Lawsuits Over Baby Powder Raise Questions About Cancer Risk
Deane Berg thought she was going to die, and she wanted to know why. She was 49, way too young, she thought, to have advanced cancer in her ovaries.
As she scrolled through websites that listed possible causes of ovarian cancer, one jumped out at her: talcum powder. She did not have risk factors like infertility or endometriosis, but she had dusted baby powder between her legs every day for 30 years.
“I went into the bathroom, I grabbed my Johnson’s Baby Powder and threw it in the wastebasket,” recalled Ms. Berg, now 59, a physician assistant in Sioux Falls, S.D. “I said, ‘What else could it be?’”
Ms. Berg was the first of thousands of women with ovarian cancer to file a lawsuit against the consumer products giant Johnson & Johnson, claiming that Baby Powder caused their disease and pointing to a long trail of studies linking talc to the cancer. The research dates to 1971, when scientists in Wales discovered particles of talc embedded in ovarian and cervical tumors.Since then, numerous studies have linked genital talc use to ovarian cancer, including a report earlier this month that among African-American women, genital use of powder is linked with a 44 percent increased risk for invasive epithelial ovarian cancer.
Johnson & Johnson says its trademark Baby Powder is safe, and it plans to appeal two multimillion dollar jury awards, including $55 million in damages awarded to a cancer survivor earlier this month and a $72 million award in February.
The International Agency for Research on Cancer in 2006 classified talcum powder as a possible human carcinogen if used in the female genital area. But the agency, part of the World Health Organization, has also said pickled vegetables and coffee are possible carcinogens and that hot dogs cause cancer.
2006年，国际癌症研究组织(The International Agency for Research on Cancer)把爽身粉归类为如在女性生殖器区域使用则有可能致癌的物质。但是这家从属于世界卫生组织的机构也称，腌菜和咖啡也是可能的致癌物，而且热狗也能致癌。
Johnson & Johnson says research implicating talcum powder is flawed and points to studies that absolve talc of any cancer risk.
“We have children ourselves,” said Tara Glasgow, the research and development lead for the company’s baby products franchise worldwide. “We would never sell a product we didn’t believe was safe.”
So did the juries get it right or wrong? Is it plausible that Johnson’s Baby Powder — that clean-smelling soft stuff that’s a medicine cabinet staple, packaged in milky-white containers and supposedly mild enough for babies’ bottom — can cause cancer?
It’s not an easy question to answer.
“There is no way we’re ever going to know for certain that any exposure is necessarily causal to a disease,” said Dr. Shelley Tworoger, an associate professor of medicine and epidemiology at Brigham and Women’s Hospital and Harvard. “We might be 99 percent sure,” in some cases, she said, “but there’s usually no way to guarantee that what you see is actually the truth.”
“我们永远无法确定，暴露在某种物质之下一定会导致某种疾病，”布里格姆妇科医院(Brigham and Women’s Hospital)与哈佛大学的医药与流行病学副教授雪莉·特沃鲁格医生(Dr. Shelley Tworoger)说。她说，在某些情况下，“我们或许可以做到99%肯定，但通常没有方法保证你看到的一定是真相”。
Cancer is hard to study because it develops over a long period of time and is influenced by many factors, including genes, behaviors and environmental exposures. The best we can do, Dr. Tworoger said, “is look at the preponderance of the evidence.”
Talc is a naturally occurring clay mineral composed of magnesium and silicon. Known for its softness, it is used in cosmetic products like blush because it absorbs moisture and prevents caking. It is also an additive in tablets, chewing gum and some rice. It’s often mined in proximity to asbestos, a known carcinogen, and manufacturers have to take steps to avoid contamination. Many women use the powder on their inner thighs to prevent chafing, while others sprinkle it on their perineum, sanitary pads or underwear to stay “fresh” and dry. A 1980s ad campaign for a once-popular powder promised with a catchy jingle that “a sprinkle a day helps keep odor away.”
There has never been an experiment to see what happens when you deliberately expose women to talcum powder — for practical and ethical reasons, there never will be — so scientists must rely on observational studies that can link an exposure to a disease but cannot determine a cause-and-effect relationship.
In 1982, a Harvard professor, Dr. Daniel W. Cramer, and his colleagues compared 215 women with ovarian cancer and 215 healthy women who served as a control group. Compared with nonusers, women who used talcum powder were at nearly twice the risk for having ovarian cancer, and those who used it regularly on their genitals and sanitary pads were at more than three times the relative risk.
1982年，哈佛大学教授丹尼尔·W·克拉默(Dr. Daniel W. Cramer)与同事们对比了215个患有卵巢癌的女性与作为对照组的215名健康女性。研究表明，使用滑石粉的女性罹患卵巢癌的风险几乎是不使用滑石粉的女性的两倍。经常在会阴部和卫生垫上使用滑石粉的女性罹患卵巢癌的风险则是对照组的三倍多。
At least 10 subsequent studies echoed the results, with varying degrees of increased risk. But a small number of studies did not find a heightened risk for talc users.
When researchers pooled the results of similar studies involving nearly 20,000 women, they found powder use was associated with a 24 percent increased risk for ovarian cancer, an uncommon disease but one that is often fatal. If the finding is true, it means that for every five or six talcum powder users who develop ovarian cancer, one may be a result of talcum powder use, Dr. Steven A. Narod, an expert in cancer genetics from Toronto, said.
研究者把涉及近2万名女性的类似研究的结果汇总起来，发现滑石粉的使用与卵巢癌风险上升24%存在关联。卵巢癌并不是一种常见疾病，但通常是致命的。如果这项发现是真实的，那么它意味着每五到六名使用滑石粉的卵巢癌患者中，就有一人是由于使用滑石粉而罹患这种疾病，多伦多癌症基因学专家史蒂文·A·纳洛德(Steven A. Narod)说。
Why talc use might lead to cancer is not clear. Studies have shown that talc crystals can move up the genitourinary tract into the peritoneal cavity, where the ovaries are. Indeed, a pathology report on Ms. Berg’s tumor found talc particles embedded in the tissue.
There is also a plausible mechanism, Dr. Tworoger said, because talc particles can set off inflammation, and inflammation is believed to play an important role in the development of ovarian cancer
Although Johnson & Johnson’s talc supplier added warning labels in 2006, J&J did not add similar warnings to its products, according to litigation documents. Baby powder does carry a warning to keep it out of the reach of children and many pediatricians discourage its use on babies, who can become ill or die after breathing in the particles. Inhalation studies in female rats demonstrated carcinogenicity, according to the National Toxicology Program. Condom and surgical glove makers have stopped dusting their products with talc.
尽管强生公司的滑石粉供应商在2006年开始增添警示标志，但是法律文件表明，强生公司并没有在自己的产品上增添类似标识。它的婴儿爽身粉上的确有警示标识，告知用户将产品放在儿童拿不到的地方。许多儿科医生也不推荐给婴儿使用婴儿爽身粉，因为如果吸入颗粒，可能导致生病或死亡。根据国家毒理学计划(National Toxicology Program)所做的研究，雌性大鼠吸入滑石粉会致癌。避孕套和外科手套制造商已经不再在产品上使用滑石粉。
“Talcum powder is an interesting case, because it’s not something that’s necessary,” said Dr. Anne McTiernan, an epidemiologist with the Fred Hutchinson Cancer Research Center in Seattle. “If there’s any doubt, why should anyone use it?”
“滑石粉是个有趣的案例，因为它并不是必需品，”西雅图弗莱德·哈钦森癌症研究中心的流行病学家安妮·麦克蒂尔南医生(Dr. Anne McTiernan)说，“如果人们对它有任何怀疑，那么为什么还要继续使用？”
As for Ms. Berg — the Sioux Falls woman with advanced ovarian cancer — she won her lawsuit against Johnson & Johnson, but the jury did not award damages. She hopes other talc lawsuits will raise awareness.
“I knew nothing about this before,” she said. “I figured baby powder is for babies, it must be safe.”