New trial over talc, cancer link: What you need to know

Two lawsuits ended in jury verdicts worth $127 million. Two others were tossed out by a judge who said there wasn’t reliable evidence that the talc in Johnson & Johnson’s iconic baby powder causes ovarian cancer. This week, yet another lawsuit is going to court, alleging that a California woman’s use of talcum powder over many years caused cancer. Her lawsuit accuses Johnson & Johnson of “negligent conduct” in making and marketing its baby powder.

So who’s right? And is baby powder safe? Most scientific research finds no link or a weak one between ovarian cancer and using baby powder for feminine hygiene, a practice generations of American mothers passed on to their daughters. Most major health groups have declared talc harmless. Johnson & Johnson, whose baby powder dominates the market, says it’s perfectly safe. Yet some 2,000 women have sued, and lawyers are reviewing thousands of other potential cases, most generated by ads touting the two big verdicts.

Jury selection in the latest trial began Monday. A look at the issue: What is talc? Talc is a mineral that is mined from deposits around the world, including the U.S. A naturally-occurring mineral, talc is mainly made up of the elements magnesium, silicon, and oxygen. The softest of minerals, it’s crushed into a white powder. It has been widely used in cosmetics and other personal care products to absorb moisture since ancient times, and Johnson & Johnson’s Baby Powder has been sold since 1894. But it’s mainly used in a variety of other products, including paint and plastics. In its natural form, talc can sometimes contain asbestos​, which is known to cause cancers in and around the lungs when inhaled. But all talcum products sold in the U.S. have not contained asbestos since the 1970’s. Does it cause ovarian cancer? Like many questions in science, there’s no definitive answer.

Determining the cause of cancer is difficult. It would be unethical to do what’s considered the best type of controlled study, asking a group of women to use talcum powder on their genitals and wait to see if it causes cancer, while comparing them to a group who didn’t use it. While ovarian cancer is often fatal, it’s relatively rare. It accounts for only about 22,000 of the 1.7 million new cases of cancer expected to be diagnosed in the United States this year. Factors that are known to increase a women’s risk of ovarian cancer include age, obesity​, use of estrogen therapy after menopause, not having any children, certain genetic mutations and a personal or family history of breast or ovarian cancer. What research can be done? Two other kinds of studies are possible. Neither of them, though, can conclusively prove something causes cancer. One looks back in time, after an illness has occurred. It compares two groups of people, one with the illness, one without, and asks about past exposures that might be factors. But people don’t always accurately remember details years later. The second approach tracks a large group of people over time. It assesses their health at the start and follows them for years, recording any illnesses they develop while tracking possible influences such as diet and use of medication, alcohol​ or other substances. Scientists generally find these “prospective” studies more reliable.

What research shows The biggest prospective studies have found no link between talcum powder applied to the genitals and ovarian cancer. But about two dozen smaller, look-back studies over three decades have mostly found a modest connection – a 20 percent to 40 percent increased risk among talc users. However, that doesn’t mean talc causes cancer. Several factors make that unlikely and there’s no proof talc, which doesn’t interact with chemicals or cells, can travel up the reproductive tract, enter the ovaries and then trigger cancer. One large study published in June that followed 51,000 sisters of breast cancer patients found genital talc users had a reduced risk of ovarian cancer, 27 percent lower than in nonusers.

An analysis of two huge, long-running U.S. studies, the Women’s Health Initiative and the Nurses’ Health Study, showed no increased risk of ovarian cancer in talc users. What experts say If there were a true link, Dr. Hal C. Lawrence III says large studies that tracked women’s health for years would have verified the results of the smaller look-back ones. “Lord knows, with the amount of powder that’s been applied to babies’ bottoms, we would’ve seen something” if talc caused cancer, said Lawrence, vice president of the American College of Obstetrics and Gynecology. Similarly, Dr. Francisco Xynos, a gynecologic oncologist at SSM Health St. Mary’s Hospital in St. Louis, told CBS affiliate KMOX Radio earlier this year that the scientific evidence of a cancer link is weak. “I think the concern for the general population should be negligible, because there is no scientific proof of that,” Xynos said.

The National Cancer Institute’s Dr. Nicolas Wentzensen says the federal agency’s position is that there’s not a clear connection. “It is very hard to establish causal relationships,” he said. “A lot of ovarian cancers occur in women who have never used talc, and many women have used talc and not gotten ovarian cancer.” The International Agency for Research on Cancer (IARC), which is part of the World Health Organization, classifies genital use of talcum-based body powder as “possibly carcinogenic to humans.” The American Cancer Society (ACS) says more research is needed on the topic. ACS research director Elizabeth Ward says it is unusual to have so much discrepancy between studies. “The risk for any individual woman, if there is one, is probably very small,” Ward said. What lawyers and courts say Like the studies, courts have produced mixed results. In the first trial two years ago, a South Dakota jury found Johnson & Johnson liable for one woman’s ovarian cancer but didn’t award any damages. This year, state court juries in St. Louis awarded plaintiffs $72 million and $55 million – verdicts the company is appealing. But U.S. District Judge Nelson Johnson in Atlantic City, New Jersey, threw out the first two of the 400 lawsuits in his court.

He reviewed the research and testimony from two doctors who are the plaintiffs’ key expert witnesses and concluded they aren’t reliable, noting they had previously written that there was no proof talc causes ovarian cancer. Other courts approved them as experts, noted the plaintiffs’ attorney, Ted Meadows of Montgomery, Alabama. J&J attorney John Beisner says the health care giant plans to fight every lawsuit, rather than settle, “for the fundamental reason that the science on which they’re based is totally lacking.” Most of the pending cases are in Missouri, California and New Jersey, where J&J is based. In the case that began Monday in St. Louis, lawyers for Deborah Giannecchini of Modesto, California, say she was diagnosed with ovarian cancer in 2012 after years of talcum use. Her lawsuit accuses the company of “negligent conduct” in making and marketing its talc.

Ovarian Cancer Still Gets Shortchanged, National Academy of Medicine Report Finds

MAGGIE FOX

Ovarian cancer is being shortchanged in terms of medical attention and understanding, even though it's one of the deadliest cancers there is, experts reported Wednesday.

It's still treated as a single cancer even though there are actually multiple types, many of which do not even start in the ovaries, the National Academy of Medicine reported.

And treatment falls short, the panel of experts said. There are not many treatments to choose from, but half of all women with ovarian cancer don't even get the best treatments out there.

"In spite of their high mortality rates, ovarian cancers often do not receive as much attention as other cancers," reads the report from the Academy, formerly named the Institute of Medicine.

"The five-year survival of women with the most common and fatal type of ovarian cancer, high-grade serous carcinoma, has increased over the past four decades as a result of advances in specialty care and the development of effective first-line chemotherapy (i.e., platinum compounds in combination with drugs of the taxane family)," reads the report from the committee, chaired by Dr. Jerome Strauss, dean of the school of medicine at Virginia Commonwealth University.

"However, there are concerning racial disparities and a number of unresolved issues regarding the optimal treatment of newly diagnosed women which if addressed could lead to further reductions in morbidity and mortality. Moreover, important discoveries that directly influence clinical recommendations or care have not been widely adopted," it adds.

A woman has a much better chance of surviving ovarian cancer if she is treated by a gynecologic cancer specialist in a place where many cases of ovarian cancer are treated. But that's not an option for many women, the report said.

Ovarian cancer is diagnosed in more than 21,000 women a year in the United States, and it kills more than 14,000. "It is the fifth leading cause of cancer deaths among women, with a five-year survival rate of less than 46 percent," the panel said in its report.

"However, five-year survival rates decreased for black women, from 42 percent between 1975 and 1977 to 36 percent between 2005 and 2007."

It's so deadly partly because the signs are vague and women don't realize they have cancer until it has spread. Women and their doctors both often fail to take seriously symptoms such as bleeding and bloating, the report finds.

"The committee found recent evidence that suggests many ovarian cancers arise in other tissues besides the ovary, such as the fallopian tubes, which eventually metastasize to the ovary, or they arise from cells that are not considered intrinsic to the ovary," the report said.

"Furthermore, researchers do not have a complete understanding of how each subtype of ovarian cancer progresses."

The committee recommended more and better research into ovarian cancer, how it arises, who's at most risk, and which treatments are the most effective.

Ovarian Cancer: Why Don't More Doctors Use This Life-Extending Technique?

American Council on Science and Health

In America this year, over 21,000 new cases of ovarian cancer are expected, and over 14,000 deaths. 

Once ovarian cancer has spread within the peritoneal cavity or to other organs, long-range survival is rare. However, shorter-term benefits can be obtained via several different chemotherapy regimens and one, essentially abdominal chemotherapy, has been very promising.

So why isn't it used more?

Clinical trials dating back almost 20 years have consistently demonstrated a survival advantage in advanced ovarian cancer treated with this IP/IV (intraperitoneal/intravenous) chemotherapy, as compared with standard IV only chemotherapy. 

In 2006, a large study known as GOG-172 (Gynecologic Oncology Group) demonstrated a 16-month improvement in median overall survival. A new study just published in the Journal of Clinical Oncology confirms the superiority of the combined IP/IV approach. But data collected from six National Comprehensive Cancer Centers Hospitals showed that the combination approach is only being utilized by slightly less than half of patients who are candidates for it.

The study was performed by a multi-center group of researchers led by Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston, and was also published in the Journal of Clinical Oncology. They examined IP/IV chemotherapy use in all patients (823) diagnosed between 2003 and 2012, and evaluated overall survival and treatment-related toxicities in a sample (402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias.

They determined that the use of IP/IV chemotherapy increased, (most likely)  as a result of the 2006 publication of the GOG-172 study, from 0% in 2003 to 50% in 2008, and plateaued thereafter; 43 percent of patients received modified IP/IV regimens at treatment initiation. IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%), compared with IV chemotherapy.

The authors concluded that although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.

An article in the New York Times by Denise Grady on this study and topic speculated on some possible reasons why this beneficial treatment method is being under-utilized: “Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.”

Those possible rationales for not giving late-stage ovarian cancer patients state-of-the-art treatment are quite simply unacceptable. Another word of advice from the Times/Grady article is this: “Patients have to be more proactive and forceful. They should ask if their doctor uses the IP/IV treatment, and if he or she does not, they should seek another doctor.”

Ten Questions to Ask Your Doctor About Ovarian Cancer:

1. Has my ovarian cancer spread?

2. Do I have to have both of my ovaries removed? If so, will I have hot flashes?

3. How confident are you that all of the cancer has been removed?

4. Which chemotherapy drugs do you recommend? Do I have any other treatment options?

5. How long will I have to undergo chemotherapy?

6. What side effects should I look for? Are there ways to minimize these side effects?

7. Will I need any additional surgery?

8. Should I be tested for the BRCA-1 BRCA-2 mutations? What should I do if the test is positive?

9. What signs should I look for that might indicate the ovarian cancer has come back?

10. How often should I come in for follow-up visits?

Bandages for Lymphedema

Bandaging is a mainstay of treatment for stage 2 and stage 3 lymphedema (moderate to severe lymphedema). Bandaging involves creating a soft cast on the arm or upper body by wrapping with multiple layers. This is a main component of the larger treatment regimen called complete decongestive therapy, or CDT, and many research studies have demonstrated the effectiveness of CDT. While there aren't many studies that focus just on bandaging, the small amount of research available suggests that bandaging can reduce arm volume.

At first, your lymphedema therapist should do the bandaging for you while teaching you the right technique. Some therapists provide an instructional DVD or written directions to guide you. The process starts with an inner liner made of stocking-like fabric or gauze, also known as a stockinette. The liner would be placed over the arm and hand after moisturizing the skin with a gentle lotion such as Eucerin or Curel. Try to avoid lotions with anything that could irritate the skin, such as perfumes or dyes.

In most cases, padding made of polyester, cotton, or foam would be placed over the stockinette, followed by multiple overlapping layers of short-stretch bandages. Short-stretch bandages look like the Ace bandages you might get at the drugstore, but they're much less stretchy. Generally, there would be more layers further down on the limb and fewer layers higher up, creating graded pressure that helps fluid move up and out of the arm. The bandages should feel snug but not tight.

Bandaging is also an option for lymphedema of the chest or trunk, as short-stretch bandages come in all sizes. Bandaging is a reductive therapy, meaning it makes the limb smaller. When your arm is bandaged, your muscles are "held in" by the multi-layer soft cast every time you use your arm. This is known as working pressure. When you do any prescribed exercises with the bandages on, or simply use your arm as for normal activities, this working pressure creates an internal pumping action that moves fluid out of the tissues and into vessels of the lymphatic system. The bandage cast helps prevent fluid from flowing back into the limb, and it also softens the tissue under the skin. This is why bandages are an important treatment for lymphedema that is causing moderate to severe swelling and/or soft tissue changes.

It is recommended to work with a certified lymphedema specialist to create a tailored plan to treat and manage your lymphedema. We have several certified lymphedema specialists on our Ricky Knowles Hair & Wellness team. Our therapists will work with you to address any problem areas and our certified compression garment fitter, Kristen, can create custom compression wear to help you improve your condition and mobility.

To schedule a free consultation, call a RNHW team member at 713-623-4247 today!

Look Good, Feel Better!

Our world-renowned hair stylist and cosmetologist, Ricky Knowles, will be teaching women undergoing cancer treatment tips and beauty techniques to manage the effects of chemotherapy and radiation on October 14th at MD Anderson - Clear Lake and on October 16th at Memorial Hermann - The Medical Center.

The Look Good...Feel Better program is offered in partnership with the American Cancer Society and is free of charge.

Ricky will teach attendees make up enhancement techniques, educate women about wigs, hairpieces and skin care and show them how to wear head scarves and turbans.  The presentation will be hands-on with plenty of time for questions.  Each woman gets a free makeup kit to use during and after the workshop.

If you or a loved one is undergoing cancer treatment, register for the free seminar and get an opportunity to visit one-on-one with Ricky and learn his secrets to Looking Good, and Feeling Better! For more information, or to register for one of these events, call the American Cancer Society Houston Office at (713) 266-2877.

Blood Test May Allow for Early Diagnosis of Lymphedema

From Oncology Nurse Advisor

Levels of a set of proteins circulating in the blood may accurately flag the presence of lymphedema, which currently is difficult to diagnose before the onset of physical symptoms.

At present, the only known way to diagnose lymphedema, an often painful inflammatory condition caused by radiation therapy for cancer, is by means of physical inspection. But by the time the main symptom of swelling of one or more limbs is detectable, the condition may be difficult or impossible to reverse with available treatment options, explained Stanley G. Rockson, MD, senior author of the study describing the new blood test, in a statement from Stanford University Medical Center in Stanford, California. Rockson is a professor of cardiovascular medicine at Stanford University School of Medicine.

Noting that the biological events underlying lymphedema may be present for 5 years or more before physical symptoms indicate the presence of the disease, Rockson's group studied skin-biopsy samples from 63 persons with lymphedema and 27 healthy subjects in an attempt to discover protein analytes that could distinguish diseased tissue from healthy tissue. The researchers focused on genes that were more actively engaged in the generation of their respective protein products in lymphedema vs healthy tissue, eventually narrowing the field to six overproduced proteins through statistical modeling.

Each of the six proteins is associated with at least one of the hallmark features of chronic lymphedema: accumulation of fibrous deposits, stimulation of fat-cell activity, inflammation, and lymphatic-vessel formation. Although none of the six proteins alone was predictive of lymphedema, in aggregate their presence at certain levels and in certain ratios appeared to serve as a biomarker for the condition.

Because levels of these proteins rise early in the course of lymphedema, the biomarker panel could lead to earlier identification of lymphedema risk or onset and earlier treatment that might ease the effects of the condition or even reverse its course.

When Rockson's team evaluated the validity of the biomarker panel using blood samples from an additional cohort of 36 adults with lymphedema and 15 healthy adults, the test was nearly 90% accurate in distinguishing persons with lymphedema from healthy subjects.

If you are a cancer survivor, or are currently undergoing cancer treatment and need help with lymphedema treatment, custom compression garments or lymphedema support groups, contact our team at Ricky Knowles Hair & Wellness at 713-623-4247 and schedule a free consultation.

Great Tool for Cancer Patients and Caregivers

Have you or a loved one experienced a health crisis? If so, you know how difficult it is to manage your doctor's appointments, treatment and communicate with family and friends.

CaringBridge is a non-profit organization which offers free personalized websites to people facing a serious medical condition or hospitalization, undergoing medical treatment and/or recovering from a significant accident, illness, injury or procedure.

It functions similar to a blog and allows family members and friends to receive consistent information via a single website, and eliminates the need to place and receive numerous telephone calls or individual emails.

Visitors are invited to view each individual website and can read updates on a patient's condition or post their own messages of support and encouragement.

The site also offers a Support Planner which is a calendar that helps family and friends coordinate care and organize helpful tasks, like bringing a meal, offering rides to appointments or taking care of pets and other needs.

Each website is password protected to ensure a space for personal and private conversations and the service is free of charge.

As part of our goal to educate our clients in their mastectomy, hair loss or lymphedema needs, our team will help you set up convenient appointments that meet your busy schedule. That's why we are open 6 days a week, and can even arrange home or on-site visits.

To schedule an appointment, call 713-623-4247 today!

I was just diagnosed with breast cancer and am terrified about losing my hair during chemotherapy treatment! How can Ricky Knowles Hair and Wellness help me?

When a woman is diagnosed with cancer her world is rocked off its axis.  And frequently treatment involves surgery, radiation or chemotherapy, which can result in hair loss.  Often women find hair loss from chemotherapy treatment more emotionally devastating than the diagnosis of cancer itself.

At Ricky Knowles Hair and Wellness, we set ourselves apart from other traditional wig shops because we are in the hair duplication business.  We provide a supportive and discreet environment for all of our clients; hair loss, mastectomy or lymphedema clients.  Our dedicated team will help guide you through your hair loss by:

• educating you about the effects of chemotherapy and when to expect hair loss to occur
  
• verifying and billing your insurance
  
• assisting you in choosing the right cranial prosthesis for your lifestyle
  
• prepping your new hair for delivery
  
• serving as your extended support system throughout the whole process

When a client is faced chemotherapy hair loss, we ask them to immediately come in with their cranial prosthesis prescription before chemotherapy treatment begins, for a complimentary consultation.  During this consultation we will discuss all of your options to help you stay confident during your temporary hair loss.

We will then educate you about the different types of wigs (human hair wigs and synthetic hair wigs) and help you decide what hair loss solution will work best for you to give you the most realistic duplication of your natural hair.

All of our consultation rooms are private and are equipped with the best salon hair styling equipment available.  A team member will explain the process of when hair loss will begin and most importantly when your natural hair will regrow.

If you choose a human hair wig, Ricky Knowles, our internationally-renowned wig stylist will color, and hi-light the hair.  Synthetic hair wigs, cannot be colored or hi-lighted, but there are many shades and hues available.

Since we assist many women and men during their chemotherapy treatment, we've become personal cheerleaders, empowering our clients in their individual fight against cancer.

Many clients will request to have us shave or cut their hair short, so that they are in charge of their hair loss. At this point, a RNHW team member will teach you how to care for your scalp and fit you with your new hair and cut and style the new hair.  After the finishing touches are completed, we will even demonstrate scarf tying methods and show you our selection of stylish turbans and hats.

We stand by our methods and will deliver a final product that will make you feel confident in your new hair.  Since our goal is to duplicate your natural hair and style, our clients look good and feel good with Ricky Knowles Hair & Wellness by their side!

For more information about our line of natural and synthetic wigs, or to schedule a free consultation, call us at 713-623-4247.