Table2_Systematic review of the association between talc and female reproductive tract cancers.DOCX

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）是一种含水镁层状硅酸盐，广泛应用于化妆品粉、陶瓷、涂料、橡胶及诸多其他产品中。我们针对人体经生殖道施用滑石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（U.S. Institute of Medicine，IOM，现更名为美国国家医学科学院）及美国环境保护署（US EPA）多项系统综述框架的相关内容，对滑石与癌症相关的流行病学、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。本研究采用《有毒物质控制法》（Toxic Substances Control Act，TSCA）框架开展标准化的资料提取与研究质量评价，这是本次分析的核心环节。经文献检索与筛选流程，最终纳入40项评估滑石暴露与女性生殖系统癌症风险的原始研究，其中人体研究36项、动物研究4项。本次评估结果强调，在系统综述中需充分考量生物学合理性与研究质量。依据美国医学科学院框架整合所有证据链后，我们得出结论：在与人体实际暴露水平相当的场景下，会阴施用滑石粉与卵巢癌风险之间不存在关联，相关证据具有提示性意义。此外我们还得出以下结论：生殖道施用滑石与子宫内膜癌之间不存在关联的相关证据同样具有提示性意义；针对宫颈癌的相关文献体量较小且整体结果多为阴性，现有证据尚不充分，无法判定生殖道施用滑石与宫颈癌之间是否存在因果关联。