Document NR9x3ZE3nwJanyawZEVOMM0V
FILE NAME Talc TALC
DATE 1997
DOC TALC026 DOCUMENT DESCRIPTION Journal Article - Perineal Powder
Exposure and the Risk of Ovarian Cancer
OO
suppl 6
of automoers in New
ty of filling
h 1994
NE American Journal of Epidemiology
NENE
Copyright '1997 by The Johns Hopkins University School of Hygiene and Public Health
All rights reserved
SSS SSS
Perineal Powder Exposure and the Risk of Ovarian Cancer
Vol 145 No. 5 Printed in U.S.A.
sea ceaseeenes
exposure to
ocytic leu-
te myeloid nded case-
zukemia in sel Eur J
gasoline in III Thorpe
oxicology
Princeton
12
A chronic
'
Am Coll
related : 1985
ell cancer nd J Work
s between
d liquids
Linda S. Cook Mary L. Kamb and Noel S. Weiss
This control study evaluated the risk of epithelial ovarian cancer associated with
various forms of powder application Cases included all
genital exposure to
women aged 20-79 years in three counties of western
Washington who were diagnosed with borderline or invasive ovarian cancer from 1986
of eligible cases were interviewed A sample of similarly aged women who lived in thestehrcoouugnhti1e9s8i8de6nt4if.ie3d
by random digit dialing served as controls The overall response among control women was 68.0
Information on powder application and other potential risk factors was ascertained during the person
interview Overall ovarian cancer cases n = 313 were more likely than controls n = 422 to ever have used
powder adjusted relative risk RR = 1.5 95 confidence interval CI 1.1-2.0 After adjustment for
and other methods of genital powder application none vs. any an elevated relative risk of
age
ovarian cancer was
noted only for women with a history of perineal dusting RR = 1.6 95 CI 1.1-2.3 or use of genital deodorant
spray RR = 1.9 95 CI 1.1-3.1 These results offer support for the hypothesis raised by prior epidemiologic
studies that powder exposure from perineal dusting contributes to the development of ovarian cancer and
they suggest that use of genital deodorant sprays may do so as well Limitations of the present study include
the fairly low proportion of eligible women who participated and the potential differential recall of powder
usage Am J Epidemiol 459
65
ovarian neoplasms powders talc
asoline a 111-14 ernational
1995
. InternaJ Cancer
e Copen-
ncer role er 1988
rol study
s Am J
er of the
idy Br
on State | Human
pational plement lajesty's
pational
lon Her
tigation
ons and 971 14
onserva-
gasoline
4/87
ige mens from 94
Studies documenting the migration of carbon parti-
cles and radioactive particulate agents from the vagina to the ovaries 1 2 as well as those that have iden-
tified like particles more frequently in ovarian
tumors than in normal human ovarian tissue 3 have raised concern that genital powder exposure may increase a woman's risk of developing ovarian cancer While the results of several epidemiologic studies have suggested elevated risks for ovarian cancer
among women with genital powder exposures 4-11 results have been inconsistent for particular methods of powder application 12 In this population control study information on the method dura-
tion and frequency of powder application was collected to evaluate the impact of genital powder exposures on the risk of epithelial ovarian cancer
MATERIALS AND METHODS
Women with invasive or borderline epithelial ovar-
ian cancer were identified from records of the popu-
Received for publication May 20 1996 and accepted for publication October 22 1996
Abbreviations Cl confidence interval RR relative risk
1
Fred Hutchinson Cancer Research Center Seattle WA
2
Department of Epidemiology University of Washington
tle WA
Seat-
Reprint requests to Dr. Linda S. Cook 381 Fred Hutchinson Cancer Research Center 1124 Columbia Street Seattle WA 98104
based Cancer Surveillance System of western
Washington Eligible case subjects included white
women diagnosed between January 1 1986 and December 31 1988 who resided in three counties of
western Washington King Pierce and Snohomish
counties and were 20-79 years of age at diagnosis After obtaining permission from their personal physi-
cians to contact the women and obtaining written informed consent we successfully interviewed 329 64.3 percent of the 512 eligible case subjects The remaining 183 women were not interviewed because
of death prior to study contact n = 104 20.3 percent physician or subject refusal n = 73 14.3 percent
and lack of success in locating the women n = 6 1.2 percent Seven women whose reported race ethnicity was other than white and nine women with
unknown genital powder use were also excluded
Thus a total of 313 white women diagnosed with borderline n = 79 or invasive n = 234 epithelial ovarian tumors were available for analysis
Women identified as control subjects for this study were part of a larger control pool selected by random digit dialing 13 for several studies of cancer in
women Of the total 10,109 calls made by random digit dialing 5,853 57.9 percent were to nonresidential phone numbers 3,830 37.9 percent were to residential phone numbers and 426 4.2 percent were to
, 1997 ]
459
The
material
on
this
cag
be page
FOES was
copied
from
t the
re
#F colection of
TE the
National
Library
te of
eee Medicne
by
a
third
4
party
and
eae may
be
er
protected
by
U.S.
Copyright
law
460 Cook et al
ee
law AGAR
Copyright
U.S.
by
protecd
be
may
BL
and
party BAM
i
third WME
aaed
by Ra
Medicne ARE et Laie
of
Library
Library
National aaeT
the ne
of MT
Ce s
Pecolection
the
from B^ S
copied B^S ^ R^ S
was ^ R^ S
STAM
page MATORKE
this MATORKE
on
material
The
numbers of unknown residential status 3,604 94.1 percent of the 3,830 calls to residential households
were screened for eligible women who were age matched in year age groups to the combined female
cancer case group Of the 721 women identified who
were eligible 521 72.3 percent were successfully
interviewed after written informed consent was ob-
tained The overall response random digit dialing screening response multiplied by the interview response was 68.0 percent Women who reported race ethnicity other than white n = 28 age greater than 79 n = 5 a history of bilateral oophorectomy n = 58 uncertainty concerning a history of bilateral oophorectomy n = 4 and unknown genital powder use n = 4 were excluded resulting in a total of 422 white control women for analysis
Information regarding genital powder exposures was collected by structured person interviews Women were queried about storing diaphragms in powder dusting perineal areas with powder after bathing powdering sanitary napkins and using genital deodorant sprays which may contain aerosolized powder Those who answered affirmatively were questioned further about the duration and frequency of powder application and about the types of powder applied Powders were grouped into five categories cornstarch talcum powder baby powder deodorant powder and scented body powder Information on demographic characteristics reproductive history medical and screening histories smoking history anthropometry and birth control methods was also provided by the women A calendar was used to record major life events and enhance recall of past exposures Relevant study information was recorded only for exposures that occurred prior to the diagnosis date of cancer among the cases or the analogous reference
date among controls
Logistic regression EGRET version 26.6 Statistics and Epidemiology Research Corporation Seattle Washington was used to determine odds ratios as
estimates of the relative risk for ovarian cancer asso-
ciated with genital powder application and 95 percent confidence intervals 14 For all the relative risk estimates reported in the present analysis women who reported any method type or frequency of genital powder application were compared with women who stated that they had never applied genital powder in any manner 154 ovarian cancer cases and 256 con-
trols Trends were evaluated using the likelihood ratio statistic 14
First the relative risk for ovarian cancer among
women who reported exclusive use of one of the four methods of powder application was assessed table 2 Then because many women used more than one
method of powder application the risk for ovarian cancer among women who reported any use of the four methods of powder application was assessed while adjusting for the other methods of powder application table 3 Similarly ovarian cancer risk by exclusive and nonexclusive use of the type of powder used for perineal dusting diaphragm storage or on sanitary napkins was assessed table 4 To assess the impact of genital powder exposure on the risk of specific histologic categories of ovarian tumors table 5 we grouped borderline and invasive ovarian tumors according to the following International Classification
of Diseasefosr Oncology histologic codes 15 serous
tumors codes 8441 8442 8460 8461 and 8462 mucinous tumors codes 8470 8472 8473 8480 and 8481 endometrioid tumors codes 8380 8381 and 8560 and other tumors that included clear cell code 8310 undifferentiated code 8020 and unclassified other codes 8010 8050 8140 8240 8260 8440 8450 and 9000 All relative risk estimates were adjusted for age Further adjustment for education income marital status body mass index weight kg
height m oral contraceptive use or parity did not
alter the estimated relative risks Information on lac-
tation was not available Separate analyses for women diagnosed with invasive ovarian cancer and for those diagnosed with borderline ovarian cancer produced results very similar to those presented in tables 2-5
RESULTS
Selected characteristics of ovarian cancer cases and
controls are presented in table 1. Less education a lower household income and a higher body mass
index were more common among women with ovarian cancer than among control women but oral contracep-
tive use and having had a term birth were less
common
Genital powder application was more common among cases 50.8 percent than controls 39.3 percent table 2 There was an overall 50 percent ele-
vation in the risk for ovarian cancer associated with
the use of one or more of the four possible methods of genital powder application 95 percent CI 1.1-2.0 Among women who exclusively used a single method of powder application ovarian cancer risk was most strongly elevated among those who dusted perineal areas with powder after bathing RR = 1.8 95 percent CI 1.2-2.9
We further examined ovarian cancer risk among
women who reported application of genital powders using each of the four methods although not necessarily exclusive use of any method table 3 Perineal dusting was associated with an increased risk of ovar-
Am J Epidemiol Vol 145 No. 5 1997
ian can
though
with inc tribution
tubal li
relative
shown
untary powder
cancer :
1976 or 1977 or in 1976
Am J Ep
Powder and Ovarian Cancer 461
varian e four
while ication lusive sed for
initary
pact of histo-
) we
ors ac-
cation
serous
8462 0 and 1 and : code
ssified
8440
adon in-
t kg
lid not on lac-
vomen
: those duced . 2-5
es and
tion a
"
mass
varian tracepre less
ommon
.3 pernt eled with ods of 2.0 method
s most
erineal
percent
among owders
neces-
erineal of ovar-
5. 1997
TABLE 1. Characteristics of epithelial ovarian cancer cases and controls King Pierce and Snohomish counties Washington State 1986-1988
Characteristic
Age years
20-34 35-44
45-54 55-64
65-79
Education years
/8 9-12
13-16
16 Unknown
Annual household income $ 15,000 15,000-30,000
30,000-45,000 ;
45,000
Unknown
Marital status
Single
Married Separated
Body mass index m
21 21-22 23-24
25
Oral contraceptive use
Never or /1m2onths 12 months but 5 years 25 years
Total pregnancies
0 1 > Unknown Total term births 0 1 2 Unknown
Cases
n 313
No.
%
JO
JO 60 88 81
DIN124 146
DINDIN-
85689 85689 85689 85689
85689
32 186
95
6225 6225 6225 6225
224 23 23
57 27 214
0
79 46 188
0
10.9 16.0 19.2 28.1 25.9
4.8 39.6 46.6
8.6 0.3
28.8 29.1 19.2 20.1
2.9
10.2 59.4 30.4
17.9 28.4 23.3 30.4
71.6 16.0 12.5
18.2 13.4 68.4
25.2 14.7 60.1
Controls
n 422
No.
%
84 136
NOR NOR NOR
14 144 ONE
ONE 0
83 153
81 96
9
33 292
97
97 145
75 105
221 93
108
56 56 309
1
83 69 269
1
19.9 32.2 15.4 14.9 17.5
3.3 34.1 51.9 10.7
19.7 36.3 19.2 22.7
2.1
7.8 69.2 23.0
23.0 34.4 17.8 24.9
52.4 22.0 25.6
13.3 13.3 73.2
0.2
19.7 16.4 63.7
0.2
ian cancer RR = 1.6 95 percent CI 1.1-2.3 although there was no clear pattern of increasing risk with increasing duration of use When the small contribution of perineal dusting after a hysterectomy or tubal ligation was excluded from the analysis our relative risk estimates were nearly unchanged data not shown In 1976 the cosmetic industry proposed voluntary guidelines to limit contamination of consumer powders 16 and we attempted to evaluate ovarian cancer risk associated with any perineal dusting in 1976 or before and with exclusive perineal dusting in 1977 or thereafter Women with any perineal dusting in 1976 or before had an elevated risk RR = 1.8 95
Am J Epidemiol Vol 145 No. 5 1997
percent CI 1.1-2.9 but we were unable to evaluate exclusive perineal dusting in 1977 and thereafter since only four cases and 10 controls had this exposure The use of genital deodorant sprays was also associated with an elevated ovarian cancer risk RR = 1.9 95 percent CI 1.1-3.1 with the strongest elevation in risk among the small number of women n = 15 who used these sprays for more than 1 year RR = 2.7 95 percent CI 1.1-6.6 Storing a diaphragm in powder or powdering sanitary napkins was not related to the risk of developing an ovarian tumor RR = 1.0 95 percent CI 0.6-1.6 and RR = 0.9 95 percent CI 0.5-1.5
respectively
The
material
on
this
3
page
was
copied
from
the
colectiona:
collection
WY
of
** the
National
$ National
Library
of
Medicine
by
a
third
party
and
may
be
% protec d
by
US
Copyright
law
462 Cook et al
law TABLE 2 Relative risk of epithelial ovarian cancer associated with
exclusive use of various methods of
any genital powder use and by
Washington State 1986-1988
powder applicationapplication King Pierce and Snohomish counties
Copyright Ovarian cancer casescases
application cancer 313 =
Controls
n = 422
RR
95 CI
U.S. No.
%
No.
%
by
Lifetime genital powder application
None
Any
154
49.2
256
60.7
1.0
159
50.8
166
39.3
1.5
Referent 1.1-2.0
protec d Exclusive use of
be
Perineal dusting only
55
17.6
00100000
11.4
1.8
1.2-2.9
may Diaphragm storage in powder only
22
7.0
00100000
8.3
0.8
and Powder on sanitary napkins only
12
3.8
00100000
2.4
1.5
0.4-1.4
0.6-3.6
Genital deodorant spray only
18
5.8
00100000
6.6
1.5
0.8-3.0
party
*
RR relative risk adjusted for age CI confidence interval
third
a
by
No specific type of powder used for perineal dust- tent of talc asbestiform minerals or
ing diaphragm storage or on sanitary napkins was ilar
structurally sim-
compounds Powder content has also varied over
strongly related to ovarian cancer risk although there time presumably with fewer asbestiform minerals
Medicne was a suggestion of an elevated risk associated with
present in more recently manufactured products 17-
of
any use of talcum powder and body powders
19
RR = 1.6 95 percent CI 0.9-2.8 and RR = 1.5 95 CI 0.9 2.r4espectively table 4 When
Our results suggest that a history of perineal dusting
percent
Library cific histologic categories of ovarian tumors
spe-
or use of genital deodorant sprays has a modest influ-
amined any genital powder application
were ex-
associated
ence on the development of epithelial ovarian tumors
with an elevated risk for
was
whereas storing a diaphragm in powder or powdering
National CI
serous tumors RR = 1.7 95
sanitary napkins does not Direct comparisons of our
the
percent
1.1-2.5 and the nonspecific category of results with those of the other nine
of
other tumors RR = 1.8 95 percent CI 1.1 2.8
published studies
and among these studies are somewhat limited be-
whereas no elevation in risk was noted for the small
number of
with
cause of differences in the definitions groupings and
women
mucinous tumors RR = 0.7
colection 95 percent CI 0.4-1.4 or endometrioid tumors RR =
analysis of genital powder use Nonetheless there is
the
1.2 95 percent CI 0.6-2.3 table 5
some consistency in results among studies Seven
studies including the present one 4 6 8-11 ) reported
from
DISCUSSION
elevated relative risks for ovarian cancer ranging from
1.3 to 3.9 among women with powder exposure by
copied There are several issues that should be considered in dusting of the perineum Of the three remaining
the interpretation of our results A sizable number of studies that evaluated the more general exposure of
was women eligible for our study did not participate par-
talc use in perineal area which may or may
ticularly among those with ovarian cancer Many not include perineal sanitary napkin diaphragm or
page women with cancer died before they could be ap-
undergarment applications two observed a modest
this
proached about participation in this study and others elevation in ovarian cancer risk 5 7 whereas one did
on
were too ill to participate If substantial differences in
not 20
powder use existed between participating and nonparticipating women our study results may over- or un-
material derestimate the true risks for ovarian cancer It is also
The possible that the completeness of the reporting of
powder use differed between cases and controls bias-
ing our relative risk estimates to some
degree Additionally it is not clear how well ascertainment
of perineal powder application correctly estimates actual exposure to particles in powder that may influence
ovarian cancer risk Different consumer brands of
powder that women used or even different lots of the
Most studies including the present one have found
little if any excess risk for ovarian cancer among
women who stored their diaphragms in powder 4-8 10 only one study has reported a suggestion of an elevation in risk 11 In the present study control women more frequently reported washing their diaphragms prior to use than did ovarian cancer cases but ovarian cancer risk was not substantially elevated for
the small number of women who did not wash their
diaphragms prior to use The relation between powdering sanitary napkins and ovarian cancer risk is less
same brand may have varied substantially in the con- clear three studies including the present study found
Am J Epidemiol Vol 145 No. 5. 1997
Powder and Ovarian Cancer 463
TABLE 3 Relative risk of epithelial ovarian cancer associated with genital powder use by methods of powder application King Pierce and Snohomish counties Washington State 1986 1988
Lifetime genital
powder application
Ovarian
cancer cases
n 313
No.
%
Controls
n 422
No.
%
RR
95 Cit
None
154
49.2
256
60.7
1.0
Referent
Any perineal dusting
95
30.4
87
20.6
1.6
1.1-2.3
The
Cumulative lifetime days
The
/2,000
2228
6.4
22
5.2
1.8
0.9-3.5
2,001-5,000 5,001-10,000
2228
7.7
26
2228
6.7
22
6.2
1.6
5.2
1.2
0.9-2.9 0.6-2.4
material
10,000
2228
8.9
17
4.0
1.8
0.9-3.4
on
Unknown
2
0.6
0
this
Diaphragm storage in powder
Cumulative lifetime months
46
14.7
115656
12.1
1.0
0.6-1.6
page
was /60
60
27
7.7
225
6.2
1.1
27
4.8
225
4.7
0.6-1.9 0.4-1.7
copied ver
Unknown
Usually washed before use
No
27
2.2
225
19
6.1
+36
1.2 3.3
1.4
0.7-3.0
als
Yes
20
6.4
+36
7.3
0.7
0.4-1.4
from
the Unknown
7
2.2
+36
1.4
Any powder on sanitary napkins
801-
12.1
40
9.5
0.9
0.5-1.5
colection ing
Cumulative lifetime months
120
801-
8.0
21
5.0
1.3
0.7-2.4
ors 120 801- 3.8 19 4.5 0.5 0.2-1.1 of
the ing
Unknown
Lifetime applications
801-
0.3
0
Our
/1,000
37-
7.3
19
2009
1.3
0.7-2.5
ies
be-
1,000 Unknown
37-
4.5
21
2009
0.6
37-
0.3
0
0.3-1.2
National
ind
Any genital deodorant spray
Cumulative lifetime months
40
12.8
40
9.5
1.9
1.1-3.1
Library
en
12
24
7.7
31
7.4
1.5
0.9-2.8
of
ted
12
15
4.8
9
2.1
2.7+
1.1-6.6
Medicne om
Unknown
1
0.3
0
Lifetime applications
by /500
20
9.3
34
8.1
1.7
1.0-2.9
by
.ng
500
20
3.2
...
1.4
2.6+
0.9-7.6
a
of
Unknown
1
0.3
0
third Tay
* Numbers do not add up to total cases and controls because women may have used a variety of methods for
or
party est
and lid
powder application RR relative risk adjusted for age and for the other methods of genital powder application none any CI
confidence interval
+ p value for trend < 0.05
may
and be
no association 6 10 whereas three other studies
powder and body powders among women using
protec d reported moderate elevations in risk 4 8 11
these powders for perineal dusting diaphragm storage
an
Only two other studies have evaluated particular or on sanitary napkins
rol
types of powder one reported an excess risk of bor-
The present study is the first to evaluate the associ-
by
US derline ovarian tumors among women who used de-
ation between genital deodorant spray use and ovarian
out
odorant powders 8 and another study reported an cancer risk these preliminary results require confir-
Copyright for
excess risk of ovarian cancer among women who used
mation in other studies It is difficult to postulate that
eir
baby powders 10 A strong relation between the
an increased risk for ovarian cancer may specifically
W-
types of powder used and ovarian cancer risk was not
be due to powder and associated constituents when
ess
found in the present study although there was a sug-
some of the deodorant sprays do not contain aerosol-
law
ind
gestion of an elevated risk with any use of talcum
ized powder It is possible that it is not powder per se
997
Am J Epidemiol Vol 145 No. 5 1997
hat may er is un-
n fibrous
hydrous all body cifically
fibrous
e across
the skin
is parti-
"
can
be
is rela-
include in open moconi-
5 1997
Powder and Ovarian Cancer 465
osis talcosis in individuals with term exposure
to talc dust 19 Occupational exposure to talc does
not appear to increase the risk for pulmonary malig-
nancies 19 Most animal studies confirm this with
lung tumors developing only in rats exposed to doses of talc dust high enough to cause chronic obstructive and restrictive lung toxicity 19 Excess ovarian tu-
mors have not been reported in rats and mice with
term exposure to aerosol talc 23 In contrast
occupational exposure to asbestos fibers has been shown to cause lung tumors 24 and has been asso-
ciated with the development of ovarian tumors 25 Thus while there is little biologic or experimental
evidence to support a role for talc per se in the devel-
opment of ovarian malignancies the potential biologic effects of consumer powders with their variable con-
stituents on the human ovary have not been well
studied
The prevalence of genital powder exposure reported among control women in this and other studies
conducted in the United States ranges from 28 percent to
51 percent 4-6 8 10 Given such a common practice even the modest elevation in ovarian cancer risk associated with genital powder application suggested
by most of the epidemiologic studies could have a notable impact on the incidence of ovarian cancer in
the United States We recommend that cohort studies
address this question these studies could eliminate
concerns regarding the potential differences in the reporting of genital powder exposures between cases and con-
trols We also believe that further characterization of the
constituents of powder products that may influence ovarian cancer risk and the investigation of their possible biologic mechanisms of carcinogenesis are warranted
2. Ventor PF Iturralde M. Migration of a particulate radioactive
tracer from the vagina to the peritoneal cavities and ovaries S
Afr Med J 917
19
3. Henderson WJ Joslin CA Turnbull AC et al Talc and
carcinoma of the ovary and cervix J Obstet Gynaecol Br
Commonw 266
72
4. Cramer DW Welch WR Scully RE et al Ovarian cancer and
talc a control study Cancer 372
6
5. Hartge P Hoover R Lesher LP et al Talc and ovarian cancer
Letter JAMA 1844
6. Whittemore AS Wu ML Paffenbarger RS Jr et al Personal
and environmental characteristics related to epithelial ovarian cancer II Exposures to talcum powder tobacco alcohol and coffee Am J Epidemiol 1228-40 7. Booth M Beral V Smith P. Risk factors for ovarian cancer a
J control study Br Cancer 592
8
8. Harlow BL Weiss NS A control study of borderline ovarian tumors the influence of perineal exposure to talc Am J Epidemiol 390-4
9. Chen Y Wu PC Lang JH et al Risk factors for epithelial
ovarian cancer in Beijing China Int J Epidemiol 1992
23-9
The
The
wos material on this page was
10. Harlow BL Cramer DW Bell DA et al Perineal exposure to talc and ovarian cancer risk Obstet Gynecol 19-26
11. 11. Rosenblatt KA Szklo M Rosenshein NB Mineral fiber ex-
posure and the development of ovarian cancer Gynecol Oncol 20-5
12. Harlow BL Hartge PA A review of perineal talc exposure and risk of ovarian cancer Regul Toxicol Pharmacol 1995
254-60
13. Waksberg J. Sampling methods for random digit dialing J Am Stat Soc 40-6
Lyon 14. Breslow NE Day NE eds Statistical methods in cancer
research Vol 1. The analysis of control studies International Agency for Research on Cancer 1980. IARC scientific publication no 32 15. World Health Organization International classification of diseases for oncology 2nd ed Geneva World Health Organization 1990
16. Cosmetic Toiletry and Fragrance Association CTFA Talc specification and methods In CTFA compendium of cosmetic ingredient composition Washington DC CTFA 1976
10-17
copied
from
ag the
get: colection
eo
of
cst the
ora
2B National
Library
of
17. Cralley LJ Key MM Groth DH et al Fibrous and mineral
content of cosmetic talcum products Am Ind Hyg Assoc J 350-4
Medicine
ACKNOWLEDGMENTS
This research was supported by grant R35 CA39779 from the National Cancer Institute and by the Cancer Surveil-
lance System of the Fred Hutchinson Cancer Research
Center which is funded by contract no 05230 from the Surveillance Epidemiology and End Results SEER Program of the National Cancer Institute with ad-
18. Rohl AN Langer AM Selikoff IJ et al Consumer talcums and powders mineral and chemical characterization J Toxicol
Environ Health 255-84
19. Zazenski R Ashton WH Briggs D et al Tale occurrence characterization and consumer applications Regul Toxicol Pharmacol 218-29
20. Tzonou A Polychronopoulou A Hsieh C et al Hair dyes
408-10 analgesics tranquilizers and perineal tale application as risk
factors for ovarian cancer Int J Cancer 408-10
21. Kasper CS Chandler PJ Possible morbidity in women from talc on condoms JAMA 846-7
by
a
third
p$arty
and
may
be
ditional support from the Fred Hutchinson Cancer Research Center
The authors thank Kay Byron and Judy Kuskin for their
22. Paoletti L Caiazza S Donelli G et al Evaluation by electron
protec d microscopy techniques of asbestos contamination in indus- 3
trial cosmetic and pharmaceutical tales Regul Toxicol Phar-
macol 222
35
programming assistance Diana Farrow for assistance with data collection and Robert C. Lee for his review of the manuscript and insightful comments
REFERENCES
151 1. Egli GE Newton M. The transport of carbon particles in the
human female reproductive tract Fertil Steril
23.
24.
25.
5
National Toxicology Program NTP Toxicology and carcinogenesis studies of talc in F344 rats and B6C3F mice
inhalation studies Research Triangle Park NC US Depart-
ment of Health and Human Services 1993. NIH publication no 93-3152
Roggli VL Human disease consequences of fiber exposures
a review of human lung pathology and fiber burden data
Environ Health Perspect 295
303
Weiss NS Cook LS Farrow DC et al Ovary In Schottenfeld
D Fraumeni JF eds Cancer epidemiology and prevention 2nd ed New York Oxford University Press 1996
by
U.S. U.S.
Copyright
law
Am J Epidemiol Vol 145 No. 5 1997