When a St. Louis jury awarded $72 million to the family of a woman who died from ovarian cancer, which she claimed was caused by using Johnson & Johnson talcum powder, it prompted many questions about just how safe such products really are.
Jackie Fox of Birmingham, Alabama, was diagnosed with ovarian cancer in March 2013 and died last October. Her civil suit, which was taken over by her son Marvin Salter after her death, was decided in February 2016 and was part of a broader claim in St. Louis Circuit Court involving nearly 60 people.
The suit claimed the talc in Johnson & Johnson's iconic Baby Powder and Shower to Shower led Fox to develop cancer after several decades of use for feminine hygiene.
In a similar case in May, a jury ordered Johnson & Johnson to pay $55 million to a South Dakota woman who said the company's talcum powder caused her to develop ovarian cancer.
A naturally-occurring mineral, talc is mainly made up of the elements magnesium, silicon, and oxygen. It's widely used in cosmetics and personal care products to absorb moisture, cut down on friction, prevent caking, and improve the product's feel.
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.
The evidence around asbestos-free talcum products and cancer risk is more unclear.
The American Cancer Society notes that research looking at the potential link between talcum powder and ovarian cancer is mixed. Some studies report a slightly increased risk in women who reported using talcum powder in the genital area, while other studies found no increased risk at all.
Experts say some of the studies that found a small increase in risk may not be highly accurate because they relied on a person's memory of talc use many years earlier.
Dr. Francisco Xynos, a gynecologic oncologist at SSM Health St. Mary's Hospital in St. Louis, told CBS affiliate KMOX 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 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 says more research is needed on the topic.
At the trial in Fox's case, Dr. Daniel Cramer, Director of the OB/GYN Epidemiology Center at Brigham and Women's Hospital in Boston, and an expert who testified for the plaintiff, said he conducted his own study that shows an increased risk of ovarian cancer with talcum powder use.
"I think the link is a persuasive one," Cramer told CBS Boston. "There have been more than 20 epidemiologic studies and a majority of these have found an elevated risk, and when you combine those risks into a single estimate, it is highly significant."
Fox's attorneys also introduced into evidence a September 1997 internal letter from a Johnson & Johnson medical consultant suggesting that denying the risks could mean that "... the talc industry will be perceived by the public like it perceives the cigarette industry: denying the obvious in the face of all evidence to the contrary."
"They made a conscious decisions not to warn the customers they were using a very dangerous product," said Jere Beasley, a lawyer for the family.
The St. Louis jury determined that Fox was entitled to $10 million in actual damages and $62 million in punitive damages. (Lawyers note that such large monetary awards are often reduced on appeal.)
"The whole fight was not just for her but so many other women and that's why I continue this fight," Fox's son, Marvin Salter, said.
Johnson & Johnson said in a statement that it sympathizes with Fox's family, but it maintains that the verdict "goes against decades of sound science proving the safety of talc as a cosmetic ingredient in multiple products."
The company said it would appeal.