A quantitative weight of evidence assessment of Hill's guidelines for causal inference for cosmetic talc as a cause of mesothelioma

Toxicol Appl Pharmacol. 2021 Apr 15;417:115461. doi: 10.1016/j.taap.2021.115461. Epub 2021 Feb 20.


Cosmetic talc has been suggested to cause mesothelioma. To assess a potential causal relationship between cosmetic talc and mesothelioma, a quantitative weight of evidence analysis was performed in accordance with Hill's nine original guidelines for causal inference using a published empirical model to weight each respective guideline. Various epidemiological, toxicological, and exposure studies related to cosmetic talc and risk of mesothelioma were included in an evaluation of each of Hill's guidelines. Probabilities that the guidelines were true were assigned based on expert judgment. We applied a sensitivity analysis to evaluate the variability of our probability estimates. The overall probability of causality for cosmetic talc and mesothelioma was approximately 1.29% (range: 0.73%-3.96%). This low probability of causality supports the conclusion that cosmetic talc is not related to the development of mesothelioma.

Keywords: Asbestos; Causal criteria; Causal viewpoints; Pleural mesothelioma; Risk assessment; Sir Bradford Hill.

Publication types

  • Review

MeSH terms

  • Animals
  • Causality
  • Humans
  • Mesothelioma / chemically induced*
  • Mesothelioma / diagnosis
  • Mesothelioma / epidemiology
  • Pleural Neoplasms / chemically induced*
  • Pleural Neoplasms / diagnosis
  • Pleural Neoplasms / epidemiology
  • Probability
  • Risk Assessment
  • Risk Factors
  • Talc / adverse effects*
  • Time Factors
  • Toxicity Tests


  • Talc