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Original Investigation
January 7, 2020

Association of Powder Use in the Genital Area With Risk of Ovarian Cancer

Author Affiliations
  • 1Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
  • 2Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
  • 3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 4Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 5Department of Epidemiology, School of Public Health, University of Washington, Seattle
  • 6Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 7Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
  • 8Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
  • 9Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville
  • 10Social and Scientific Systems, Inc, Durham, North Carolina
  • 11Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
JAMA. 2020;323(1):49-59. doi:10.1001/jama.2019.20079
Key Points

Question  Is use of powder in the genital area associated with the risk of developing ovarian cancer?

Findings  In this analysis that pooled data from 4 cohorts with a total of 252 745 women, the hazard ratio for the association between self-reported ever use vs never use of powder in the genital area and incident ovarian cancer was 1.08 (95% CI, 0.99-1.17).

Meaning  Among women from 4 prospective cohorts, there was not a statistically significant association between use of powder in the genital area and ovarian cancer, but the study may have been underpowered to identify a small increase in risk.

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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