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FILE NAME Talc TALC DATE 1973 Feb DOC TALC048 DOCUMENT DESCRIPTION Journal Article - Talc- A Possible Occupational and Environmental Carcinogen Talc A Possible Occupational and Environmental Hector P. Blejer M.D. D.I.H. and Robert Arlon Pharm D. Carcinogen .# : Talc is mineralogically closely related to three of the five major asbestos group minerals specifically the serpentine Chrysotile as well as the first two of the amphiboles Anthophyllite Tremolite Amosite and Crocidolite In present some new conclusions about related possible health risks arising from occupational and environmental ex- posures to asbestos contaminated talcs than a mineral species It includes all gradations from the pure mineral to im- pure massive talcose rocks such as soapstone In fact some commercial talc deposits can contain a very small talc certain toxicological aspects talc and content with varying amounts of many asbestos are also closely related They are silicates which produce fibrosis of Definitions and Composition of Talc accessory minerals such as asbestos quartz and other impurities In the the lung and other tissues Talcs and the Pure talc and the three related United States for example the Saint asbestos minerals cited are magnesium silicates difficult hydrous to dif- asbestos group minerals are hydrous - magnesium silicates whose theoretical Lawrence County New York State commercial talc deposits contain 30 or less | ferentiate with special techniques such as electron microscopy with selected area diffraction which form in the same as well as similar geological processes Con- sequently many talc deposits contain asbestos minerals so that and commercial use such contain varying amounts in industrial talcs always of asbestos fibers Because of this asbestos con- tamination of talcs we reviewed data on 1 The composition of talc and related asbestos minerals 2 The toxic chemical formulae are True Talc Mg6 Si8 020 OH Anthophyllite Asbestos Chrysotile Asbestos Mg7 Si8 O22 OH 2 Mg6 Si4 010 OH Tremolite Asbestos Ca2 Mgs Si8 O22 OH Mineralogically there are two forms of talc Nonasbestiform also called platy or nonfibrous and Fibrous also called tremolitic As used commercially however the term talc connotes cer- tain desired physical properties rather of mineralogically pure talc The remainder consists partly of 1 Serpentine the host mineral of chrysotile antigorite and lizardite 2 Tremolite and An- thophyllite which can convert naturally to talc Although mineralogical im- purities the asbestos minerals are con- sidered in many cases as an integral part of such commercial talc whereas other mineralogical impurities such as hematite and pyrite are commercially unacceptable An example is that talcs effects of both substances 3 The | general environmental exposures to talc ;. and 4 Its common uses including those involving ingestion of talc- containing foods and drugs Ad- ditionally 5 Mineral residues from coated rice washings were analyzed for asbestos Then we evaluated such | data together with new findings on the asbestos contamination of coated polished white rice As a result we Dr Blejer is Medical Officer and Head Occupational Health Southern California Bureau of Oc- Epidemiology cupational Health and Environmental State of California Department of Public Health Los Medicine Angeles and Assistant Clinical Professor of School of Medicine University of Southern California Los Angeles Dr. Arlon is from Kaiser Foundation Hospitals Los Angeles Reprint requests to 1449 Temple St Suite 106 Los Angeles 90026 Dr. Blejer Presented in part at the 15th annual Western In- dustrial Health Conference San Francisco October 1 1971 92 Source Selikoff et al.6 7 * US data not available but figure should be only slightly less than 11.1 + US data not available but these are rare causes of death in the general population al for tiall puri talc ficu mos mac asb of F Hea eval asb All . pera type pot / asb bio still con me mo asb dec esp hav Wit plet pre res ple inje anc of 1 Seli am Joul reviewed recently and succinctly by Wagner.8 In addition inhaled asbestos particles retained in lung tissues can be covered with a proteinaceous coating which produces a type of ferruginous body commonly termed asbestos body Talc - As shown in Table 2 Kleinfeld et al ,,demonstrated that talc miners and millers in Northern New York State have 3.4 times an excess mortality from lung and pleural carcinomas Such ex- cess was shown to be statistically * After Kleinfeld et al.9 + Number of deaths in a group divided by total deaths in same group x 100 * Gastrointestinal tract $ Difference not statistically significant # Difference statistically significant p = < 0.01 | Statistical analysis not done due to small number in group significant and appeared 20 years later than among asbestos insulation workers The New York investigators ascribed this difference in part to talc being less carcinogenic than asbestos without con- sidering the fact that talc deposits in the for milling are often chosen preferentially on the basis of how much impurity is present apparently because talc with larger purer grains is more dif- ficult to mill Also of note is that the most recent revision of the US Phar- macopeiadoes not specifically exclude asbestos as an impurity in its definition of pharmaceutical grade talc The World Health Organization in its 1971 re- northern part of that state contain much sulation workers of the 418 deaths ob- asbestos as we noted above No served from January 1 1943 to June 30 significant difference was found be- 1971 20 were due to bronchogenic tween the observed and expected mor- carcinoma 10 to cancer of the stomach colon and rectum and % to pleural and peritoneal mesothelioma tality from carcinoma of the gastrointestinal tract and peritoneum among these talc workers.9 The asbestos forms used in the past by these workers were mostly chrysotile and amosite with possibly small amounts of crocidolite A known effect of talcs especially the fibrous variety is talcosis another of the many occupational lung fibroses Other toxic effects are the evaluation of food additives noted that asbestos is a contaminant in some talcs As a group the same asbestos in- sulation workers show about eight times production of granulomas in wounds and scars and intense mesothelial All of these are factors which make it im- an excess mortality from bronchogenic irritation with fibrosis and adhesion in perative to ascertain the mineralogical carcinoma Moreover asbestos in- the pleural and peritoneal cavities These type and purity of talcs in assessing their sulation workers who smoke have a 92- occurred often in the past due to the potential health effects fold risk of dying from bronchogenic car- operated tissues being contaminated cinoma as compared with men who with the talc used as dusting powder for neither smoke nor work with asbestos.7 and shed from surgical gloves use no h Toxic Effects Thus this type of occupational asbestos longer recommended Likely for similar 4 Asbestos - Different forms of inhalation exposure points to another ef- reasons the Kaiser Foundation Hospital asbestos appear to have different fect of asbestos that of a cocarcinogen in Los Angeles discontinued the use of biological effects These differences are The asbestos group minerals have the talcum powders for any inpatient use still too incompletely understood and added toxic effect of fibrogenicity which A bizarre new and serious talc effect is complex to be discussed here except as results in Asbestosis the known that of pulmonary intravascular mentioned briefly below Nevertheless it occupational lung fibrosis due to granulomas with vascular thrombosis can be stated that carcinogenicity is the chronic inhalation overexposure Pleural and sclerosis leading to pulmonary most serious toxic effect of the various asbestos group minerals In the last few decades in particular these substances especially some types of crocidolite plaques and calcifications as well as the less known asbestos corns or warts of the skin among workers handling such materials hypertension due to intravenous injection of containing oral tablets and adulterated substances in drug misuse have been occupationally associated with greatly excessive incidence of pleural and peritoneal mesotheliomas previously extremely infrequent cancers As mentioned toxicological effects of different forms of asbestos appear to be different For example as compared with chrysotile exposure to the amphiboles is Inhaled fibrous talc particles can also be changed by cells in the lung into another type of ferruginous body which some call talc bodies in humans.4 Moreover a number of generally more likely to produce researchers have experimentally induced asbestosis and bronchogenic carcinoma pleural mesotheliomas after intrapleural injection of various forms of asbestos and demonstrated the neoplastic nature Also inhalation of crocidolite pecially of some types with shorter finer fibers as measured by electron Hygienic Work Standards Asbestos _ For 1972 the Committee of those tumors As shown in Table 1 microscopy to produce more on Threshold Limit Values for Airborne Selikoff et al6 recently reported that among a cohort of 632 asbestos in- mesotheliomas than other amphiboles and chrysotile This subject was Contaminants of the American Conference of Governmental Industrial Journal of Occupational Medicine 15 No. February 1973 93 Hygienists ACGIH has proposed a weighted average limit value for an hour workday hour workweek for all forms of asbestos of 5 fibers per earlier in the year by the National Institute for Occupational Safety and Health Public Health Service US Department of Health Education and and illustrated in the Figure Talc - For 1972 the ACGIH has a TLV for each form of talc a Nonasbestiform Talc 20 million par- _ milliliter longer than 5 ...in length as determined by the membrane filter method at times magnification Welfare adopted for all forms of asbestos effective July 1 1976 by the Occupational Safety and Health Ad- ticles per cubic foot of air mppcf based on the Light dust count b Fibrous Talc The same TLV of 5 contrast illumination This Threshold Limit Value TLV has been ministration OSHA US Department of Labor Until that effective date the 5- fibers discussed above The Documentation for these TLV's takes developed as the air concentration of fiber TWA discussed above applies as into account the different biological ef- asbestos fibers which 1 should afford the US standard for all forms of fects of the two forms of talc and of the protection against asbestosis and 2 asbestos.14 need to determine their type and reduce to an acceptably low risk the It should be noted that all these stand- purit1y3 development of neoplasms This TLV ards are based on the identification and The revised Table Mineral Dusts does not assure complete elimination of quantification of all forms and types of in the same OSHA standards cited lists the carcinogenic risk because of in- asbestos fiber by contrast op- only one hygienic work standard of 20 complete understanding of effect tical microscopy Although evidence mppcf for talc This is an error which relationships Moreover even though about their toxic effects is still not well should be rectified Otherwise the 20 different forms of asbestos appear to understood certain chrysotile mppcf applies as the US Federal Stand- have different toxic effects a single TLV crocidolite and other asbestos fibers are ard for both platy and fibrous talc was established for all forms because of too short and fine to be detected ex- incomplete information about these dif- ferences.13 In June 1972 a similarly documented but lower Weighted Average TWA of two such proposed cept by electron microscopy Essentially the same can be said of chrysotile ultramicroscopic morphological units of a chrysotile fiber mentioned in the section on Environmental Exposures Environmental Exposures to Talc Talc is ecologically virtually ubiquitous through its many uses in modern living Only very recently has Electronphotomicrographs of particles extracted from coated rice Left Talc T and Amphibole asbestos A fibers Right Talc fiber T with Chrysotile asbestos fibril C Identification confirmed with selected area diffraction Electron microscopic studies by Dr. A. M. Langer New York Original magnification X 45,000 ad tami won " 19 + So * Les S 94 Talc A Possible Occupational and Environmental Carcinogen and Arlon Jour es es efhe nd 242526 242526 242526 242526 242526 ly has Left with 1 dif- ginal there been some indication of its widespread environmental inhalation and other exposures to humans As reported in 1972 Langer et 16 set out through electron microscopy to identify asbestos materials in the lungs of 28 consecutive autopsy cases of New York City residents Asbestos bodies were found in only three cases whereas chrysotile fibers were present in 24 Moreover chrysotile fibrils were found in all 28 cases In addition clay and talc particles were identified in the lungs of 18 of these 28 decedents all of whom had been time residents of that city None had been asbestos workers nor from our review of the published data talc workers Recently Henderson et al17 drew attention to the close association Source Henderson et al.17 + Particle size range 1000 ^ = 5 um * Same patient of talc and asbestos minerals when searching for asbestos through special electron microscopic techniques they unexpectedly identified talc particles deeply imbedded within the tissue of whether the ventitious or j-- different presence of talc causative study reported in was ad1971 primary ovarian endometrial and cer- vical carcinomas Table 3 summarizes these data and also shows that no talc i | particles were found in the one secon- by the Environmental Sciences Laboratory Mt. Sinai School of Medicine The City University of New York revealed that significant amounts dary ovarian carcinoma thus studied of asbestos were present in two brands Additionally the same investigators of commercial household fibrous found talc particles also in normal ovarian tissues removed from patients talc dusting talcum powder As a | result the US Food and Drug Ad- with breast cancer They made no com- ! ! ministration announced that if such ment however as to how the talc par- ;| ticles reached the ovaries and other reproductive tissues in which the talc i was found nor did they comment as to { , results were to be corroborated by an independent expert panel it would ask the manufacturers to recall such talcum powders It is of interest that in- dependent geologists informed the FDA that talc and asbestos can appear in the same mines and that contamination could be caused at that source 19 Uses of Talc General - Talc is found in cosmetics spray and dusting powder including talcum chalks and crayons ceramics electric and heating insulating materials roofing materials insecticides foundry facings textiles white shoe polishes and glove cleaners Talc is also used as pigment in paints varnishes and rubber filler for asphalt paper rubber plastic and soap dusting powder in rubber manufacturing and products such as inflatable toy ballons prophylac- tic condoms and contraceptive 10 diaphragms.1 in Foods and ters into food Drugs - Talc also enprocessing and phar- maceuticals It is used as an excipient and filler for pills and tablets for dusting tablet molds in clarifying liquids by = 1963 US consumption 763 x 10 short tons + Source Wells.,, + Less than 1 percent 1964-1965 Source Segi et 22 1957-1964 for Issei and Niser 1959-1961 for Black and White Source Dunn and Buell.26 + Foreign born Japanese born Japanese Journal of Occupational Medicine 15 No. February 1973 filtration in salami dusting candy uncooked and washed cooked rice vitamins as well as in some cases high molding in peanut polishing and in the samples Similar analyses revealed that in spicy and salty additives For exam- coating of polished rice.1 10 Table 4 all samples were contaminated with ple the Japanese ingest large amounts of presents quantitative data on many of much Amphibole asbestos A. M. white rice and salty sauces they also ~ these uses California in the United States and Langer personal communications Feb Mar Apr 1972 Similar work done at have as a nation the highest agestandardized gastric cancer mortality and the School of Public Health University morbidity rates 23 of California Berkeley revealed essen- Lastly for a variety of environmental Coated Polished Rice tially identical results even after multiple factors which are not clear but which As stated above talcs are used in a washings of the rice ( C. Murchio per- point to dietary changes the foreign and multitude of ways which can lead to sonal communications Feb Jul 1972 born Japanese in California are at a widespread inhalation ingestion and other exposures One such major use involving ingestion is that of coating of polished white rice In the United States and especially in Discussion of New Findings Regarding the asbestos contamination of processed coated rice much reduced risk from gastric cancer than the Japanese in Japan This change is quite evident from the data in Table 5 In the last few years these Californians of Japanese extraction have begun to show tg California a significant portion of the polished rice is coated with glucose and our findings and those of others cited above appear to be important for a num- a new and marked preference for shortgrain coated rice Apparently ex- talc This process which imparts to ber of reasons Firstly talcs have no cept for the coating this is the same white rice a pearly esthetically more at- nutritional value 21 Thus agricultural rice traditionally and habitually eaten in i tractive prolong appearance and may its shelf has to also our researchers have tried unsuccessfully to convince the processing industry to Japan since most of the Californiaproduced rice is of the japonica variety knowledge never been traditionally substitute talc for other substances with of Oryza sativa 21 Given the possibility me used in the Orient Currently in Califor- some nutritional value though to that the ingestion of enough asbestos- we nia food stores it is common to see sacks our knowledge these researchers did not contaminated talc were to be car- ye of rice displaying the mandatory warning label that the rice contains added talc know that talcs could be contaminated with asbestos Secondly the Delaney cinogenic the question arises therefore whether the Americans might and glucose and that it should be Amendment to the US Food Additives not be adding to their risk of gastric and washed before cooking Consequently Act essentially prohibits the use of any other gastrointestinal cancers from their "/ we set out to determine whether the talc food additive substance known to be new and increasing ingestion of enough used in such coated rice contained carcinogenic to man or any animal contaminated coated rice asbestos and if so whether a related Thirdly the Hawaiian Italian Latin thereby counteracting the gastric cancer- ingestion exposure existed American Okinawan and Spanish reducing factors in their new en- 2 New Findings - In this regard early peoples currently prefer the smooth and vironment Similarly might other cited i in 1971 using contrast shiny coated type of white rice such nations and peoples who now also " microscopy we could not identify any asbestos in the residue obtained from washings of uncooked Californiaprocessed coated rice Later however electron microscopic studies using selected area diffraction were done to analyze similar samples of coated rice bought at nearby stores in small quantities eg 85 gm for 4 cents scooped out of large rice sacks and handed over the the clerk in a plain as the one processed in California In fact the Associated Commonwealth of Puerto Rico buys much of this type of rice and requires that all rice sold there be both enriched and coated Some of the nations cited as well as others in the Orient where white rice has been a staple for centuries continue to experience widely different agestandardized gastric cancer rates and none higher than Japan Moreover in prefer coated rice be at a similarly greater risk If this were so and considering the long lapse for the carcinogenic effects of asbestos to become manifest it would take years maybe decades to find conclusive answers In any case talc has no known nutritional value As such its use as a food and drug additive is questionable at least and unwarranted if these talcs are con- taminated with asbestos Oe i en en oy! brown paper bag Amphibole asbestos some European and other nations where fibers and Chrysotile fibrils were identified in the mineral residue as shown in the Figure Similar work done by another program of the California State Department of Public Health in Berkeley also rice is not a staple the pertinent gastric cancer rates are almost as high as in Japa2n2 23 World such high gastric cancer experience can therefore be ascribed specifically neither to just a General Conclusions and Summary Talcs can be contaminated with . asbestos minerals Both talc and asbestos produce various fibrosing conditions identified asbestos in samples of talccoated rice sold locally At essentially habitually large intake of uncoated white rice nor to a habitually large intake of Asbestos taminated as well talc are as asbestos known to be oc- the same time the Environmental contaminated coated rice cupationally associated with excess mor- Science Laboratory Mt. Sinai School of as one report in Science did recently tality from various cancers Talc enters Medicine the City University of New York extracted the minerals from several Thus far the one common denominator in gastric cancer throughout the world into our lives through everyday items Ingestion inhalation skin samples of coated rice marketed in the West Coast of the United States appears balance to be a with an gross nutritional intake high in im- car- vaginal and other routes of talc ex- posure and absorption might therefore Such extracts were prepared from both bohydrate low in fat and certain be associated with increased en- 96 Talc A Possible Occupational and Environmental Carcinogen and Arlon e k s a vironmental and consumer health risks evidence of any carcinogenicity of talc granulomatosis Amer Rev Resp Dis 101.104 gh Environmentally produced deposition per se we would be remiss if we did not 1970 ^ 12. American Conference of Governmental of and retention of talc particles in human suggest a need for feasible properly con- Industrial Hygienists Threshold Limit Values lungs appear to be widespread Also trolled experimental animal exposure of Airborne Contaminants and Physical o talc particles have been found in some studies to ascertain any possible car- Agents with Intended Changes Adopted by normal ovaries as in the core of primary cinogenicity of pure talc nd cancers of the ovary endometrium and ACGIH for 1972. Cincinnati 1972 13. American Conference of Governmental cervix of nonoccupationally talc- or The authors thank Drs A. M. Langer and I. J Industrial Hygienists Documentation of the Threshold Limit Values for Substances in asbestos Nevertheless the women in Britain presence of talc in Selikoff Mt Sinai School of Medicine New York for their constructive comments and assistance Ms. Marilyn Hunter and the Communication Service Cen- Workroom Air ed 3. Cincinnati 1971 14. US Office of the Federal Register Oc- these tissues cannot presently be said to ter California Department of Public Health Berkeley cupational safety and health standards Title be more than adventitious and a finding whose significance must await for their painstaking work on manuscript preparation the Reference Staff Public Health Library University of California Berkeley and Mr. E. Hughes Medical 29 - Labor Chap XVII Section 1910.93a as of June 7 1972 p 11230 15 US Office of the Federal Register Table corroboration by controlled studies preferably from diverse geographical Librarian Kaiser Foundation Hospital Los Angeles for their indispensible help in researching the literature G - Mineral Dusts Section 1910.93 1972 p 11230 areas Moreover many talc dusting talcum powders and California- References 16. Langer AM Selikoff ) Sastre A. Chrysotile asbestos in the lungs of persons in New York City Arch Environ Health 348- processed coated rices recently 1. Wells R Talc soapstone and 361 1971 : tested were found to contain significant pyrophyllite in Mineral Facts and Problems 17. Henderson W Joslin CAF Turnbull AC amounts of asbestos Such findings raise questions of possible world increased health risks to humans arising from occupational and environmental 1965 ed US Bureau of Mines US Government Printing Office 1965 pp 919-927 2. The United States Pharmacopera 18th revision US Pharmacopeial Convention Inc 1965 p 708 et al Talc and carcinoma of the ovary and cervix { Obstet Gynaec Brit Comm 266272 1971 18. Trade and government memos in D Reports 33 July 12 1971 exposures to those every use cosmetics foods drugs and other products which contain talcs significantly contaminated with asbestos 3. World Health Organization Technical Report Series No 462 Evaluation of Food Additives Geneva 1971 p 16 4 Wagner JC Sleggs CA Marchand P. Diffuse pleural mesothelioma and asbestos ex- 19. Trade and government memos in D Reports 33:12 July 19 1971 20. Ferrel RE Kohler GO Mickus RR New rice coating materials Rice / 69:11 1966 21. Houston DF Kohler GO Nutritional It is not the intent here to imply that posure in the North Western Cape Province Properties of Rice Washington National all forms of talc pose an occupational or environmental carcinogenic risk although there are obvious instances in which certain talcs can be a source of Brit | Industr Med 260-271 1960 5. Smith WE Miller L Churg , et al Mesotheliomas in hamsters following intrapleural injection of asbestos | Mount Sinai Hosp NY 1-8 1965 Academy of Sciences 1970 22. Segi M Kurihara M Matsuyama T Can- cer Mortality For Selected Sites in Twenty Countries No. 5 1964-1965 Sendai Japan Dept of Public Health Tohoku University asbestos exposure The data presented here indicate that whenever talc ex- posures are expected to occur adequate analyses be done beforehand to deter- 6. Selikoff ) Hammond EC Churg | Mortality experience of asbestos insulation workers 1912-1971 Presented at the IV In- ternational Conference on Pneumonconiosis Bucharest Sept 29 1971 School of Medicine 1969 23. Doll R Payne P Waterhouse | eds Cancer Incidence in Five Continents A Technical Report International Union Against Cancer Berlin Springer 1970 vol 2 mine that mineral's type and purity as 7. Selikoff 11. Hammond EC Churg : 24. Merliss RR treated rice and well as the related need for proper oc- cupational and environmental controls This approach is warranted because in Asbestos exposure smoking and neoplasia JAMA 106-112 1968 8 Wagner JC Current opinions on the asbestos cancer problem Ann Occup Hyg Japanese stomach cancer Science 173.11411142 1971 25. Wynder EL Kmet , Dungal N et al An epidemiological investigation of gastric can- our experience many exposed em- 61-64 1972 cer Cancer 1461-1496 1963 ployees and consumers at large consider working with or using containing materials essentially safe which has not been the universal occupational ex- 9. Kleinfeld M Messite , Kooyman O et al Mortality among talc miners and millers in New York State Arch Environ Health 663- 667 1967 10. Merck Index ed 8. 1968 p 1011 26. Dunn JE Jr Buell PE intestinal cancer among the ethnic groups in California Epidemiology of Gastrointestinal Cancer Symposium Proceedings of the Third World Congress of Gastroenterology Recent Ad- perience Although there is no scientific 11. Hopkins GB Taylor GD Pulmonary talc vances in Gastroenterology 35-47 1967 Journal of Occupational Medicine 15 No. February 1973 97