Recall bias in population-based case-control studies of ovarian cancer and genital talc use: potential impact and quantitative bias analysis

Recall bias in population-based case-control studies of ovarian cancer and genital talc use: potential impact and quantitative bias analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Recall bias in population-based case-control studies of ovarian cancer and genital talc use: potential impact and quantitative bias analysis Diezhang Wu, Igor Burstyn, William J. Thompson, Jing Qian, Kenneth A. Mundt This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7924814/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Mar, 2026 Read the published version in BMC Medical Research Methodology → Version 2 posted 6 You are reading this latest preprint version Show more versions Abstract Introduction . Quantitative bias analysis (QBA) methods have been developed, with growing applications to epidemiological studies. Bayesian QBA (BQBA) methods may be superior in effectively using evidence-based priors and study data to displace fixed-value assumptions, and in characterizing distributions of adjusted point estimates and associated uncertainty. Methods . We applied simple QBA (SQBA) and BQBA methods to population-based case-control studies on ovarian cancer and genital talcum powder use. Our hypothesis was that differential misclassification of self-reported historical talcum powder use led to statistically significant associations in several of these studies. SQBA results covering ranges of published exposure sensitivity and specificity estimates for genital talcum powder use were generated. BQBA models generated posterior means and 95% credible intervals (CrI’s) of bias-adjusted odds ratios (ORs), sensitivities and specificities of controls and cases, respectively, using pooled case-control study data. Results . The mean Bayesian posterior OR was 1.08 (95% CrI 0.67–1.77), mean case and control sensitivities were 0.87 and 0.78 and mean case and control specificities were 0.86 and 0.90, respectively. Model diagnostics indicated good fit. Conclusion . Upon adjusting only for hypothesized differential exposure misclassification bias, the association between ovarian cancer and genital talcum powder use was attenuated relative to the unadjusted one. While other potential sources of bias may be operating within this body of studies, exposure reporting bias likely accounts for the statistically significant ORs reported in the individual case-control studies. Full Text Additional Declarations Competing interest reported. K.A.M. and W.J.T. have served as expert witnesses for the Defense in litigation involving talc and cancers including ovarian, and K.M. provides epidemiological consulting to EUROTALC, a trade association of talc producers and users and the financial sponsor of this work. D.W., I.B. and J.Q. declare no potential conflicts of interest Supplementary Files Appndix1.docx Appendix2.docx Appendix3.docx Cite Share Download PDF Status: Published Journal Publication published 23 Mar, 2026 Read the published version in BMC Medical Research Methodology → Version 2 posted Editorial decision: Accepted 16 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 12 Feb, 2026 Reviewers invited by journal 10 Feb, 2026 Submission checks completed at journal 16 Jan, 2026 First submitted to journal 13 Jan, 2026 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7924814","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[{"code":1,"date":"2025-10-28 16:37:05","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-research-methodology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmrm","sideBox":"Learn more about [BMC Medical Research Methodology](http://bmcmedresmethodol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmrm/default.aspx","title":"BMC Medical Research Methodology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":594117927,"identity":"393d7ca1-0ddb-11f1-907b-06cc9d20a69f","order_by":0,"name":"Diezhang Wu","email":"","orcid":"","institution":"University of Massachusetts Amherst","correspondingAuthor":false,"prefix":"","firstName":"Diezhang","middleName":"","lastName":"Wu","suffix":""},{"id":594117996,"identity":"426911c0-0ddb-11f1-907b-06cc9d20a69f","order_by":1,"name":"Igor Burstyn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYBACNhDB2ADlfQBzmRug4oS0AFmMM+BcPFoYkLUw8xCjhY9/8bEPjDsO58vP7zF7bFN2T87geGMDw4eyw7gdJvEseQbjmcOWG47xmBvnnCs2luw52MA44xw+LWeMGRjbDhsYsPGYSee2JST2SyQ2MPO2EaFFvg2oxbItob5N/mED8198Wvh7IFoYjgG1MLYlJPBLMDYwM+K1hS2ZIfFMuoHBsbQyyZ5zCYYzexIbDvacS8epRb7/8GGGjzusDeSbD2+T+FGWIG9w/PDBBz/KrHFqYZBIYGBIALM4DOCCB3CrBwJ+uDT7A7wKR8EoGAWjYOQCACAAUKFjWSTUAAAAAElFTkSuQmCC","orcid":"","institution":"Drexel University","correspondingAuthor":true,"prefix":"","firstName":"Igor","middleName":"","lastName":"Burstyn","suffix":""},{"id":594119282,"identity":"51425fcf-0ddb-11f1-907b-06cc9d20a69f","order_by":2,"name":"William J. Thompson","email":"","orcid":"","institution":"Independent Consultant","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"J.","lastName":"Thompson","suffix":""},{"id":594119851,"identity":"6032406c-0ddb-11f1-907b-06cc9d20a69f","order_by":3,"name":"Jing Qian","email":"","orcid":"","institution":"University of Massachusetts Amherst","correspondingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Qian","suffix":""},{"id":594119977,"identity":"6a267686-0ddb-11f1-907b-06cc9d20a69f","order_by":4,"name":"Kenneth A. Mundt","email":"","orcid":"","institution":"University of Massachusetts Amherst","correspondingAuthor":false,"prefix":"","firstName":"Kenneth","middleName":"A.","lastName":"Mundt","suffix":""}],"badges":[],"createdAt":"2025-10-22 14:53:38","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-7924814/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-7924814/v2","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12874-026-02836-x","type":"published","date":"2026-03-23T16:10:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":105756077,"identity":"5496b3b1-33d4-40c1-8f5d-272956524d8e","added_by":"auto","created_at":"2026-03-30 16:35:16","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":781642,"visible":true,"origin":"","legend":"","description":"","filename":"RevisedQBAManuscriptontalcandovariancancerBMCMRMclean.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7924814/v2_covered_85d06a29-511b-4efd-9d9d-84a689da9a7e.pdf"},{"id":103029652,"identity":"f8155947-f01d-49d7-bbba-c9a07f0f3607","added_by":"auto","created_at":"2026-02-19 21:45:31","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":38926,"visible":true,"origin":"","legend":"","description":"","filename":"Appndix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7924814/v2/d3c4654ad0ac73b5ec9e482a.docx"},{"id":103503874,"identity":"bea6d3d4-5530-4fe7-8c44-fea12ad65144","added_by":"auto","created_at":"2026-02-26 13:03:46","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":8051,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7924814/v2/16419cdda8e06ee5706c68a9.docx"},{"id":103050411,"identity":"b48da006-4b02-4663-90ea-0285edf3a1fd","added_by":"auto","created_at":"2026-02-20 07:49:55","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":1655770,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix3.docx","url":"https://assets-eu.researchsquare.com/files/rs-7924814/v2/a20796ab7238ce66d124389b.docx"}],"financialInterests":"Competing interest reported. K.A.M. and W.J.T. have served as expert witnesses for the Defense in litigation involving talc and cancers including ovarian, and K.M. provides epidemiological consulting to EUROTALC, a trade association of talc producers and users and the financial sponsor of this work. D.W., I.B. and J.Q. declare no potential conflicts of interest","formattedTitle":"Recall bias in population-based case-control studies of ovarian cancer and genital talc use: potential impact and quantitative bias analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-research-methodology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmrm","sideBox":"Learn more about [BMC Medical Research Methodology](http://bmcmedresmethodol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmrm/default.aspx","title":"BMC Medical Research Methodology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7924814/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7924814/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003e. Quantitative bias analysis (QBA) methods have been developed, with growing applications to epidemiological studies. Bayesian QBA (BQBA) methods may be superior in effectively using evidence-based priors and study data to displace fixed-value assumptions, and in characterizing distributions of adjusted point estimates and associated uncertainty.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e. We applied simple QBA (SQBA) and BQBA methods to population-based case-control studies on ovarian cancer and genital talcum powder use. Our hypothesis was that differential misclassification of self-reported historical talcum powder use led to statistically significant associations in several of these studies. SQBA results covering ranges of published exposure sensitivity and specificity estimates for genital talcum powder use were generated. BQBA models generated posterior means and 95% credible intervals (CrI\u0026rsquo;s) of bias-adjusted odds ratios (ORs), sensitivities and specificities of controls and cases, respectively, using pooled case-control study data.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e. The mean Bayesian posterior OR was 1.08 (95% CrI 0.67\u0026ndash;1.77), mean case and control sensitivities were 0.87 and 0.78 and mean case and control specificities were 0.86 and 0.90, respectively. Model diagnostics indicated good fit.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e. Upon adjusting only for hypothesized differential exposure misclassification bias, the association between ovarian cancer and genital talcum powder use was attenuated relative to the unadjusted one. While other potential sources of bias may be operating within this body of studies, exposure reporting bias likely accounts for the statistically significant ORs reported in the individual case-control studies.\u003c/p\u003e","manuscriptTitle":"Recall bias in population-based case-control studies of ovarian cancer and genital talc use: potential impact and quantitative bias analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2026-02-19 21:45:26","doi":"10.21203/rs.3.rs-7924814/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2026-03-16T08:52:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T09:08:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146872630485597835107324732973983401923","date":"2026-02-12T09:28:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-10T07:11:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-16T06:18:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Research Methodology","date":"2026-01-13T14:37:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-research-methodology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmrm","sideBox":"Learn more about [BMC Medical Research Methodology](http://bmcmedresmethodol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmrm/default.aspx","title":"BMC Medical Research Methodology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f6ad1ff4-8712-469b-aaac-925d9b0969b0","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:31:39+00:00","versionOfRecord":{"articleIdentity":"rs-7924814","link":"https://doi.org/10.1186/s12874-026-02836-x","journal":{"identity":"bmc-medical-research-methodology","isVorOnly":false,"title":"BMC Medical Research Methodology"},"publishedOn":"2026-03-23 16:10:53","publishedOnDateReadable":"March 23rd, 2026"},"versionCreatedAt":"2026-02-19 21:45:26","video":"","vorDoi":"10.1186/s12874-026-02836-x","vorDoiUrl":"https://doi.org/10.1186/s12874-026-02836-x","workflowStages":[]},"version":"v2","identity":"rs-7924814","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7924814","identity":"rs-7924814","version":["v2"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}