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The most significant uncertainty identified by the EU experts was the concern that TiO₂ particles may have genotoxic effects. Genotoxicity refers to the ability of a chemical to directly damage genetic material within a cell (DNA), which may lead to cancer in certain situations. Although the experts did not conclude that TiO₂ particles in E171 are genotoxic, they could not rule out the concern that they might be.

Yet another study, this one published in 2006 by the International Agency for Research on Cancer said there was insufficient evidence to conclude that titanium dioxide causes cancer. However, the study also categorized the ingredient as a potential human carcinogen.

Food-grade titanium dioxide differs from what’s added to plastics and paints to enhance whiteness. However, there have been concerns about the environmental impact of titanium dioxide production and the potential health risks from exposure to its particles.