Can Baby Powder Really Cause Ovarian Cancer?

A jury has ordered Johnson & Johnson to pay $417 million in damages to a 63-year-old woman in Los Angeles who developed ovarian cancer after using the company’s talc-based baby powder for decades.

Like many women who use baby powder to freshen up or reduce chafing between their thighs, on their genitals, or in their underwear, Eva Echeverria was unaware for many years of the potential link between ovarian cancer and talc, an ingredient in some types of baby powder.

This isn’t the first time the company has been involved in a lawsuit over its popular powder—and it will likely face hundreds more cases in the future, according to Reuters. In May, a Missouri jury awarded $110 million to a Virginia woman who alleged that her cancer was caused by baby powder, and last October, a Missouri woman was awarded more than $70 million.

Earlier in 2016, Johnson & Johnson was also ordered to pay $72 million to the family of a woman who died in 2015, and $55 million to a South Dakota woman who survived. Two similar suits in New Jersey and one in Saint Louis have been dismissed after a judge deemed there was insufficient evidence linking talc to ovarian cancer.

Johnson & Johnson said in a statement that the company will appeal this latest verdict, and cites a National Cancer Institute report from April that found the weight of evidence “does not support an association between perineal talc exposure and an increased risk of ovarian cancer.” (However, the New York Times reports, the report takes a different tone in another section, noting that “it is not clear” whether talc is a risk factor for cancer.)

All of this may leave you wondering, “can using baby powder cause ovarian cancer?” The answer to this question is murky. Here’s everything we know so far.

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What is talc?

Talc is a naturally occurring mineral found in baby powders as well as other cosmetic and personal care products, and it’s good at absorbing moisture, cutting down on friction, and preventing rashes. For many years, parents used it to diaper babies, until doctors began discouraging it for health reasons. As for adults, many still use it around their genitals or rectum to prevent chafing or sweating, says Dr. Mary Jane Minkin, clinical professor of obstetrics, gynecology, and reproductive services at Yale School of Medicine.

As the American Cancer Society points out on its website, talc in its natural form may contain asbestos, a known carcinogen.

The FDA does not allow talc-based products to contain any asbestos. But the trouble is, cosmetics don’t have to be reviewed or approved by the FDA before they land on store shelves, so there’s no guarantee that they haven’t been contaminated.

In light of this concern, the FDA visited several retail outlets in the Washington, D.C. metro area and bought and tested a variety of cosmetic products containing talc across a wide range of prices for a study that ran from 2009 to 2010. They found no traces of asbestos in any of the products.

But of course, that doesn’t prove that all talc-based products are asbestos-free.

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Can “asbestos-free” talc cause ovarian cancer?

As of now, it’s unclear. The FDA says that literature dating back to the 1960s has suggested a possible association between talc powders and ovarian cancer.

But “the data is wishy-washy,” says Minkin. “Some studies haven’t found a connection, and other ones have only shown a small increase in the hazard ratio [or risk]. And there are lots of different variables in these studies for researchers consider.”

For example, one 2013 study analyzed nearly 20,000 people and found that those who used any type of powder down there were 20% to 30% more likely to have ovarian cancer than those who didn’t use any powder. The findings led the researchers to suggest that “avoidance of genital powders may be a possible strategy to reduce ovarian cancer incidence.”

However, the researchers pointed out a few of the study’s limitations: Participants might have overestimated how often they used these products, and not all powders contain talc—some contain cornstarch instead.

Then, a 2014 study published in the Journal of the National Cancer Institute looked at data from about 60,000 women and found no link between powder use and ovarian cancer risk.

Back in 2010, the International Agency for Research on Cancer (part of the World Health Organization) concluded that there is “limited evidence in humans” that using talc-based body power on the genital areas is “carcinogenic,” and stated that using it down there is “possibly carcinogenic in humans.”

Robyn Andersen, an ovarian cancer researcher at Fred Hutchinson Cancer Research Center, says that when she works with women with ovarian cancer, she asks them about their use of talcum powder. “We know it’s a possible risk factor, we just don’t know how [big] of a risk factor it is,” she says.

Andersen says that because the powder is made up of such finely-ground particles, it might be able to travel up the mucus membranes in the vaginal canal and eventually work its way into the ovaries. Once there, the powder might cause inflammation and eventually cancer.

What you should know

On its “Facts About Talc” website, Johnson & Johnson states that its talc-based products are are asbestos-free, and cites several studies that found no overall increase in ovarian cancer risk among women who used talcum powder versus women who didn’t. It also cites that FDA study mentioned above, which found no asbestos in Johnson & Johnson’s talc-based baby powder.

That said, if all of this is enough to concern you, you’ve got other options besides talc-based powder. Some baby powders (including some by J&J) contain cornstarch instead of talc, and there is no evidence linking cornstarch to ovarian cancer, according to the American Cancer Society.

Something else to keep in mind: when it comes to vaginal health solutions, sometimes less is more.

This article originally appeared on Health.com