title: The Association Between Talc Use and Ovarian Cancer: A Retrospective Case-Control Study in Two US States.
abstract: BACKGROUND
  Multiple studies of ovarian cancer and genital talc use have led only to consensus about possible carcinogenicity. Seeking greater clarity, we examined this association in 2,041 cases with epithelial ovarian cancer and 2,100 age- and-residence-matched controls.
  
  
  METHODS
  We defined genital talc use as regular application to the genital/rectal area directly, on sanitary napkins, tampons, or underwear. To estimate "talc-years," we multiplied applications per year by years used. Unconditional logistic regression, Wald statistics, likelihood-ratio tests, and polytomous logistic regression were used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI), trends, effect-modification, and heterogeneity by ovarian cancer histologic subtype.
  
  
  RESULTS
  Overall, genital talc use was associated with an OR (95% CI) of 1.33 (1.16, 1.52), with a trend for increasing risk by talc-years. Women who used talc were more likely to be older, heavier, asthma sufferers, and regular analgesic users--none of which was a confounder. Dose-responses were more apparent for premenopausal women, especially nonsmokers and those heavier or postmenopausal users of menopausal hormones (hormone therapy [HT]). Subtypes of ovarian cancer more likely to be associated with talc included invasive serous and endometrioid tumors and borderline serous and mucinous tumors. Premenopausal women and postmenopausal HT users with these subtypes who had accumulated >24 talc-years had ORs (95% CI) of 2.33 (1.32, 4.12) and 2.57 (1.51, 4.36), respectively.
  
  
  CONCLUSIONS
  Risks for epithelial ovarian cancer from genital talc use vary by histologic subtype, menopausal status at diagnosis, HT use, weight, and smoking. These observations suggest that estrogen and/or prolactin may play a role via macrophage activity and inflammatory response to talc.
authors.affiliation: From the aObstetrics and Gynecology Epidemiology Center, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; bDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; cDepartment of Pathology, Brigham and Women's Hospital, Boston, MA; and dDepartment of Community & Family Medicine, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Cramer
authors.forename: Allison F
authors.initials: AF
authors.lastname: Vitonis
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Terry
authors.forename: William R
authors.initials: WR
authors.lastname: Welch
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Titus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000453:epidemiology*; D000077216:Carcinoma, Ovarian Epithelial; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005836:Genitalia, Female; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000453:epidemiology*; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology*; D009513:New Hampshire / Q000453:epidemiology; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000453:epidemiology*; D017698:Postmenopause; D012189:Retrospective Studies; D012307:Risk Factors; D013627:Talc / Q000627:therapeutic use*; D013997:Time Factors; D055815:Young Adult
chemical_list: D013627:Talc