former Epidemiologia dei Tumori, Dipartimento di Scienze Mediche, Università di Torino e Centro per la Prevenzione Oncologica del Piemonte, Turin (Italy).
Epidemiol Prev. 2024 May-Jun;48(3):220-232. doi: 10.19191/EP24.3.A688.057.
in 2006, the International Agency for Research on Cancer (IARC) concluded that the evidence of carcinogenicity for asbestos-free talc was inadequate (group 3), whereas perineal use of talcum powder was classified as possibly carcinogenic (group 2B).
to assess whether later studies provide more solid information on the carcinogenic risk from asbestos-free talc and talcum powder and a better characterization of exposure.
systematic review.
cohort studies of talc miners and millers exposed to asbestos-free talc, as well as cohort and case-control studies reporting cancer risk in talc powder consumers published from 2006 onwards were identified through PubMed and reference lists. Pooled analyses were included, but not reviews and meta-analyses. In the case of repeatedly reported studies, the article with the longest follow-up or the largest number of observed cases was selected for data abstraction. Notice was taken of studies which were both reported individually and included in pooled analyses.
publications meeting inclusion criteria were: 2 cohort studies on talc miners and millers, 10 cohort studies on talcum powder users (4 of which estimated ovarian cancer risk), and 14 case-control studies (13 on ovarian and 1 on endometrial cancer) on the risk from talcum powder use. No excess cancer mortality has been reported among asbestos-free talc miners and millers. Case-control studies consistently led to estimates of ovarian cancer excesses associated with the use of perineal talcum powder (odds ratios up to 1.5). Most studies quantifying exposure also provided evidence of a dose-response relationship. Individual cohort studies estimated hazard ratios (HR) just above 1. In an analysis of pooled cohorts for a total of 3,112 cases, the HR for women with patent reproductive tract was 1.13 (95%CI 1.01-1.26) with a correlation between HR and frequency of use (p for trend 0.03). In all cohort studies, the perineal use of talcum powder was measured only once in the early phases of follow-up, thus producing an inaccurate measure of cumulative exposure. Results of epidemiological studies regarding cancer risk in other organs are limited and inconsistent.
epidemiological studies updated or published after IARC 2006 evaluation indicate that: no increase in cancer risk is apparent among miners and millers of asbestos-free talc; risk for ovarian cancer increases following the perineal use of commercial talcum powder. A correlation between indicators of quantity of use and cancer risk is suggested by a number of studies. The composition of talcum powders considered in such studies is not known.
2006 年，国际癌症研究机构（IARC）得出结论，无石棉滑石粉的致癌证据不足（第 3 组），而会阴使用滑石粉则被归类为可能致癌（第 2B 组）。
评估后来的研究是否提供了关于无石棉滑石粉和滑石粉致癌风险的更可靠信息，以及更好地描述暴露情况。
系统综述。
通过 PubMed 和参考文献列表，确定了 2006 年以后发表的研究无石棉滑石矿工和轧石工人暴露于无石棉滑石粉、以及报告滑石粉使用者癌症风险的队列和病例对照研究的系统综述。包括汇总分析，但不包括综述和荟萃分析。在重复报道的研究中，选择随访时间最长或观察到的病例数最多的文章进行数据提取。注意到既单独报道又包含在汇总分析中的研究。
符合纳入标准的出版物有：2 项关于滑石矿工和轧石工人的队列研究，10 项关于滑石粉使用者的队列研究（其中 4 项估计了卵巢癌风险），以及 14 项关于会阴使用滑石粉与癌症风险的病例对照研究（13 项关于卵巢癌，1 项关于子宫内膜癌）。无石棉滑石矿工和轧石工人的癌症死亡率没有增加。病例对照研究一致得出结论，会阴使用滑石粉会导致卵巢癌发病率增加（比值比高达 1.5）。大多数量化暴露的研究也提供了剂量-反应关系的证据。个别队列研究估计的危害比（HR）略高于 1。在对总共 3112 例病例的汇总队列进行分析时，对于生殖道通畅的女性，HR 为 1.13（95%CI 1.01-1.26），HR 与使用频率呈相关性（趋势检验 p 值为 0.03）。在所有队列研究中，会阴使用滑石粉仅在随访早期阶段进行了一次测量，因此对累积暴露量的测量不准确。关于其他器官癌症风险的流行病学研究结果有限且不一致。
IARC 2006 年评估后更新或发表的流行病学研究表明：无石棉滑石矿工和轧石工人的癌症风险没有增加；商业滑石粉会阴使用后卵巢癌风险增加。一些研究表明，使用量指标与癌症风险之间存在相关性。这些研究中考虑的滑石粉的成分尚不清楚。
