What Can We Do About PFAS Exposure?
A New Report Offers Guidelines for PFAS Blood Tests & Medical Care & We Spoke With Ned Calonge, The Committee Chair For The Report.
In late July, a new report from the National Academies of Sciences, Engineering, and Medicine was released about how to handle PFAS exposure, testing, and clinical follow-up.
FYI: The National Academies provide independent, objective advice to inform policy with evidence, spark progress and innovation, and confront challenging issues for the benefit of society, according to their website.
As many of you know, in thousands of communities across the United States (and also the world), drinking water is contaminated with a class of chemicals known as perfluoroalkyl and polyfluoroalkyl substances (PFAS).
PFAS are used in many different products from non-stick cookware to stain-repellent fabrics to firefighting foam, because these chemicals are so good at repelling oil and water, reducing friction, and resisting temperature changes.
But use of these toxic forever chemicals has come with a price. They leak into the environment where they are made, used, disposed of, or spilled and don’t go away easily. PFAS exposure has been linked to a number of adverse health effects including certain cancers, thyroid dysfunction, changes in cholesterol, and low birth weight.
We’ve written many times about the dangers of PFAS in this newsletter, and the people and communities dealing with this massive contamination issue from Maine to Michigan to Florida and beyond.
In fact, all 50 states and two territories have documented some PFAS contamination in more than 2,850 locations—and that’s just in the communities where testing is happening.
The real problem is likely much more pervasive, so the need to understand how people are exposed and what they can do about it has never been greater.
Let’s talk more about some of the findings in the new report, which focuses on PFAS that are currently monitored by the CDC including MeFOSAA, PFHxS, PFOA, PFDA, PFUnDA, PFOS, and PFNA.
This report is filled with a ton of information in more than 250 pages and confirms that people are primarily exposed to PFAS through ingestion, such as by drinking contaminated water or eating contaminated food.
Health Impacts of PFAS Exposure
The report reviews research on the health impacts associated with PFAS across many levels of exposure, concluding:
There is sufficient evidence of association between exposure to PFAS and increased risk of decreased antibody response in adults and children, dyslipidemia (abnormally high cholesterol) in adults and children, decreased infant and fetal growth, and kidney cancer in adults.
There is limited or suggestive evidence of increased risk of breast cancer in adults, liver enzyme alterations in adults and children, pregnancy-induced hypertension, increased risk of testicular cancer in adults, thyroid disease and dysfunction in adults, and increased risk of ulcerative colitis in adults.
There is inadequate or insufficient evidence of many other health impacts, such as cardiovascular outcomes other than high cholesterol or developmental outcomes other than small reductions in birthweight, among others.
We talked with Ned Calonge, associate professor of family medicine at the University of Colorado, Denver, associate professor of epidemiology at the Colorado School of Public Health, and chair of the committee that wrote the report.
“It’s likely as the research goes forward that there will be more conditions, and that we may move a condition from one of the categories like the limited suggested evidence, which is a moderate level of certainty, into one of the higher levels,” he said.
Association Vs. Cause
Ned discussed the committee’s choice to use the word “association.”
“We ended up using the word association because that's the word we’re left with scientifically,” Ned said. “It's not a bad word, but it’s different from cause. Some scientific details are missing from being able to say, ‘PFAS causes this disease.’ That’s because of things like not having the biological mechanism. We’re left with being able to say “these conditions are associated.” For me, that was strong enough to say that clinicians should have a heightened sense of surveillance on conditions that we are able to screen for because of these increased associations.”
The report recommends CDC, Agency for Toxic Substances and Disease Registry (ATSDR), and public health departments support clinicians by creating educational materials on PFAS exposure, potential health effects, the limitations of testing, and the pros and cons of testing. Laboratories conducting PFAS testing should report the results to state public health authorities to improve PFAS exposure surveillance.
Clinicians should offer PFAS blood testing to patients who are likely to have a history of elevated exposure, including occupational exposure, those who have lived in communities with documented contamination, and those who have lived where contamination may have occurred such as near facilities that use or have used fluorochemicals, commercial airports, military bases, wastewater treatment plants, farms where sewage sludge may have been used, or landfills or incinerators that have received waste containing PFAS, according to the report.
Ned told us that he feels the report is “a good start” as a guidance document for clinicians, and that while the recommendations are tailored to clinicians, patients can also read it to gain a better understanding about these issues and feel more empowered to know how to approach their clinicians about testing and thinking about their levels.
You can download the whole report here.
Another recommendation from the committee is that the CDC should update its clinical guidance for PFAS when it comes to serum and plasma concentrations.
The committee found:
Patients whose tests show a PFAS blood concentration below 2 nanograms per milliliter (ng/mL) are not expected to have adverse health effects, while patients with test results between 2 and 20 ng/mL may face the potential for adverse effects, especially in sensitive populations, such as pregnant individuals. Patients with test results above 20 ng/mL may face a higher risk of adverse effects.
“We were able to put some bounds around who should be more concerned and who will benefit most from testing, rather than saying everyone needs to be tested,” he explained adding that “I have to feel that as we test more and we know more, we'll see more granularity in those cut-offs, but this was the best we could do with the information we have today. We are truly trying to hone in on individuals who are going to be most helped.”
The committee obtained perspectives from people living in or working with communities with PFAS contamination by hosting three town halls and working with community liaisons. We were happy to see some familiar names on that list including Stel Bailey, cancer survivor and health advocate, (read her full story here) and pharmacology and toxicology researcher Jamie DeWitt (read our interview with her here).
“We purposefully reached out, listened to, and gathered information from individuals in the exposed communities,” Ned told us. “It was an important part of the process and something that the National Academies has not done much in the past in their reports, so we tried to engage the advocacy community in the report and listen to their stories, and learn how it impacted their community.”
He said working with the communities had a big influence on how the entire committee thought about the issue and applied an evidence-based lens to the information—in a way that was informed by the people who have really suffered the exposures.
“I've done other study reports where we've talked mainly to experts, but having people with the exposures who have actually lived through this was really very important,” he said.
A Methodology To Move Forward
Ned also talked about the way the committee approached the research in this report and how it may help for future reports and studies on other toxic exposures.
“One of the things I hope the report does is start a more ubiquitous methodology for environmental toxins and environmental contamination, in terms of trying to take the strategy of looking for associations with conditions and then classify those into categories,” he said.
He said the committee created a methodology that would give their recommendations evidence-based credence for a National Academies report.
“We had to think about how this could fit for a contaminant that is not PFAS and be able to take it through the same process of engaging communities, reviewing the evidence about exposures with different conditions, and then searching for potential levels and cut-off levels, and then keeping the cycle going to update the information,” Ned explained.
PFAS Labels Spotted in Maine
Learn more about how PFAS is impacting famers in Maine in this video below.
The future of farming and food in Maine and across the country depends on how we meet the challenge of PFAS contamination on our farms and farmland.
Again, you can download or read the full report online: Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. Have questions or comments? Post below!