ABSTRACT

The association between perineal talc use and ovarian cancer has been evaluated in several epidemiology studies. Some case-control studies reported weak positive associations, while other case-control and three large prospective cohort investigations found this association to be null. A weight-of-evidence evaluation was conducted of the epidemiology, toxicity, exposure, transport, in vitro, and mechanistic evidence to determine whether, collectively, these data support a causal association. Our review of the literature indicated that, while both case-control and cohort studies may be impacted by bias, the possibility of recall and other biases from the low participation rates and retrospective self-reporting of talc exposure cannot be ruled out for any of the case-control studies. The hypothesis that talc exposure induces ovarian cancer is only supported if one discounts the null results of the cohort studies and the fact that significant bias and/or confounding are likely reasons for the associations reported in some case-control investigations. In addition, one would need to ignore the evidence from animal experiments that show no marked association with cancer, in vitro and genotoxicity studies that did not indicate a carcinogenic mechanism of action for talc, and mechanistic and transport investigations that did not support the retrograde transport of talc to the ovaries. An alternative hypothesis that talc does not produce ovarian cancer, and that bias and confounding contribute the reported positive associations in case-control studies, is better supported by the evidence across all scientific disciplines. It is concluded that the evidence does not support a causal association between perineal talc use and ovarian cancer.

摘要

几项流行病学研究已经评估了会阴滑石粉使用与卵巢癌之间的关系。一些病例对照研究报告了弱的正相关性，而其他病例对照和三项大型前瞻性队列研究则发现这种相关性为零。进行了证据权重评估，包括流行病学，毒性，暴露，运输，体外和机械证据来确定这些数据是否共同支持因果关系。我们对文献的回顾表明，尽管病例对照研究和队列研究都可能受到偏见的影响，但不能排除由于低参与率和滑石粉暴露的回顾性自我报告而引起的回忆和其他偏见的可能性。病例对照研究。仅当滑石粉暴露会诱发卵巢癌的假说被人们驳斥的队列研究的无效结果以及某些病例对照研究中报道的相关性可能是显着偏倚和/或混淆的事实这一事实时，才支持滑石粉暴露诱发卵巢癌的假说。此外，人们需要忽略动物实验中的证据，这些证据表明在体外与癌症无明显关联遗传毒性研究（未表明滑石的致癌作用机理）以及机制和运输研究不支持滑石向卵巢的逆行运输。滑石粉不会产生卵巢癌，偏见和混淆有助于病例对照研究中报道的阳性关联的另一种假设得到了所有科学学科的证据的更好支持。结论是，证据不支持会阴滑石粉使用与卵巢癌之间的因果关系。