Ovarian cancer: are hairdressers, beauticians and accountants more at risk?
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Jobs as a hairdresser, beautician and accounting clerk may be related to an increased risk of ovarian cancer. And cumulative exposure to some substances – in particular talcum powder (already in the spotlight, but no firm data has ever been reached), ammonia, propellant gases, petrol and bleach – could play a role. The hypothesis – because we are talking about hypotheses – emerges from a Canadian study just published on Occupational & Environmental Medicine. However, conditionals – as always happens in epidemiological studies carried out a posteriori like this one – are more than a must: the data, in fact, show a wide range of variability and uncertainty. Furthermore, as always, it must be remembered that correlation is never synonymous with a cause-and-effect relationship. Which for the substances mentioned has never been proven.
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The only certainty that we have, to date, is that few studies on occupational factors of cancer have included women, and that the possible environmental causes of ovarian cancer are not yet well understood: only asbestos has been recognized as an occupational carcinogen for this tumor. Hence the need for investigations such as this one, conducted by the Department of Preventive and Social Medicine at the University of Montréal, Canada, and by the Exposome and Heredity group at Inserm in Paris, France.
I study
Between 2010 and 2016, the researchers interviewed 491 Canadian women, aged 18 to 79, who had been diagnosed with ovarian cancer (of the serous epithelial type, the most common) in the previous 4 months. As a control sample they selected 897 with the same age, without the neoplasm. Information collected included medical history, reproductive history, weight and height, lifestyle factors, and employment history. Most of the women with ovarian cancer used the contraceptive pill less and had fewer children than the women in the control sample (the two protective factors against this neoplasm, and the difference was considered in the study).
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The results
The data indicate that those who have worked for more than 10 years as a hairdresser or beautician would have a risk from 1.25 to over 8 times higher (about 3 times, on average), while those who have worked as an accountant would see their risk increased by double (always on average). No correlations emerged, however, with the work of a nurse. The number of women employed in certain occupations – paper, printing, textile manufacturing, dry cleaning, manufacturing or who had been exposed to specific agents, including those previously reported as potential risk factors for ovarian cancer – asbestos and pesticides – is small , the researchers acknowledge. And some observed statistically significant associations were probably due to chance. “The merit of the study is undoubtedly that of turning the spotlight on the possible occupational risks for ovarian cancer and on the scarcity of research in this area”, he comments Charles La Vecchia, Professor of Medical Statistics and Epidemiology at the State University of Milan and researcher at the Airc Foundation – “The excess risk is observed only for two professions out of about 20 considered: hairdressers/beauticians and accountants. Specifically, 21 patients with ovarian cancer were hairdressers/beauticians versus 23 women in the control group, and 29 patients were accountants versus 35 controls. The numbers are then run, which explains the high variability in the increased risk found. Furthermore, for the first category, the increase in risk is not time-dependent under 10 years of exposure. Lastly, the data on nurses is very interesting, since the alteration of sleep-wake rhythms and the fact that they usually tend to have children later are two possible risk factors”.
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29 “investigated” substances
From the type of employment and the time, the researchers traced the possible cumulative exposure to 29 chemical agents in the workplace (through a standard “scale”, the Canadian job-exposure matrix CANJEM). They then analyzed the relationship between exposure to these substances and the risk of ovarian cancer. Here it emerges that a cumulative exposure of at least 8 years to 18 different substances appears to increase the risk by 0.4 times compared to no exposure. Among these substances, as anticipated, we find talcum powder, ammonia, hydrogen peroxide (hydrogen peroxide), hair powders, synthetic fibers, polyester fibers, organic dyes and pigments, cellulose, formaldehyde, propellant gases, compounds found in gasoline and whiteners. Hairdressers and beauticians (and those who work in the same environments) are exposed to 13 of these agents, say the scholars.
But ovarian carcinogenicity is not proven
“The most important point to highlight is that there is no biological and toxicological explanation of the carcinogenic effect of the substances mentioned on the ovary – he comments Angelo Moretto, Professor of Occupational Medicine at the University of Padua – There is no experimental data that indicates that they can reasonably cause this neoplasm”. For example, ammonia, explains the expert, is highly irritating and causes necrosis of the skin and mucous membranes, but not tumours. Again: we know that some polycyclic aromatic hydrocarbons (PAHs) are carcinogenic to the skin and lungs, but can’t carcinogenicity automatically be extended to other tissues? “No: in the case of polycyclic aromatics, carcinogenicity occurs through skin contact or inhalation. Experimentally it has been seen that always and only skin or lung tumors develop and not in other sites. This can tell us two things: either that the substances do not reach other organs or that these tissues have a different biology and therefore a different toxicology or, more reasonably, both”.
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The talc question
Talc may contain traces of asbestos, which is well known to be carcinogenic. Several studies have therefore investigated the use of talcum powder, however arriving at contradictory results (which the decisions of the US courts have not always taken into account, given the lawsuits by patients against large companies that sell talc-based products) . Notably in 2020 the largest study ever published had found no statistically significant correlation. “In ovarian cancer the only associations for which the IARC (International Agency for Research on Cancer) considers the evidence in humans sufficient are exposure to asbestos, X-rays and gamma rays – he also comments Lucia Mangone, head of the Cancer Registry and epidemiologist of the Local Health Authority-Irccs of Reggio Emilia – The effort of the authors is appreciable, because they want to draw the attention of the scientific community to the environmental and occupational exposures that are less studied in the female sex. But, although the study is well conducted and the series is large, the same authors conclude that further studies are needed to confirm the results. Which at the moment, in my opinion, are still too weak ”.
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“One of the problems when so many factors are considered together is that at least one of these emerges only as a result of chance – adds La Vecchia – It must also be said that polycyclic hydrocarbons which are not very common in hairdressers and that it is very difficult to find an common to those who have dealt with accounting at the time”. Hairdressers had already been included among the possible potentially carcinogenic jobs by the IARC but above all for bladder cancer linked to the possible presence of aromatic amines in dyes, which however have been eliminated or strongly controlled since the 70s. draw – concludes the expert – is that even in small companies it is necessary to pay maximum attention and respect the safety standards required in large industries”.
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