and douching, has been investigated for potential health risks, including an increased risk of ovarian cancer. Genital powders have been popular for maintaining dryness and freshness, but studies suggest that talc particles from these powders can travel through the reproductive system to the ovaries, potentially causing inflammation and contributing to cancer development. The International Agency for Research on Cancer classifies talc-based body powder as "possibly carcinogenic to humans" when used in the genital area.
The relationship between intimate care products, particularly genital powders and douching, and ovarian cancer risk has been studied extensively, though findings have been inconsistent. Pooled analyses of case-control studies have shown a 24%-32% increased risk of ovarian cancer for women who have ever used genital powder compared to those who have never used it. However, cohort studies have provided more ambiguous results.
In a recent editorial published in Journal of Clinical Oncology, Dr. Holly Harris and her colleagues discuss a recent article by O'Brien et al., in which the researchers employ various methodologies to address the potential biases and misclassifications in studying the association between intimate care products and ovarian cancer risk within the Sister Study, a prospective cohort of sisters of women who have had breast cancer. O’Brien and colleagues used quantitative bias analysis to examine different exposure reporting scenarios and reclassify exposures to address recall bias. The study also examined the impact of exposure during different life periods and explored the associations between intimate care products and other hormone-associated cancers, such as uterine and breast cancers.
After adjusting for potential biases, O'Brien et al. found a significant increase in ovarian cancer risk associated with genital powder use, with the strongest associations observed during the 20s and 30s. This finding suggests that early adulthood is a critical period for the risks associated with intimate care product exposure.
The editorial underscores the challenges in studying intimate product use and ovarian cancer risk, exacerbated by media coverage and lawsuits linking talcum powder to cancer. This coverage may influence reporting, as those aware of potential risks might over-reporting use, while those unaware might under-report, skewing results. Despite these challenges, O’Brien et al.'s analysis suggests that even with considerable misclassification, a significant association remains, supporting the plausibility of a true link between genital powder use and ovarian cancer.
Additionally, this study extends the sparse literature on the risks of uterine and breast cancers associated with intimate care products, finding no significant association. The lack of association with uterine cancer, despite both being gynecologic cancers, provides additional evidence that recall bias does not fully explain the relationship between genital powder use and ovarian cancer.
The editorial also noted one limitation: the rarity of ovarian cancer, which limits the power to examine associations by ovarian cancer histotype in prospective cohorts. Nonetheless, the study reports stronger associations for the serous histotype, consistent with previous studies. Serous ovarian cancer is the most common and one of the most fatal histotypes, with fewer identified risk factors compared to other histotypes, like endometrioid cancer. These results suggest that genital powder use and douching may be modifiable risk factors, providing some insight into the underlying etiology for this histotype.
Given that genital powder use and douching are modifiable risk factors, the editorial concludes by emphasizing the importance of informing those at risk, particularly those in their 20s and 30s, about the potential risks of using genital powders and douching. Primary care providers and gynecologists should address the potential risks of routine genital powder use and douching with their patients, considering the motivations behind intimate product use to more effectively influence behavior change. This proactive approach is crucial for reducing the risk of ovarian cancer and improving overall women's health.
This research was supported by Aspira (Inst).
Harris, H. R., Davis, C. P., & Terry, K. L. (2024). Epidemiologic Methods to Advance Our Understanding of Ovarian Cancer Risk. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 42(22), 2619–2621.