Johnson & Johnson (J&J) has agreed to pay billions of dollars to settle lawsuits alleging that its talcum powder products caused ovarian cancer and other illnesses because they contained asbestos. The proposed settlement, among the largest of its kind in US history, comes after years of litigation, conflicting scientific evidence and repeated legal setbacks for the company.For decades, the pharmaceutical giant sold talc-based baby powder and other products. Thousands of consumers alleged that long-term use caused ovarian cancer and mesothelioma — a rare and aggressive cancer in the thin tissue lining our internal organs — because the talc was contaminated with asbestos, a known carcinogen. The company has consistently denied that its talc products were unsafe and says the settlement is intended to end years of costly litigation and provide certainty for claimants and shareholders.In 2020, J&J stopped selling talc-based baby powder in the US and Canada. In 2023, it discontinued talc-based baby powder globally, replacing it with a cornstarch-based formulation. So how safe is your talcum powder? What are its chances of getting contaminated with asbestos? What about the cancer risks? We explain, citing experts.Based on current medical evidence, what is the scientific consensus on the link between talcum powder and ovarian cancer?The International Agency for Research on Cancer (IARC) classifies talc, not containing asbestos, as “probably carcinogenic to humans” (what is called group 2A) for ovarian cancer, based on limited evidence in humans and sufficient evidence in animal studies. Also Read | Expert Explains | A daily pill that slashes cholesterol: How it works, why it’s a breakthrough“There is not sufficient evidence to support that talc is a definite (or Group 1) carcinogen for ovarian cancer. Prospective cohort studies, which are less prone to recall bias than case-control studies, have generally not shown a statistically significant increase in risk for ovarian cancer,” says Dr Gauravi Mishra, Deputy Director, Centre for Cancer Epidemiology (CCE), Tata Memorial Centre, Mumbai, Story continues below this adHow does cosmetic talc differ from asbestos and under what circumstances can talc become contaminated with asbestos?Talc and asbestos are both naturally occurring silicate minerals that may co-form within the same geological deposits, a relationship documented in geological studies since the late 19th century. “Contamination of talc with asbestos is, therefore, dependent on the mine of origin and the rigour of ore screening, and is not an inherent property of the consumer talc product itself. Mining of asbestos is banned in India. Existing tests are not sensitive enough to reliably exclude trace asbestos contamination. Hence, there is no standardised testing method currently recommended by any regulatory body,” says Dr Ashwin Sathyan, senior resident, Department of Preventive Oncology, CCE.Should people who have used talcum powder regularly for years be concerned?There is no cause for alarm among long-term users of talcum powder. This position is consistent across IARC and independent reviews. “Prior use should not be attributed as the cause of any current symptoms without appropriate clinical evaluation. Women with a family history of ovarian or breast cancer are advised to discuss this concern with their physician,” advises Dr Mishra.What are the current guidelines about use of talcum powder?No major regulatory or scientific body has issued a prohibition on talcum powder use on any body part, including the genital area. “Use of talc on open wounds or sensitive skin is not recommended, as it may lead to irritation or mineral toxicity. Regulatory policy in India is still under development and scrutiny,” says Dr Mishra. Story continues below this adThe Central Drugs Standard Control Organisation (CDSCO) ordered a manufacturing halt for one major brand in 2018 pending asbestos-free certification, and the Maharashtra Food and Drug Administration (FDA) cancelled a manufacturing licence in 2022 on grounds of pH specification and not cancer-associated risks.Also Read | How the world’s first weekly insulin shot could change diabetes treatment in India“Talc is not a reason for panic but it is also not an indispensable personal care product. Given the remaining uncertainty, the prudent approach is to choose a traceable, talc-free product where a powder is genuinely needed,” says Dr Usha Khemani, associate professor of dermatology, JJ Hospital, Mumbai.However, there are caveats. According to Dr Pralhad Rathod, professor and HOD, dermatology at JJ Hospital, Mumbai: “Body powder should be avoided altogether on babies, especially near the nose and the mouth; in individuals with asthma or chronic respiratory diseases; on raw, broken, inflamed, or infected skin; when there is an undiagnosed genital rash; where the powder repeatedly cakes with sweat and increases friction; in poorly ventilated areas.”Are cornstarch-based powders a safer alternative?Cornstarch-based powders are a reasonable substitute, being plant-derived and free of any asbestos-contamination pathway. “They are not linked in literature to ovarian cancer risk. Body powders of either type are best avoided on broken or irritated skin, on post-surgical or post-partum wounds, and in infants, where inhalation risk is highest,” says Dr Mishra.Story continues below this adAre India-made talcs safe?Available India-specific data is limited and in its early stages. “Tremolite asbestos was found in seven of 13 commercially available Indian talc products tested, and an earlier Indian Institute of Toxicology Research (IITR), Lucknow report similarly identified asbestos fibres in five Indian brands,” says Dr Sathyan.Also Read | Expert Explains | Why govt banned 16 combination drugs, from antibiotics to aloe vera creamsUnder India’s Cosmetics Rules, 2020, finished skin powders must conform to the applicable Bureau of Indian Standards specifications: IS 3959 for skin powders and IS 5339 for infant skin powders, respectively. A peer-reviewed Indian public health review has also called for stronger asbestos testing and regulatory transparency in the talc manufacturers. “Consumers should look for a licensed manufacturer, complete labelling, and traceable batch details, while regulators should ensure periodic market sampling and sensitive asbestos testing,” says Dr Rathod.Besides, the IARC hazard classification is not a calculation of the risk from the occasional personal use. “This means that under certain exposure circumstances, the substance is capable of causing cancer; it does not mean that every user — or even most users — will develop cancer,” says Dr Rathod.