A brand new 33-patient case examine printed within the Journal of Occupational and Environmental Medication supplies a few of the strongest proof but that publicity to asbestos-tainted talcum powder could trigger malignant mesothelioma, a uncommon and lethal most cancers that impacts tissues lining inner organs.

This isn’t solely an vital scientific discovery—it may additionally give new ammunition to plaintiffs within the 1000’s of circumstances introduced in opposition to manufacturers promoting talcum-powder-based merchandise alleged to trigger most cancers, like Johnson & Johnson’s Child Powder.

“It’s very, very hard, in general, to prove exactly what caused your specific case of disease,” says Steve Gold, a professor at Rutgers Regulation Faculty who focuses on poisonous and unsafe substances. “If a credible physician and researcher is willing to testify and has published that these individual cancers appear to be caused by asbestos exposure from talcum powder, that’s evidence that is usually not available to plaintiffs. That’s very powerful.”

Asbestos is a bunch of naturally occurring fibrous minerals that’s thought of a human carcinogen by the World Well being Group and different public well being teams. It’s linked to mesothelioma, ovarian most cancers and lung most cancers. Amongst different locations, it’s present in constructing provides, insulation, some automotive elements—and the talc from which talcum powder is made. (Talc additionally turns up in cosmetics like blush and facial make-up.) For the reason that 1970s, producers have pledged to make use of talc that’s free from detectable ranges of asbestos, however there’s nonetheless little regulation over the beauty business, and issues about asbestos contamination persist. A bombshell 2018 Reuters report additionally discovered that J&J knew for many years that a few of its Child Powder was tainted by asbestos, however didn’t report that info publicly or to federal regulators.

J&J has additionally for years been beneath hearth within the courtroom. In March, for instance, a California jury awarded greater than $29 million to a girl who claimed talcum-powder-based J&J merchandise contributed to her mesothelioma. The yr earlier than, a jury ordered J&J to pay greater than $four billion in damages to a bunch of ladies who claimed its merchandise triggered them to develop ovarian most cancers. And in 2016, the patron merchandise large was ordered to pay $55 million to a girl who stated Child Powder contributed to her ovarian most cancers.

J&J has refuted and, in lots of circumstances, appealed these selections, citing conflicting proof on whether or not talcum powder could cause most cancers. An organization consultant didn’t return TIME’s request for touch upon the newest analysis earlier than press time.

The brand new examine could make that time tougher to argue. “This is the first time that anyone has said, ‘Let me look at all these cases, put it all together and identify the ones where [talc] is the sole exposure,’” says co-author Dr. Jacqueline Moline, a professor of occupational medication, epidemiology and prevention on the Feinstein Institutes for Medical Analysis at Northwell Well being. “People aren’t even aware that cosmetic talcum powder might have had asbestos in it.”

Within the paper, Moline and her colleagues current case research of 33 folks, largely ladies, who had been confirmed to have malignant mesothelioma, and whose solely substantial publicity to asbestos was via using talcum powder—theoretically ruling out different causes of the illness, since asbestos publicity is the first danger issue for malignant mesothelioma. (All the folks profiled within the examine gave depositions as a part of lawsuits associated to beauty talc.) The authors broke out particularly element the circumstances of six people, all of whom underwent tissue testing that confirmed fibers in line with the kind of asbestos present in beauty talc, however not in issues like constructing provides and insulation. A few of these folks used merchandise containing talcum powder every day for many years.

“Everything points to cosmetic talc being the cause,” Moline says. From a scientific perspective, 33 case research is compelling. However Gold cautions that they might be much less persuasive within the courtroom.

“In general, courts have been somewhat skeptical of case studies as proof of causation,” Gold says, since it may be troublesome to use the small print of 1 individual’s case to a bigger affected person inhabitants. The examine “ought to be [seen as] basically a brick in a wall. It’s nowhere near a wall—but it’s a brick.”

On one hand, Gold says, linking mesothelioma tumors to asbestos in talc gives compelling causal proof. However then again, it could open up a brand new counterargument to defendants. “Will a company like Johnson & Johnson argue that…in cases where those fibers are not found in the tissue samples, that means asbestos in talc did not cause mesothelioma?” he asks. “I don’t think that inference is supportable, but I can imagine that argument being made.”

No matter what occurs in courtroom, Moline says she hopes the examine raises consciousness for individuals who have used beauty talc prior to now, and people who proceed to take action to this present day.

“Anything you use on your body or in your body, you want to be careful [about],” Moline says. “I would tell people that there is no regulation for talc, and that if there is a safer alternative then I would advise them to do that. I would not recommend people use talcum powder.”

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