Document 15vrQZmMdYNekgRqkgGNV2Gym

FILE NAME Talc TALC DATE 1977 June 25 DOC TALC139 DOCUMENT DESCRIPTION Medical Journal Article - Cosmetic Talc Powder 1348 THE LANCET JUNE 25 1977 subjects whether manifest in the fasting or in the stimulated state is independent of coexisting obesity and glu- cose intolerance although both are often contributory factors Which is chicken and which is egg is unresolved but experimental evidence favours a causal role for hyperinsulinemia continued administration of insulin to animals in optimal doses can give rise to histological and biochemical lesions resembling those of human atheroma,,and insulin encourages the synthesis of cholesterol and other lipids by arterial tissue both in vivo and in vitro Of the many factors known to cause exaggerated insulin secretion some such as obesity and high sucrose consumption have been implicated on epidemiological grounds in the pathogenesis of ath- erosclerosis whilst others such as increased consumption of sugary alcoholic drinks have so far not been Con- versely certain types of vegetable fibre the exclusion from the diet of which have been claimed to increase the risk of atheroma reduce the immediate and overall in- sulin secretory response to ingested carbohydrate19 with- out adversely affecting glucose tolerance The role of the insulinotropic gastrointestinal hormones in providing the link between composition of the diet and the hyper- insulin^mia of atherosclerosis is undetermined and awaits investigation by the newer methods of measuring them in blood COSMETIC TALC POWDER FROM time immemorial man like his evolutionary predecessors has been exposed to airborne dusts Such exposure is a corollary of living and survival Not unexpectedly therefore the lungs have efficient means of clearing themselves of inhaled particles and a functional reserve such that the accumulation of uncleared dust may be considerable before there is any obvious loss of capacity However it has long been recognised that heavy exposure to dusts such as quartz and asbestos may lead to loss of function and in the case of asbestos to cancer of the pleura and of the lung itself The observation that even casual exposure to asbestos may be associated with increased risk of mesothelioma now occurring at the rate of nearly 200 new cases a year in the United Kingdom has brought into question the safety of other common dusts such as cosmetic talc There are two main concerns Firstly will inhalation of a dust cause loss of function through fibrosis or emphysema And secondly will it predispose to cancer 10. Sloane J. M. Mackay J. S. Sheridan B. ibid 1970 11 586 11. Kaskyap M. L. Magill F. Rojas L. Hoffman M. M. Can med Ass J. 1970 102 1165 .. 12. Stout R. W. Bierman E. L. Brunzell J. D. in Diabetes its Physiological and Biochemical Basis edited by J. Vallance Lancaster 1977 J. 13. Stout R. W. Br med 1970 i685 14 Stout R. W. Lancet 1969 ii 467 15. Stout R. W. Buchanan K. D. Vallance J. Atherosclerosis 1973 18 153 : 16. Szanto S , Yudkin J. Postgrad med J. 1969 45 602 17. O'Keefe S. J. D. Marks V. Lancet June 18 1977 p 1286 18 Cleave T. L. The Saccharine Disease Bristol 1974 19. Jenkins D. J. A. Goff D. V. Leeds A. R. Alberti K. G. M. M. Wolever T. M. S. Gassull M. A. Hockaday T. D. Lancet 1976 ii 172 1 Greenberg M. Lloyd Davies T. A. Br J. ind Med 1974 31 91 Although talc can cause granulomas when introduced into the tissues or body cavities exposure to cosmetic talc has been widely assumed not to predispose to pulmonary fibrosis However the fact that no association has been seen between the use of talc and loss of lung function might simply reflect the lack of methods sensi- tive enough to detect losses of function that are small compared with those due for example to smoking and to heterogeneity in antritypsin status For similar rea- sons any effect of talc exposure on cancer incidence would probably escape notice unless deliberately sought Until lately facilities for studying the term effects of inhalation of dusts in laboratory animals have been scarce and even now the predictive value of animal models is questionable Thus even in the case of tobacco smoke where the cancer hazard to man is indisputable duplication of the effect by the inhalation route in laboratory animals has proved difficult or impossible although inhaled asbestos dust has given positive results in animals.4 The possibility that talc causes cancer dramatically hit the headlines of the daily Press when workers in Car- diff reported finding talc particles in cancers of the ovary and uterine cervix The report was greeted with scepticism because the particles were not positively identified as talc because their presence did not prove causation and because they might have found their way onto the sections as a result of contamination of tissues after removal from the body Subsequent mineral analysis failed to confirm that the particles were talc and the passage of six years without publication of confirmatory evidence suggests that the early scepticism was wellfounded A meeting of powder manufacturers and independent scientists took place at Cardiff during May 1976 under the chairmanship of Dr J. C. Gilson direc- tor of the Medical Research Council Pneumoconiosis _ Unit At that meeting the toxicology of talc was reviewed and the need for further information discussed Assessment of toxicity necessarily starts with a consideration of the physical and chemical specifications of the test material and this unfortunately is also where much of the assessment ends in the case of cosmetic talc because most of the published epidemiological clinical and experimental exposure either to industrial talcs that are variously contaminated with minerals known to be hazardous or to talc of undefined physical and chemical characteristics The long thin fibrous shape of asbestos particles enables them to be carried more deeply into the lungs than spherical particles of similar mass The fact that the normally effective clearance mechanisms have difficulty in coping with large long thin particles deposited deeply in the lungs is an important determinant of the hazards from asbestos dust Geologically talc which is nominally a hydrated magnesium silicate and certain amphiboles actinolite and anthophyllite occur in juxtaposition and consequently talc may be contaminated with these minerals Apart 2. Bluemel G. Piza F. Konorsa W. Wien klin Wschr 1962 12 3. Davis B. R. Whitehead J. K. Gill M. E. Lee P. N. Butterworth A D J. Roe F. J C. Br Cancer 1975 31,469 31,469 4. Wagner J. C. Berry G. Skidmore J W. Timbrell V. ibid 1974 29 252 5. Henderson W. J. Joslin C. A. F. Turnbull A C. Griffiths K. J Obstet Gynec Br Commonw 1971 78 266 6. Hildick Y. BrJ Ind Med 1976 33 217 THE LANCET JUNE 25 1977 1349 from this talc may contain chlorite quartz carbonates such as calcite dolomite and magnesite and occasionally other minerals in lesser amounts During the past few years major cosmetic manufacturers in the United Kingdom and the United States of America as represented by the Toilet Preparations Federation and the Cosmetic Toiletry and Fragrance Association have drawn up specifications for cosmetic talc which ensure the virtual absence of fibrous amphiboles At present there is no direct statutory control of the quality of cosmetic talc in any country and it is questionable whether such control is necessary to bring minor manufacturers into line with the standards now adopted by the major firms The presence of fibrous particles in talc reduces its free flow and lubricity thereby rendering it less cosmetically desirable Such contamination is thus limited More important however is the fact that the fibrous materials most likely to contaminate talcs which do not comply with the specifications tremolite anthophyllite and actinolite not those most clearly associated with carcinogenic hazard crocidolite amosite and chrysotile Furthermore it would be sensible to consider what controls if any are necessary for talc as used in medicines before introducing legislation specifically in relation to cosmetic talc If the inhalation of particles of amphibole and silica contaminated talc dust were found to be harmless one might reasonably assume that talc free from these materials is safe Kleinfeld and his colleagues have studied the incidence of cancer and respiratory diseases in talc miners and millers in New York State The talc con- cerned which is heavily contaminated with both amphiboles and free silica was initially reported to be associated with an increased mortality from mesothelioma and cor pulmonale Later the same workers reported that men employed in the mine after dust levels had been reduced had death from malignant diseases that were similar to those for White males in the U.S.A. generally Also in the U.S.A. Fine and his colleagues,, have reported a higher prevalence of productive cough and chronic obstructive lung disease among rubber workers exposed to a fibrous industrial talc than among control workers From their data they calculated that a safe exposure level would be provided by a threshold limit value of 0.25 mg respirable particulate talc In Italy Rubino and his colleagues compared the spectra of causes of death among talc miners talc millers and agricultural workers The talc miners were exposed to dusts containing % silica at levels far in excess of threshold limit value Significantly more of them than of the controls died from respiratory disease but death from all forms of cancer includ- ing lung cancer were significantly lower among the 7. Toilet Preparations Federation Ltd. specification no 12 Cosmetic Talc 1977 C. A Specification Talc Cosmetic Cosmetic Toiletry and Fragrance Association Inc , issue 10-7.1976 10-7.1976 9. Toilet Preparations Federation Ltd. analytical method 77 Cosmetic Talc 1977 10 Hamer D. H 296 Rolle F. R. Schelz J. P. Am ind Hyg Ass J. 1976 37 11 Kleinfeld M. Messite J. Kooyman O. Zak~-M. H. Archs envir Hlth 1967,14,663 1967,14,663 1967,14,663 H.J. 12. Kleinfeld M. Messite J. Zaki M. H.J. occup Med 1974 16 345 13 Fine L. J. Peters J M. Burgess W. A. Di Beradinis L. J. Archs envir Hlth 1976 31 195 14. Rubino G , Scansetti G. Piolatto G , Romano C. J. occup Med 1976 18 186 miners among the controls By contrast among the talc millers exposed to dusts containing 0.05 silica but no detectable asbestos at concentrations of 20 mil- lion particles per cubic foot 27 litres there was no excess of deaths from pulmonary disease or cancer of any site compared with the control group The deficit of lung cancer among the talc miners plausible in so far as a similar deficit of lung cancer among coal miners seems to be real A continuing study of over 3200 persons mainly women at a factory in Britain where cos- " metic talc has been made and packed for over fifty years has so far revealed no evidence of health hazard but follow would need to be extended for at least a result further decade before one could be confident of a nega- tive Other less informative epidemiological stu- dies are reviewed by Hildick : In most of the work in animals the quality of the talc has not been specified An exception is a report by Wehner and others who studied the effects in hamsters of repeated exposure to aerosols of cosmetic talc up to total doses of respirable particles equal to nearly 2000 times those received by humans using cosmetic talc dur- ing baby care Exposure had no adverse effect on body- weight survival incidence of pathological changes in the respiratory tract or incidence of neoplasia at any site Another exception is the report by Wagner and his colleagues who saw no mesotheliomas in 48 rats after intrapleural administration of cosmetic talc whereas 18 out of 48 rats similarly exposed to chrysotile asbestos acquired such tumours The same workers exposed rats to cosmetic talc by the inhalation route on five days a week for up to a year At the highest level of exposure -about three times that studied by Wehner and his col- leagues was slightly more pulmonary fibrosis than in controls but no substantial excess of pulmonary neoplasms A number of less relevant animal studies all of which gave negative results for carcinogenicity are reviewed by Hildick In summary there is no reason to believe that normal consumer exposure to cosmetic talc has in the past led either to cancer at any site or to measurable loss of lung function It seems unlikely that future exposure to cosmetic tale of the specifications now agreed to by major manufacturers will present a health hazard H^ MOPHILUSENDOCARDITIS H^mophilusendocarditis is rare Until lately the published reports were small and conflicting now three substantial and independent investigations have been reported from the United States 15. Goldman K. P. Br J. ind Med 1967 22 72 16. Newhouse M. L. Miller B. F. Moore W. K. S. Paper given at seminar on Biology of Talc Used in Health Products Cardiff May 1976 17. Wehner A. P. Zwickei G. M. Cannon W. C. Watson C. R. Carlton W. Fd Cosmet Tox 1977 15 121 Skidmore 18. Wagner J. C. Berry G. Cooke T. J. Hill R. J. J. W. in Pro- ceedings of Fourth International Symposium on Inhaled Particles and Vapour Oxford 1977 1. Geraci J. E. Wilkowske C. J. Wilson W. R. Washington J. A. Mayo Clin Proc 1977 52 209 2. Chunn C. J. Jones S. R. McCutchan J. A. Young E. J. Gilbert D. N. Medicine Baltimore 1977 56 99 3. Lynn D J. Kane J. G. Parker R. H. ibid 1977 56 115