Genital powder use and risk of uterine cancer: A pooled analysis of prospective studies

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.

Intimate Care Products and Incidence of Hormone-Related Cancers: A Quantitative Bias Analysis

“…Our findings that neither genital talc use nor douching was strongly associated with uterine cancer were consistent with previous literature 24,41,42 ; we are unaware of any relevant breast cancer studies. We hypothesized that the endocrine disruptors in douche could affect carcinogenesis for any hormone-related cancer, but only the uterus and ovaries could experience adverse effects caused by direct physical contact.…”

Epidemiologic Methods to Advance Our Understanding of Ovarian Cancer Risk

“…This study also adds to the sparse literature on intimate care product use and uterine and breast cancer risks, [24][25][26] with no association observed between genital powder or douching and uterine or breast cancer. Given that ovarian and uterine cancers are both gynecologic cancers and the reported association with one but not the other may not be appreciated by the general population, one could expect them to be similarly affected by recall bias.…”

Douching and Genital Talc Use: Patterns of Use and Reliability of Self-reported Exposure

“…Missing data at enrollment: douching as adolescent = 359, douching last 12 months = 165, ever douching = 155. Missing data at detailed follow-up 4: ever douching = 220, douching as teen = 287, douching in 20s = 281, douching in 30s = 286, douching in 40s = 292, douching in 50s = 295 (716 ineligible), douching in 60s = 269 (7,611 ineligible), douching in 70s = 180 (22,192…”

“…Missing data detailed at follow-up 4: ever genital talc use = 182, genital talc use as teen = 247, genital talc use in 20s=248, genital talc use in 30s = 248, genital talc use in 40s = 252, genital talc use in 50s = 249 (716 ineligible), genital talc use in 60s = 222 (7,611 ineligible), genital talc use in 70s = 124 (22,191 Boxes with shading indicate women who reliably reported ever vs. never use. Those in the darker shaded boxes provided the same responses on the enrollment and follow-up questionnaires that were fully consistent with one another.…”

“…Using data from the Sister Study, we examined patterns of use and reliability of recall for two feminine hygiene products thought to be associated with gynecologic cancers 4,[17][18][19][20][21][22] and other reproductive health-related outcomes 2,23 : douche and powder applied to the genital area. More specifically, we describe how women of varying ages, racial and ethnic groups, and education levels use these products over their lifetimes and examine how reliably the use of such products can be recalled over time.…”