1
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O’Brien KM, Ogunsina K, Wentzensen N, Sandler DP. Douching and Genital Talc Use: Patterns of Use and Reliability of Self-reported Exposure. Epidemiology 2023; 34:376-384. [PMID: 36652669 PMCID: PMC10187135 DOI: 10.1097/ede.0000000000001589] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Feminine hygiene products contain chemicals that may be harmful to human health. Observational studies of the long-term health effects of such products largely rely on self-reported, recalled exposure. We sought to capture patterns of use over the life course and evaluate the reliability of self-reported data. METHODS We collected retrospective data on douching and genital talc use in the US-based Sister Study at two-time points and evaluated the consistency of reporting. At enrollment (2003-2009), participants were asked to report use in the last year and during ages 10-13. On a follow-up questionnaire (2017-2019), participants were asked about their use of douche or genital talc over their lifetimes. RESULTS Among 36,202 women who completed both questionnaires, 14% initially reported ever douching and 27% initially reported ever using genital talc. On the follow-up questionnaire, 51% of participants reported ever douching and 32% reported ever using genital talc. Comparisons across the two questionnaires for use in the year before enrollment showed good consistency, with 90% providing the same responses about douching and 87% providing the same responses about genital talc use. Reliability did not vary by cancer status, race and ethnicity, attained education, or age, though there was some evidence of recall bias for genital talc use among ovarian cancer survivors. CONCLUSIONS Classification of ever use of feminine hygiene products may be recalled with good consistency, but agreement was lower for specific time periods and trends may vary by subgroup. These potential differences warrant careful consideration in future studies.
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Affiliation(s)
- Katie M. O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (KMO, KO, DPS)
| | - Kemi Ogunsina
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (KMO, KO, DPS)
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD (NW)
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC (KMO, KO, DPS)
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2
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Townsend MK, Trabert B, Fortner RT, Arslan AA, Buring JE, Carter BD, Giles GG, Irvin SR, Jones ME, Kaaks R, Kirsh VA, Knutsen SF, Koh WP, Lacey JV, Langseth H, Larsson SC, Lee IM, Martínez ME, Merritt MA, Milne RL, O’Brien KM, Orlich MJ, Palmer JR, Patel AV, Peters U, Poynter JN, Robien K, Rohan TE, Rosenberg L, Sandin S, Sandler DP, Schouten LJ, Setiawan VW, Swerdlow AJ, Ursin G, van den Brandt PA, Visvanathan K, Weiderpass E, Wolk A, Yuan JM, Zeleniuch-Jacquotte A, Tworoger SS, Wentzensen N. Cohort Profile: The Ovarian Cancer Cohort Consortium (OC3). Int J Epidemiol 2022; 51:e73-e86. [PMID: 34652432 PMCID: PMC9425513 DOI: 10.1093/ije/dyab211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/24/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Mary K Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Britton Trabert
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Alan A Arslan
- Division of Epidemiology, Departments of Obstetrics and Gynecology, Population Health, and Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Julie E Buring
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian D Carter
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Sarah R Irvin
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Michael E Jones
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Victoria A Kirsh
- Ontario Health Study, Ontario Institute for Cancer Research, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - James V Lacey
- Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Hilde Langseth
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Susanna C Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I-Min Lee
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Melissa A Merritt
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Katie M O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Michael J Orlich
- School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, USA
| | - Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Ulrike Peters
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Jenny N Poynter
- Division of Pediatric Epidemiology and Clinical Research, University of Minnesota, Minneapolis, MN, USA
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA, USA
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, New York, NY, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Leo J Schouten
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - V Wendy Setiawan
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology and Division of Breast Cancer Research, Institute of Cancer Research, London, UK
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Piet A van den Brandt
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elisabete Weiderpass
- Office of the Director, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jian-Min Yuan
- UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health and Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Davis CP, Bandera EV, Bethea TN, Camacho F, Joslin CE, Wu AH, Beeghly-Fadiel A, Moorman PG, Myers ER, Ochs-Balcom HM, Peres LC, Rosenow WT, Setiawan VW, Rosenberg L, Schildkraut JM, Harris HR. Genital Powder Use and Risk of Epithelial Ovarian Cancer in the Ovarian Cancer in Women of African Ancestry Consortium. Cancer Epidemiol Biomarkers Prev 2021; 30:1660-1668. [PMID: 34155063 PMCID: PMC8419086 DOI: 10.1158/1055-9965.epi-21-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/01/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Genital powder use is more common among African-American women; however, studies of genital powder use and ovarian cancer risk have been conducted predominantly in White populations, and histotype-specific analyses among African-American populations are limited. METHODS We used data from five studies in the Ovarian Cancer in Women of African Ancestry consortium. Participants included 620 African-American cases, 1,146 African-American controls, 2,800 White cases, and 6,735 White controls who answered questions on genital powder use prior to 2014. The association between genital powder use and ovarian cancer risk by race was estimated using logistic regression. RESULTS The prevalence of ever genital powder use for cases was 35.8% among African-American women and 29.5% among White women. Ever use of genital powder was associated with higher odds of ovarian cancer among African-American women [OR = 1.22; 95% confidence interval (CI) = 0.97-1.53] and White women (OR = 1.36; 95% CI = 1.19-1.57). In African-American women, the positive association with risk was more pronounced among high-grade serous tumors (OR = 1.31; 95% CI = 1.01-1.71) than with all other histotypes (OR = 1.05; 95% CI = 0.75-1.47). In White women, a significant association was observed irrespective of histotype (OR = 1.33; 95% CI = 1.12-1.56 and OR = 1.38; 95% CI = 1.15-1.66, respectively). CONCLUSIONS While genital powder use was more prevalent among African-American women, the associations between genital powder use and ovarian cancer risk were similar across race and did not materially vary by histotype. IMPACT This is one of the largest studies to date to compare the associations between genital powder use and ovarian cancer risk, overall and by histotype, between African-American and White women.
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Affiliation(s)
- Colette P Davis
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elisa V Bandera
- Cancer Epidemiology and Health Outcomes, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Campus, Washington, District of Columbia
| | - Fabian Camacho
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago School of Medicine and Division of Epidemiology and Biostatistics, School of Public Health, Chicago, Illinois
| | - Anna H Wu
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Alicia Beeghly-Fadiel
- Department of Medicine, Division of Epidemiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patricia G Moorman
- Department of Family Medicine and Community Health, Duke University Medical Center, Durham, North Carolina
| | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York
| | - Lauren C Peres
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Will T Rosenow
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Veronica W Setiawan
- University of Southern California Norris Comprehensive Cancer Center and Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Joellen M Schildkraut
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Holly R Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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4
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Wentzensen N, O'Brien KM. Talc, body powder, and ovarian cancer: A summary of the epidemiologic evidence. Gynecol Oncol 2021; 163:199-208. [PMID: 34366148 DOI: 10.1016/j.ygyno.2021.07.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/19/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
Many women apply powder to the genital area as a drying agent. Talc, an inert mineral with a high capacity to absorb water, has historically been a major component of body powders. Due to its similarity and co-occurrence with asbestos, the association of body powder/talc use and gynecological cancer risk, specifically ovarian cancer risk, has been a long-standing research question. Retrospective case-control studies have shown associations between genital powder use and ovarian cancer risk, with summary relative risk estimates from meta-analyses and pooled analyses ranging from 1.24 to 1.35 for ever versus never use. In contrast, prospective cohort studies have not shown a statistically significant association until recently, when a pooled analysis of four large cohorts demonstrated a weak, but statistically significant association among women with patent reproductive tracts (hazard ratio 1.13). Taken together, the epidemiological data from case-control studies and cohort studies suggest that there may be a small, positive association between genital powder use and ovarian cancer. The causal factors underlying this association are not clear. Proposed factors include talc, other minerals, such as asbestos or quartz, that are known carcinogens and may contaminate talc products, or other powder ingredients that could cause inflammation of the reproductive tracts. Given the rarity of ovarian cancer in the general population, the small increase in relative risk translates to a very low increase in absolute risk. Further research is needed to understand the underpinnings of the observed association between genital powder use and ovarian cancer risk.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States of America.
| | - Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, United States of America
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5
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O’Brien KM, Weinberg CR, D’Aloisio AA, Moore KR, Sandler DP. The association between douching, genital talc use, and the risk of prevalent and incident cervical cancer. Sci Rep 2021; 11:14836. [PMID: 34290340 PMCID: PMC8295379 DOI: 10.1038/s41598-021-94447-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
While human papillomavirus is the primary cause of cervical cancer, other factors may influence susceptibility and response to the virus. Candidates include douching and talcum powder applied in the genital area. We used Cox proportional hazards models to estimate confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) in the Sister Study (2003-2009), a US cohort of women aged 35-74. We considered pre-baseline (n = 523) and incident (n = 31) cervical cancers. Douching at ages 10-13 was positively associated with pre-baseline cervical cancer (HR 1.32, 95% CI 0.86-2.03), though the association was not statistically significant. We did not observe an association between adolescent talc use and pre-baseline cervical cancer (HR 0.95, 95% CI 0.76-1.19). Douching in the year before enrollment was positively associated with incident cervical cancer (HR 2.56, 95% CI 1.10-5.99). The association between recent genital talc use and incident cervical cancer was positive, but not statistically significant (HR 1.79, 95% CI 0.78-4.11). The observed positive association between douching and incident cervical cancer is consistent with previous retrospective case-control studies. In the first study to examine genital talc use and cervical cancer, we did not see evidence of an association.
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Affiliation(s)
- Katie M. O’Brien
- grid.280664.e0000 0001 2110 5790Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr., Research Triangle Park, NC 27709 USA
| | - Clarice R. Weinberg
- grid.280664.e0000 0001 2110 5790Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC USA
| | | | - Kristen R. Moore
- grid.280664.e0000 0001 2110 5790Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr., Research Triangle Park, NC 27709 USA
| | - Dale P. Sandler
- grid.280664.e0000 0001 2110 5790Epidemiology Branch, National Institute of Environmental Health Sciences, 111 TW Alexander Dr., Research Triangle Park, NC 27709 USA
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6
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O’Brien KM, Tworoger SS, Harris HR, Trabert B, Weinberg CR, Fortner RT, D’Aloisio AA, Kaunitz AM, Wentzensen N, Sandler DP. Genital powder use and risk of uterine cancer: A pooled analysis of prospective studies. Int J Cancer 2021; 148:2692-2701. [PMID: 33433939 PMCID: PMC8106926 DOI: 10.1002/ijc.33470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022]
Abstract
When powder is applied to the genital area, it has the potential to reach internal reproductive organs and promote carcinogenesis by irritating and inflaming exposed tissues. Although many studies have considered the association between genital powder use and ovarian cancer risk, the relationship between genital powder use and uterine cancer is less well-studied. We pooled data from four large, prospective cohorts (the Nurses' Health Study, the Nurses' Health Study II, the Sister Study and the Women's Health Initiative - Observational Study). We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for prespecified confounders. In total, 209 185 women were included, with 37% reporting ever genital powder use. Over a mean 14.5 years of follow-up, 3272 invasive uterine cancers were diagnosed. There was no overall association between ever genital powder use and uterine cancer (HR = 1.01, 95% CI: 0.94-1.09), with little difference observed for frequent (≥1 times/week) vs never use (HR = 1.05, 95% CI: 0.95-1.16; P-for-trend = .46). Long-term use (>20 years; HR = 1.12, 95% CI: 0.96-1.31; P-for-trend = 0.14) was associated with a small, but not statistically significant, increase in risk, compared to never use. There were not clear differences by uterine cancer histologic subtypes or across strata of relevant covariates, including race/ethnicity, follow-up time, menopausal status and body mass index. The results of this large, pooled analysis do not support a relationship between the use of genital powder and uterine cancer, although the positive associations observed for long-term use may merit further consideration.
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Affiliation(s)
- Katie M. O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Holly R. Harris
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Britton Trabert
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Clarice R. Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Renee T. Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | | | - Andrew M. Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine- Jacksonville, Jacksonville, FL
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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Nowak D, Schmalfeldt B, Tannapfel A, Mahner S. Asbestos Exposure and Ovarian Cancer - a Gynaecological Occupational Disease. Background, Mandatory Notification, Practical Approach. Geburtshilfe Frauenheilkd 2021; 81:555-561. [PMID: 34035550 PMCID: PMC8137273 DOI: 10.1055/a-1361-1715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/18/2021] [Indexed: 12/01/2022] Open
Abstract
In 2017, ovarian cancer due to asbestos exposure was designated a new, and thereby the first, gynaecological occupational disease in Germany. Asbestos is a naturally occurring mineral fibre with an annual usage in Germany of 160 000 – 180 000 metric tonnes in the 1960s and 1970s. The carcinogenicity of asbestos for the target organs lungs, larynx, pleura including pericardium, and peritoneum including tunica vaginalis testis has been clearly established for many years. Recent meta-analyses of data from cohort studies have demonstrated that the risk of ovarian cancer roughly doubles in women with occupational exposure to asbestos. Since the group of people with double the risk of developing lung cancer due to work-related asbestos exposure has a 2.25-fold increased risk of mortality from ovarian cancer on average, work-related ovarian cancer has been assigned the same recognition requirements as in occupational lung (and laryngeal) cancer. Thus, gynaecologists must obtain
a thorough history of occupational exposure to asbestos, even if it may have taken place long in the past. The law mandates that suspected such cases must be reported to the Statutory Accident Insurance carrier or the State Occupational Safety and Health Agency.
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Affiliation(s)
- Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München, Germany
| | - Barbara Schmalfeldt
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Tannapfel
- Institut für Pathologie der Ruhr-Universität Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Sven Mahner
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU Klinikum, München, Germany
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8
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O'Brien KM, Sandler DP, Wentzensen N. Genital Powder Use and Ovarian Cancer-Reply. JAMA 2020; 323:2096-2097. [PMID: 32453361 DOI: 10.1001/jama.2020.3861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katie M O'Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Nicolas Wentzensen
- Clinical Genetics Branch, National Cancer Institute, Rockville, Maryland
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9
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O’Brien KM, Tworoger SS, Harris HR, Anderson GL, Weinberg CR, Trabert B, Kaunitz AM, D’Aloisio AA, Sandler DP, Wentzensen N. Association of Powder Use in the Genital Area With Risk of Ovarian Cancer. JAMA 2020; 323:49-59. [PMID: 31910280 PMCID: PMC6990816 DOI: 10.1001/jama.2019.20079] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/16/2019] [Indexed: 12/17/2022]
Abstract
Importance The relationship between use of powder in the genital area and ovarian cancer is not established. Positive associations reported in case-control studies have not been confirmed in cohort studies. Objective To estimate the association between use of powder in the genital area and ovarian cancer using prospective observational data. Design, Setting, and Participants Data were pooled from 4 large, US-based cohorts: Nurses' Health Study (enrollment 1976; follow-up 1982-2016; n = 81 869), Nurses' Health Study II (enrollment 1989; follow-up 2013-2017; n = 61 261), Sister Study (enrollment 2003-2009; follow-up 2003-2017; n = 40 647), and Women's Health Initiative Observational Study (enrollment 1993-1998; follow-up 1993-2017; n = 73 267). Exposures Ever, long-term (≥20 years), and frequent (≥1/week) use of powder in the genital area. Main Outcomes and Measures The primary analysis examined the association between ever use of powder in the genital area and self-reported incident ovarian cancer. Covariate-adjusted hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models. Results The pooled sample included 252 745 women (median age at baseline, 57 years) with 38% self-reporting use of powder in the genital area. Ten percent reported long-term use, and 22% reported frequent use. During a median of 11.2 years of follow-up (3.8 million person-years at risk), 2168 women developed ovarian cancer (58 cases/100 000 person-years). Ovarian cancer incidence was 61 cases/100 000 person-years among ever users and 55 cases/100 000 person-years among never users (estimated risk difference at age 70 years, 0.09% [95% CI, -0.02% to 0.19%]; estimated HR, 1.08 [95% CI, 0.99 to 1.17]). The estimated HR for frequent vs never use was 1.09 (95% CI, 0.97 to 1.23) and for long-term vs never use, the HR was 1.01 (95% CI, 0.82 to 1.25). Subgroup analyses were conducted for 10 variables; the tests for heterogeneity were not statistically significant for any of these comparisons. While the estimated HR for the association between ever use of powder in the genital area and ovarian cancer risk among women with a patent reproductive tract was 1.13 (95% CI, 1.01 to 1.26), the P value for interaction comparing women with vs without patent reproductive tracts was .15. Conclusions and Relevance In this analysis of pooled data from women in 4 US cohorts, there was not a statistically significant association between use of powder in the genital area and incident ovarian cancer. However, the study may have been underpowered to identify a small increase in risk.
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Affiliation(s)
- Katie M. O’Brien
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Holly R. Harris
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Garnet L. Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Clarice R. Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Britton Trabert
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Andrew M. Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville
| | | | - Dale P. Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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10
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O'Brien KM, D'Aloisio AA, Shi M, Murphy JD, Sandler DP, Weinberg CR. Perineal Talc Use, Douching, and the Risk of Uterine Cancer. Epidemiology 2019; 30:845-852. [PMID: 31584892 PMCID: PMC6779343 DOI: 10.1097/ede.0000000000001078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Perineal talc use and douching could affect the risk of uterine cancer through several possible pathways, including inflammation response, microbiota changes, or endocrine disruption. Two previous cohort studies of the association between talc use and uterine cancer have reported weak positive associations, but we know of no previous evaluations of the relationship between douching and uterine cancer. METHODS Using a large prospective cohort, we examined the relationship between incident uterine cancer and self-reported use of talc or douche using Cox proportional hazards models. RESULTS After excluding those with prior hysterectomy, 271 of 33,609 women reported incident uterine cancer (mean follow-up = 8.3 years in noncases; maximum 12.6 years). Overall, 26% of women reported ever using talc and 15% reported ever having douched. Ever talc use was associated with an increase in risk of uterine cancer (adjusted hazard ratio [HR] = 1.2; 95% confidence interval [CI] = 0.94, 1.6), with some evidence of a dose-response for frequency of talc use (P-for-trend = 0.07). Ever douching was not associated with uterine cancer risk (HR = 1.0; 95% CI = 0.72, 1.5), with no evidence of a frequency dose-response (P = 0.96). The estimates were similar when we restricted to invasive endometrial cancers, but not when we further restricted to endometroid adenocarcinomas. CONCLUSION The positive association we observed between talc use and uterine cancer risk is consistent with findings from previous prospective cohort studies of endometrial cancer. The relationships between uterine cancer and both douching and talc use merit further consideration, particularly as both exposures are preventable.
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Affiliation(s)
- Katie M O'Brien
- From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | | | - Min Shi
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - John D Murphy
- From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dale P Sandler
- From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC
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