Harlow BL, Murray EJ, Rothman KJ. Genital powder use and ovarian cancer. JAMA. 2020 May 26;323(20):2096. doi: 10.1001/jama.2020.3858.

To the Editor.  We disagree with the analysis and interpretation of the findings presented by Dr O’Brien and colleagues.1 The increased risk of ovarian cancer in women with intact genital tracts exposed to powder (HR, 1.13) is actually greater than the estimated 10% increased incidence of ovarian cancer attributable to cumulative talc exposure with 10 000 or more applications previously reported in women with intact genital tracts.2 The lack of association in women without an intact genital tract is consistent with their curtailed exposure. O’Brien and colleagues discounted the results because their statistical test for heterogeneity was not statistically significant. No statistical test is needed to know that women without an intact genital tract face a different risk of ovarian cancer than women whose genital tract is intact.

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