Were You Diagnosed with Ovarian Cancer After Talcum Powder Use? Learn Your Legal Options

A jury in St Louis City, Missouri, stunned the world on July 12, 2018, by awarding 22 plaintiffs claiming their use of Johnson & Johnson Baby Powder over many years caused their ovarian cancer, $550 million in compensatory damages and a whopping $4.14 billion in punitive damages. Medical malpractice lawyers have filed thousands of suits against talc powder manufacturers on behalf of injured plaintiffs who claim their use of powder caused inflammation that contributed to the development of ovarian cancer.

Ovarian Cancer

An estimated one woman in 78 will develop ovarian cancer during her lifetime. In women ages 35-74, ovarian cancer is the fifth leading cause of cancer-related deaths.

Ovarian cancer is a type of cancer that begins in the ovaries, which is an almond-shaped organ that produces ova (eggs) as well as progesterone and estrogen. There are two ovaries, one on each side of the uterus, in the female reproductive system.

Ovarian cancer is determined by the type of cell where cancer begins, and include:

  • Epithelial tumors – about 90% of tumours and begin in the covering of the ovary.
  • Stromal tumors – about 7% and start up in the hormone-producing cells. They are often diagnosed earlier.
  • Germ cell tumors – very rare, mostly found in younger females, and begin in the egg-producing cells.

Early-stage ovarian cancer is easier to treat when it is still confined to the ovary and has a good survival rate of about 90%; unfortunately, most ovarian cancers (up to 80%) go undetected until it has spread throughout the pelvis or abdomen, and becomes very difficult to treat. Researchers are trying to find early detection tools. Surgery and chemotherapy are the treatments of choice.

Symptoms of Ovarian Cancer

The biggest problem with identifying ovarian cancer is the lack of symptoms, especially in the early stages. Advanced-stage ovarian cancer may cause few and nonspecific symptoms, but they are frequently misdiagnosed for benign conditions.

  • Abdominal bloating or swelling
  • Changes in bowel movement
  • Loss of appetite or feeling full sooner
  • Discomfort in the pelvic area
  • Pressure in the pelvis or lower back
  • Changes in menstruation
  • Weight loss
  • A frequent need to urinate
  • Increased abdominal girth
  • Tiredness or low energy

Similarly, ovarian cysts, masses or tumors (that can be benign or malignant) have non-specific symptoms too:

  • Abnormal bleeding
  • Pelvic pain
  • Pain shortly before or after the start of your period
  • Pain during sex
  • Difficulty emptying your bladder
  • Nausea or vomiting
  • Swelling, pressure or pain in the abdomen
  • Dull ache in the lower back and thighs

Stages of Ovarian Cancer

Your doctor will stage your cancer depending on how far it has spread. Each of the four stages has sub-stages.

  • Stage 1 – early, limited spread (71%)
    • 1A: limited, or localized, to one ovary (93%)
    • 1B: in both ovaries (91%)
    • 1C: also on the outside of the ovary (84%)
  • Stage 2 – spread to pelvic structures (61%)
    • 2A: spread to the uterus or fallopian tubes (82%)
    • 2B: spread to the bladder or rectum. (72%)
  • Stage 3 – spread to the abdomen (28%)
    • 3A: the lining of the abdomen and the lymph nodes in the abdomen (63%)
    • 3B: outside of the spleen or liver (53%)
    • 3C: ¾” on the abdomen or outside the spleen or liver (41%)
  • Stage 4 – metastisized (19%)
    • 4A: in the fluid around the lungs
    • 4B, inside of the spleen or liver or the skin or brain

The survival rate is the percentage of women who survive a certain number of years at a given stage of diagnosis, and the above percentages represent the 5-year survival for epithelial cancers.

Causes of Ovarian Cancer

Cancer starts with mutations to the DNA of a cell, and these ‘errors’ results in the cell growing fast and creating tumours with masses of abnormal cells, which invade other organs or break off and spread elsewhere causing metastases.

While several factors predicting ovarian cancer risk have been identified, no factors have been proven to cause ovarian cancer, although talc has long been considered a potential risk for the disease.

Risk factors for Ovarian Cancer: the research

  • Family history of ovarian cancer – two or more close relatives with ovarian cancer
  • Inherited gene mutations – a small percentage of tumors – breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), higher risk for breast cancer too.
  • Other gene mutations – e.g. Lynch syndrome
  • Older women – common 50-60 years.
  • Obesity
  • Early menstruation
  • Pregnancy over the age of 35
  • No history of pregnancy carried to term
  • Certain fertility drugs
  • Estrogen hormone replacement therapy – large doses, long-term use
  • Androgens for over ten years
  • Late menopause
  • Endometriosis
  • Personal history of uterine, breast or colon cancer
  • Use of talc has not been scientifically proven as a risk factor

Diagnosis

A rectovaginal exam can help discover any irregularities, but again, only once the tumor is much larger and pressing against the bladder or rectum.

Other tests that may be done if ovarian cancer is suspected:

  • Transvaginal ultrasound (TVUS) – can pick up a tumor not diagnose malignancy
  • Abdominal and pelvic CT scan
  • Pelvic MRI scan.
  • Blood test – cancer antigen 125 (CA-125) – a biomarker used to assess treatment response for ovarian cancer, but other factors affect levels in the blood, such as menstruation, uterine fibroids, and uterine cancer
  • Biopsy – only way to confirm the presence of ovarian cancer

Treatment of Ovarian Cancer

A combination of surgery and chemotherapy is the typical treatment:

  • Removal of the affected ovary and its fallopian tube which will preserve fertility.
  • Removal of both ovaries and fallopian tubes, leaving the uterus which still allows pregnancy with preserved or donor ova.
  • Complete hysterectomy with nearby lymph nodes, if advanced, may do chemotherapy first to shrink the tumors before the surgery.

Chemotherapy can be administered orally, intravenously or intraperitoneally and consist of a cocktail of drugs that kill fast-growing cells. It is used before or after surgery.

Targeted therapy uses medications that target the specific vulnerabilities present within your cancer cells, when ovarian cancer recurs or resist other treatments, and is a very active area for ovarian cancer research.

Supportive (palliative) care – providing relief from pain and other symptoms to improve quality of life.

Talc and Baby Powder – The Research and Evidence

The concerns around the use of talcum powder and cancer have been focused on:

  • The possibility of inhaling talc particles at work (talc miners, talc factory workers) creating a higher risk of lung cancer.
  • The possibility of using talcum powder in the genital area creating a higher risk of ovarian cancer.

In the ‘70s, histological examination of removed ovaries found some talc particles in the ovaries, which are suspected of having migrated up the reproductive system into the ovaries, and this raised the first questions about the possibility of it causing inflammation in the organ, which could increase the risk of developing cancer cells.

What is talcum powder?

Talcum powder (often sold as baby powder) is a mineral made up of magnesium, silicon and oxygen, and it absorbs moisture and reduces friction. It is used widely in baby powder, cosmetic powders and several other products.

As the layers it is found in its natural state is close to layers of asbestos, it is sometimes contaminated with asbestos, which is known to cause cancer when inhaled.

According to the Cosmetic, Toiletry, and Fragrances Association (CTFA), a trade organization for cosmetics and personal care products, their standards dictate that all talc products used in personal care products or cosmetics must be free from detectable amounts of asbestos – this guideline was issued in 1976.

Asbestos

Asbestos is a group of minerals that naturally form bundles of fibers, comprises silicon and oxygen and other elements and are found in soil and rocks.

  • Chrysotile asbestos – curly, serpentine or white asbestos, is the most common type of asbestos in industrial applications
  • Amphibole asbestos – straight needle-like fibers – actinolite, anthophyllite, tremolite, amosite (brown asbestos), and crocidolite (blue asbestos)

Both types of asbestos have been linked with cancer.

Research evidence

The ‘evidence’ that talc products use may be associated with an increased incidence of ovarian cancer is entirely reliant on women’s memories of their use of talc products; thus, their scientific rigor has been criticized, and further research studies have raised doubt on the reliability of the results.

The studies also did not specify the type, composition, brand or components of the talc they remember using – there is a tenuous correlation at best. There are no experimental studies linking talc to ovarian cancer.

Neither talc nor asbestos has been shown to cause ovarian cancer, but asbestos has been shown to cause mesothelioma and to cause cancers in and around the lungs when inhaled.

Many cases filed against talc manufacturers failed due to the lack of scientific evidence and this may be part of the change in strategy in recent cases, shifting the blame from talc to asbestos contamination, and being able to convince juries that asbestos is a strong enough carcinogen despite the minuscule amounts found in a small number of samples tested over the years.

Research in this area continues – using cells in Petri dishes, lab animals, and case-controlled studies to determine the possibility of increased risk for ovarian cancer. However, so far, studies have not yielded any definitive results.

Agencies and Carcinogens

Substances in the environment are studies by several national and international agencies to determine if they are carcinogenic.

  • The American Cancer Society – uses their research to inform the public and medical community
  • The International Agency for Research on Cancer (IARC) – a part of the World Health Organization (WHO) and will use research studies on potential carcinogens to classify and inform, but it needs to be noted that some research studies used before has been invalidated and then retracted, so proper investigation is needed when using classifications. Items like toothpaste are classified as a carcinogen.
    • Talc that contains asbestos as “carcinogenic to humans.”
    • Talc not containing asbestos as “not classifiable as to carcinogenicity in humans.”
    • Perineal (genital) use of talc-based body powder as “possibly carcinogenic to humans,” but these limited studies have been heavily criticized as unscientific as it relies on memories.
  • The US National Toxicology Program (NTP) – a group of several different government agencies, including:
    • The National Institutes of Health (NIH)
    • The Centers for Disease Control and Prevention (CDC)
    • The Food and Drug Administration (FDA)
    • The NTP has not fully reviewed talc (with or without asbestos) as a possible carcinogen.

Ovarian cancer talc lawsuits

Talcum powder manufacturers do not label their products with warnings against a possible link with ovarian cancer, and J&J refuse to do so unless there is scientific evidence to support such labeling. Lately, after some of these verdicts, a few decided to label to protect themselves from lawsuits. Other manufacturers include Nivea, Avon, Ponds, and Gold Brand Baby Powder. Products are also being switched to corn flour.

  • Johnson & Johnson (J&J) in California – $417 million:

The first ovarian cancer verdict for a plaintiff – $70 million in damages and $347 million in punitive damages.

  • Mrs Fox vs J&J – $72 million

$10 million in damages and $62 million in punitive damages in failing for years to warn consumers about the risk of talc-based products and their link to ovarian cancer.

  • J&J in Missouri 2016 – $55 million

$5 million in damages and $50 million in punitive damages.

  • J&J in St Louis – $70 million

$2.5 million in damages, and $65 million in punitive damages.

Imergys Talc America also found liable for damages -$2.5 million.

  • J&J in St. Louis City 2018 – 4.69 Billion for 22 plaintiffs

$550 million in compensatory damages and $4.14 billion in punitive damages

Why such big awards with no scientific proof?

It is postulated that the awards are based on anger against big corporations and refers to J&J knowing since the early ‘70s that there have been small amounts of asbestos found in their talc products, but not reporting it to authorities nor notifying the public as if they were trying to hide it. Johnson & Johnson maintains that there was nothing to report as it was too minuscule to have any impact, and there is no scientific proof otherwise.

If you or a loved one has been diagnosed with ovarian cancer, discuss your case with Eileen Kroll, a registered nurse and personal injury trial attorney, at Cochran, Kroll & Associates at 1-866-MICH LAW (1-866-642- 4529) in Michigan. Our law firm only represents individuals and operates on a contingency basis so you will never be charged a fee unless we win your case.

Nikole has a special interest in medical-legal issues and holds post-basic degrees in medical law and business. She has developed quality improvement and safety plans for many practices and facilities to prevent medical-legal issues and teaches several courses on data protection and privacy, legal, medical examinations and documentation, and professional ethics. She has been writing professionally on legal, business, ethics, patient advocacy, research and medico-legal issues in articles, white papers, business plans, and training courses for over thirty-five years.

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