Genital powder use and risk of ovarian cancer: a pooled analysis of 8,525 cases and 9,859 controls

Abstract

Genital powder use has been associated with risk of epithelial ovarian cancer in some, but not all, epidemiologic investigations, possibly reflecting the carcinogenic effects of talc particles found in most of these products. Whether risk increases with number of genital powder applications and for all histologic types of ovarian cancer also remains uncertain. Therefore, we estimated the association between self-reported genital powder use and epithelial ovarian cancer risk in eight population-based case-control studies. Individual data from each study were collected and harmonized. Lifetime number of genital powder applications was estimated from duration and frequency of use. Pooled ORs were calculated using conditional logistic regression matched on study and age and adjusted for potential confounders. Subtype-specific risks were estimated according to tumor behavior and histology. 8,525 cases and 9,859 controls were included in the analyses. Genital powder use was associated with a modest increased risk of epithelial ovarian cancer [OR, 1.24; 95% confidence interval (CI), 1.15-1.33] relative to women who never used powder. Risk was elevated for invasive serous (OR, 1.20; 95% CI, 1.09-1.32), endometrioid (OR, 1.22; 95% CI, 1.04-1.43), and clear cell (OR, 1.24; 95% CI, 1.01-1.52) tumors, and for borderline serous tumors (OR, 1.46; 95% CI, 1.24-1.72). Among genital powder users, we observed no significant trend (P = 0.17) in risk with increasing number of lifetime applications (assessed in quartiles). We noted no increase in risk among women who only reported nongenital powder use. In summary, genital powder use is a modifiable exposure associated with small-to-moderate increases in risk of most histologic subtypes of epithelial ovarian cancer.

Figure 1

Association between genital powder use and ovarian cancer risk in eight studies, p-heterogeneity=0.61. Adjusted for age (continuous), oral contraceptive duration (never use, <2yrs, 2–<5yrs, 5–<10yrs, >=10yrs), parity (0, 1, 2, 3, 4+ children), tubal ligation history, BMI (quartiles), race/ethnicity (non-Hispanic white, Hispanic white, black, Asian, other). Studies listed in decreasing order of effect size standard error (funnel plot). No evidence of heterogeneity based on Conchran’s Q statistic (p=0.61). AUS=Australian Cancer Study, DOV=Diseases of the Ovary and their Evaluation Study, HAW=Hawaii Ovarian Cancer Study, HOP=Hormones and Ovarian Cancer Prediction Study, NCO=North Carolina Ovarian Cancer Study, NEC=New England Case-Control Study of Ovarian Cancer, SON=Southern Ontario Ovarian Cancer Study

Figure 2

Association between genital powder use and subgroups of ovarian cancer defined by behavior and histology. Estimates are adjusted for the same covariates as in the model presented in figure 1.

Figure 2

Association between genital powder use and subgroups of ovarian cancer defined by behavior and histology. Estimates are adjusted for the same covariates as in the model presented in figure 1.

Figure 2

Association between genital powder use and subgroups of ovarian cancer defined by behavior and histology. Estimates are adjusted for the same covariates as in the model presented in figure 1.

Figure 2

Association between genital powder use and subgroups of ovarian cancer defined by behavior and histology. Estimates are adjusted for the same covariates as in the model presented in figure 1.

Figure 2

Association between genital powder use and subgroups of ovarian cancer defined by behavior and histology. Estimates are adjusted for the same covariates as in the model presented in figure 1.

Figure 2

Association between genital powder use and subgroups of ovarian cancer defined by behavior and histology. Estimates are adjusted for the same covariates as in the model presented in figure 1.