Sister Study Cohorts Shows Association of Genital Talc Use and Ovarian Cancer

Fumiko Chino, MD, discusses how recent findings of talcum powder use were linked to ovarian cancer.

Results of a recent study published in the Journal of Clinical Oncology highlighted the association of ovarian cancer with talcum powder (talc) use.¹ The findings were from an extensive analysis of the Sister Study cohort.²

CancerNetwork® spoke with Fumiko Chino, MD, assistant attending radiation oncologist at Memorial Sloan Kettering Cancer Center, and the American Society of Clinical Oncology (ASCO) expert who was quoted in the press release of the findings.1 She shared her expertise in why having a cohort population study like Sister Study is so important in enhancing cancer outcomes.

The study found that of the 50,884 women enrolled, there was a positive correlation between ovarian cancer and genital talc use (HR, 1.17-3.34). Overall, data were collected on 41% to 64% of patients who douched and 35% to 56% of patients who used genital talc.

CancerNetwork: What is the importance of these findings on the association between talc use and ovarian cancer?

Chino: This research backs up some information that’s been known for a while, but mostly from retrospective data at a population level. This research provides a little bit more of a nuanced view of it, and the information was collected prospectively. What it shows is that there seems to be an association between these feminine hygiene products, their use, and things like ovarian cancer. That’s important because hygiene products are often sold as a self-care item—something that’s going to improve how you feel about yourself, or your overall investment in yourself. The fact that these products may be inadvertently associated with harm for patients is an important takeaway message. It aligns with some of the information that’s coming out, which is that the female genital system is quite good at cleaning itself. We probably don’t need to be putting a lot of extra products down there, and that may be harming us.

Were there any study limitations that should be highlighted?

Even though the data were collected prospectively, it’s still somewhat susceptible to recall bias, because people have to report their use. It is a population that is enriched for female cancers because it’s via the Sisters Study project, which is essentially the healthy sister of someone who had breast cancer. The female cancers can ride together, so maybe this is a slightly higher-risk population. All that needs to be accounted for. Overall, though, I was encouraged by how large the sample was and the longitudinal nature of the follow-up, meaning, how often they got information from this population, and how much they tried to account for an analysis for things like confounders.

Those involved in the Sister Study were the population used to extrapolate these findings. How do cohort studies like this help advance the field?

In general, we think about trying to answer important questions. If I’m trying to translate a drug, it makes sense. You find a population of people who have the disease, and you get this driver, or that drug, and try to see what happens [in the long run]. If you’re trying to measure things like exposure and long-term risk, these studies are much harder to do, because it requires enrolling a sample of healthy [patients] and seeing what happens to them over the long run. These types of studies require a lot of effort and require a lot of time and dedication from the volunteers who are enrolled. My main message when we get good information from a study like this cohort study is that it is my profound gratitude for the women who enrolled on the study and did these sequential surveys. They gave a lot of themselves, sharing some of their personal information to try to help the larger good.

What are the next steps for further developing these findings?

There have been some efforts. For example, the [Johnson & Johnson] lawsuits to try to define who was potentially harmed from some of these products and to try to find the best way of making sure that we’re getting the right population [for these studies]. We’re screening them early, meaning trying to catch long-term harm early, making sure they have the right treatment for the cancers that do develop. [We also make sure] that they do have things like restitution, and they have proper and adequate care for cancers, if it wasn’t related to harm from a consumer product.

As a radiation oncologist, how does this fit into the treatment plans for ovarian cancer?

In general, radiation is used sparingly with ovarian cancer. My specific research is on access, affordability, and equity. For some feminine hygiene products, this is more of an equity issue in that there has been a disproportionate role of these products in certain populations. Those populations are also the ones most at risk for health care disparities or gaps. In terms of actual radiation, radiation is used for things like isolated reoccurrences for ovarian cancer, or for symptomatic disease that could benefit from radiation, meaning something that’s causing pain or something that’s bleeding, radiation is quite effective for those patients.

Are you presenting anything at the 2024 ASCO Annual Meeting that you would like to highlight?

I’m involved in a couple of different projects that we’re very excited about. They’re having to do primarily with access to care, and also obstructions to care, which is the flip side of the coin for access. I’m presenting research on prior authorization and about how prioritization, and denial of pain medications specifically for [patients] with cancer led to some negative downstream effects, meaning things like hospitalization. That is a pressing issue right now because prior authorization is proliferated in the modern era. We also have some research typically looking at high deductible health care plans. Plans that require a big payout upfront before paying anything out for things like a cancer diagnosis. Overall, we found that these plans are associated with just worse outcomes, as you would expect, because people are [not incentivized] to get proper care.

References

1. Study finds association between genital talc use and increased risk of ovarian cancer. News release. American Society of Clinical Oncology. May 15, 2024. Accessed May 20, 2024. https://shorturl.at/boATU
2. The Sister Study. For researchers. Accessed May 20, 2024. https://shorturl.at/glnD8