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ST <6 wet ee eyesta eT -m Py j seasde. ewe ster Ger wy ewe Roe Editoral EditoralEditoral THE LANGET JUNE 25 1977 1348 when introduced or in the stimu- Although tale can cause granulomas body cavities exposure to cosmetic subjects whether manifest oinf tchoeexfiassttiinnggobesity and glu- into the tissues or assumed not to predispose to pul- lated state is independent intolerance although both are often contributory is unresolved tale has fbiebernosiwsideHloywever the fact that no association monary talc and loss of lung cose factors Which is chicken and which is egg for has been seen between the use of sensi- evidence favours a causal role but experimental administration of in- function might simply reflect the lack of methods detect losses of function that are small hyperinsulinemia continueddoses can give rise to tive enough to for example to smoking and optimal sulin to animals in resembling those of compared with those due status For similar rea- histological and biochemical lesions atheroma and insulin encourages the synthesis 10 heterogeneity in -antritypsin incidence talc exposure on cancer sons any effect of human and other lipids by arterial tissue14.ts of cholesterol factors known to would probably escape notice unless deliberatelyefsfoecutgshotf facilities for studying the term both in vivo and in vitro Of the many insulin secretion some such as obesity Until lately of dusts in laboratory animals have been cause exaggerated consumption have been implicated inhalation now the predictive value of animal and high sucrose in the pathogenesis of ath- scarce and even Thus even in the case of tobacco questionable on epidemiological grounds consumption whilst others such as increased been Con- models is smoke where the cancer hazard to man is indisputablien corfossculgearroysiaslcoholic drinks have so far not exclusion duplication of the effect by the inhalation route versely certain types of vegetable fibre the the laboratory animals has proved difficult or impossible the diet of which have been claimed to increase from immediate and overall in- although inhaled asbestos dust has given positive results animals dramatically risk of atheroma reduce the carbohydrate with- in that tale causes cancer ingested sulin secretory response to The role of the affecting glucose tolerance The hpeoassdilbiinleistyof the daily Press when workers in Car- hit the of the out adversely gastrointestinal insulinotropic hormones in providing diff reported finding talc particles in cancers between composition of the diet and the hyper- and uterine cervix The report was greeted with the link insulinemia of atherosclerosis is undetermined and methods of measuring ovary because the particles were not positively iden- scepticism did not prove causa- awaits investigation by the newer methods tified as talc because their presence them in blood tion 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 of six years without publication of confirmatory passage that the early scepticism was well- evidence suggests manufacturers and founded A meeting of powder POWDER scientists took place at Cardiff during May independent chairmanship of Dr J. C. Gilson direc- COSMETIC TALC like his evolutionary 1976 under the Council Pneumoconiosis FROM time immemorial man airborne dusts Such tor of the Medical Research of tale was predecessors has been exposed to survival Not unex- Unit At that meeting the toxicology discussed is a corollary of living and exposure of reviewed and the need for further information therefore the lungs have efficient means Assessment of toxicity necessarily starts with a consider- pcleecatreidnlgythemselves of inhaled particles and a functional ation of the physical and chemical specifications of the such that the accumulation of uncleared dust material and this unfortunately is also where reserve of be considerable before there is any obvious loss of may been test much of the assessment ends in the case cosmetic tale published epidemiological recognised capacity However it has long and because most of the to dusts such as quartz exposure either to experimental that heavy exposure loss of function and in the case of asbestos may lead to itself and of the lung cilnidnuisctarlialantdales that are variously contaminated with tale of undefined asbestos to cancer of the pleura to asbestos minerals known to be hazardous or to The observation that even casual exposure risk of mesothelioma physical and chemical characteristicosf asbestos particles may be associated with increased The long thin fibrous shape now occurring at the rate of nearly 200 new cases a year enables them to be carried more deeply into the lungs the United Kingdom has brought into question the in dusts such as cosmetic talc than spherical particles of similar mass The fact that effective clearance mechanisms have safety of othermacionmcmoonncerns Firstly will inhalation of empty- There are two fibrosis or the normally de- difficulty in coping with large long thin particles is an important determinant a dust cause loss of function through sema And secondly will it predispose to cancer posited deeply in the lungs tale of the hazards from asbestos dust Geologically is nominally a hydrated magnesium silicate and which 86 actinolite and antho- amphiboles 10. Sloane J. M. Mackay Sheridan A. ibid 1970 M. Gen. med Ass J. 11. Kaskyap M. Magill F. Rojas L. Hellman | certain occur in juxtaposition and consequently 1971 102 1365 its Physiological phyllite with these minerals Apart 12. Stout R. W. Bierman L. Brunzell J. D. in Diabetes 1977 talc may be contaminated and Biochemical Rasis edited by J. Vallance Owen Lancaster iii 13. Stman Br med 1970 631 W. J. 15. 14. Shet R. Lancet 1969 467 Atherosclerosi 1973 18 W. Huchanan Huchanan D. Vallance 7 J. Stoun J. 31 16. p 17. D. V. Lancer J. 18. .. 6 19. T. J. eee 1. 153 Szanto S. Yudkin J. Postgrad med J. 1969.45,502 1969.45,502 O'Keefe MarMak rkss June 16 1977 1286 Orave The Saccharine Disease Pristol 1974 Wodever 3. D. J. A. Goff D. V. Ireds A. R. Alberts G. M. 31. Jenkins R. Lancet 1976 ii 172 M. G aufM. Hockaday Greenberg M. Loyd Davies T. A. Br J. ind Afr2 1974 31 ? W Wien klin Wschr 1952 74 G. Pira F. Zuschka Hunerwomb A 2. Blagne 3. 15 R. Whichead J. K. Gil E. Ize N Kne J. Hr Concer 1975 469 Tirabre^ V. JAIJ 1974 29 252 4. Wagner C. Berry G. Skid.noreTJu.rWnb.ull A. C. Grilliths K. Obia 5. Henderson W. Jestin C. A. F. Gvnite Hr Cosrionz 1971 75 6. Hildick Smith G. Y. Br ind Atz2 1976 33 Z17 mse + 0106395 JNJ 000039247 wes * LANCET JUNE 25 1977 1349 from this tule may contain chlorite quartz carbonates such as calcite dolomite and magnesite and occasionally other minerals in lesser amounts During the nast few years major cosmetic manufacturers in the nited 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 tale which ensure the virtual absence of fibrous amphiboles At present there is no direct statutory control of the quality of cos- metic tale 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 cosmeti- specifications cally desirable Such contamination is thus limited More important however is the fact that the fibrous materials most likely to contaminate tales which do not comply with the tremolite antbophyllite and actinolite not those most clearly associated with carcinogenic hazard crocidolite amosite and chrysotile Furthermore it would be sen- sible to consider what controls if any are necessary for tal^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 tale free from these materials is safe Kleinfeld and his colleagues have stu- died 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 amphi- boles and free silica was initially reported to be associ- ated 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 tale millers and agricultural workers The tale miners were exposed to dusts containing % silica at levels far in excess of threshold limit value Significantly more of them than of the conirols died from respiratory disease but death from !! forms of cancer includ- ing lung cancer were significantly lower among the miners than among the controls By contrast among the tale 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 site compared with the control group The deficit of any the tale miners is plausible in so far lung cancer among as a similar deficit of lung cancer among coal miners seems to be real A continuing study of over 3200 per- sons 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 further decade before one could be confident of a nega- tive result Other less informative epidemiological stu- dies are reviewed by Hildick In most of the work in animals the quality of the tale 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 bab care Exposure had no adverse effect on bodyweight 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 tale 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 10 a year At the highest level of exposure aboutthree times that studied by Wehner and his col- leagues therewas 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 10 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.- 7. Toilet Preparations Federation Ltd. specification no 12 Cosmetic Tale 1977 9.C.T.F.A. Specification Tal Cosmetic Cosmetic Toiletry and Fragrance Inc. nue Tale Association 10 17976 9. Toiles Preparations Federation Lad analytical method 77 Cosmetic 1977 10. Hamer 13. H. Rulle F. R. Schelz J. P. Am ind Hyg Ass J. 1976 37 11. Kla7n9f6eld M. Messite J. Kooyman O. Zaki Mt. Archi anvir Hith 1967,14,643 1967,14,643 M.1967,14,643 12. Klarte Mol snl ic J. Zaki M. J. occup 3B1esr2ad1i9n7is4 1L.6 J3. 4A3rcha ensi 13. Kuse J. Peters M. Burgess W. A. Di 7634 1976.31 195 G. C. 14. Rubina K. Scansetti P'nitatio G. Rumstu J. occup Afed 1976 15 184 15. Goldman P. Br J. ind Aled 1967 22 72 16. Newhouse M. L. Miller B. F. Moore W. K. S. Paper given at seminar as of CardiT Biology Tale Used in Health Products May 1976 17. Wehner P. Zwickei G. M. Cannon C. Watson C. R. Carlton W. Fd Cosmes Tox 1977 15 121 and 18. Wagner J. C. Herry G. Cooke T. J. Hill R. J. Skidmore } W. in Pro- verdings of Founh International Symposium on Inhaled Panicles 1. GerVaacpiouJ.rEO.xWfiorldko1w9s7k7e C. Wihon W. R. Washington 3. A. Mayo Chin Pear 1977 32 2119 2. Chunn C. J. Jines R. AleCurchan J. A. Young E. J. Gilbert N. Medi inc Bulumare 1977 56 99 3. Lyn)n J. Kane G , P rker H. ibid 1977 56 115 _: 3 3 | F J * 0106396 JNJ 000039248 ROLE 0106397 JNJ 000039249