Table11_Systematic review of the association between talc and female reproductive tract cancers.XLSX

Talc is a hydrous magnesium sheet silicate used in cosmetic powders, ceramics, paints, rubber, and many other products. We conducted a systematic review of the potential carcinogenicity of genitally applied talc in humans. Our systematic review methods adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and incorporated aspects from the US Institute of Medicine (IOM, now the National Academy of Medicine) and several US EPA frameworks for systematic reviews, evaluating and integrating the epidemiological, animal, and mechanistic literature on talc and cancer. We conducted a comprehensive literature search. Detailed data abstraction and study quality evaluation, adapting the Toxic Substances Control Act (TSCA) framework, were central to our analysis. The literature search and selection process identified 40 primary studies that assessed exposure to talc and female reproductive cancer risks in humans (n = 36) and animals (n = 4). The results of our evaluation emphasize the importance of considering biological plausibility and study quality in systematic review. Integrating all streams of evidence according to the IOM framework yielded classifications of suggestive evidence of no association between perineal application of talcum powders and risk of ovarian cancer at human-relevant exposure levels. We also concluded that there is suggestive evidence of no association between genital talc application and endometrial cancer, and insufficient evidence to determine whether a causal association exists between genital talc application and cervical cancer based on a smaller but largely null body of literature.

滑石（Talc）是一种水合镁层状硅酸盐，广泛应用于化妆品粉、陶瓷、涂料、橡胶等诸多产品中。我们针对经生殖道施用的滑石对人类的潜在致癌性开展了系统综述。本系统综述的方法遵循《系统综述与元分析优先报告条目》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，并吸纳了美国医学研究所（US Institute of Medicine，IOM，现更名为美国国家医学院National Academy of Medicine）以及美国环境保护署（US EPA）的多项系统综述框架，对涉及滑石与癌症关联的流行病学、动物实验及机制研究文献进行评估与整合。我们开展了全面的文献检索工作，核心分析环节包括采用《有毒物质控制法》（Toxic Substances Control Act，TSCA）框架开展详细的数据提取与研究质量评价。文献检索与筛选流程最终纳入40项基础研究，分别评估了人类（n=36）与动物（n=4）接触滑石与生殖系统癌症风险的相关性。本评估结果强调，在系统综述中需同时兼顾生物学合理性与研究质量。基于美国医学研究所框架整合所有证据链后得出结论：在符合人类实际暴露水平的场景下，会阴部位施用滑石粉与卵巢癌风险之间不存在关联，该证据具有提示性效力。我们同时得出结论：经生殖道施用滑石与子宫内膜癌之间亦不存在提示性关联证据；鉴于现有关于宫颈癌的文献体量较小且整体结果多呈零效应，目前尚无足够证据确定经生殖道施用滑石与宫颈癌之间是否存在因果关联。