“Talcum powder has a very positive image in the minds of American consumers,” says Dr. Cramer. “It seems clean and fresh. It smells nice and we’re putting it on our babies so how could it be bad?”
Although it has yet to be classified as a carcinogen, Dr. Cramer estimates that talc-based baby powder and body powder are responsible for thousands of cases of ovarian cancer every year in the US.
There have been more than 20 studies on the use of talcum powder over the last several decades. All found a modest, but scientifically speaking insignificant increase in the risk of ovarian cancer.
Dr. Cramer argues that risk increases to a much more dangerous level if you look at different sub groups and with different exposures.
“The main problem is that most of the studies don’t show a so-called dose response,” says Dr. Cramer. “That is, the longer you use it and the more times you apply it, the greater the risk.”
In October 2013, Dr. Cramer testified at the first talcum powder ovarian cancer trial ever held in the US.
A South Dakota woman, Deane Berg, who developed premenopausal ovarian cancer after 30 years of using Shower to Shower body power, brought suit against Johnson & Johnson (J&J), claiming it failed to warn consumers about the dangers of talc and ovarian cancer.
Dr. Cramer, a gynecologist and epidemiologist, has authored five studies on the link between talcum powder and ovarian cancer, and was one of three medical experts who testified for the plaintiff.
“For the trial I pulled together all the data that I had. It showed that when you consolidate all the information, you can clearly see a causal link between talc and ovarian cancer,” says Dr. Cramer.
“Only 25 percent of women develop ovarian cancer before menopause. Deane Berg was premenopausal when she was diagnosed with stage-3 ovarian cancer. She had no family history of the disease, and no other risk factors such as the BRAC1 and BRAC2 gene,” says Dr. Cramer.
“We calculated that she had had more than 8,000 applications of talcum powder. Tests showed the talc was in her ovaries, her endometrium and lymph nodes,” he adds.
“You could see her sort of tearing up when this information came out during the trial,” says Dr. Cramer. “Here was this talc in her lymph nodes. It had been there forever. She had no idea this was going on and it was clearly was upsetting to her.”
The “modest increase” in risk is considered to be so small that none of the major regulatory agencies officially classify talc-based powders as carcinogenic.
In 2007, the International Agency for Research on Cancer (IARC) re-evaluated its position and described talc as “possibly carcinogenic to humans.”
The jury in the Berg case found that J&J failed to adequately warn consumers about the risk of ovarian cancer, and found that J&J’s Baby Powder and Shower to Shower product did indeed cause her cancer.
Despite a South Dakota law that says damages must be awarded when a jury finds a defendant negligent, the jury did not do that in the Berg cause. Her lawyer, R. Allen Smith, finds that unacceptable.
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Smith has filed a post-trial motion asking for a new trial strictly on damages. The judge’s decision on the motion is expected in late March.
Dr. Daniel Cramer has been a gynecologist and an epidemiologist for 40 years. He is currently a professor of Obstetrics and Gynecology and Reproduction Technology at Brigham and Women’s Hospital and Harvard Medical School.