PFAS Information for Clinicians Factsheet

• Per- and polyfluoroalkyl substances (PFAS) are a family of thousands of synthetic chemicals; relatively few have been studied for their effect on health
• Used widely to reduce friction or resist oil, water, and stains
• Widespread and persistent in the environment
• Among studied PFAS: absorbed in intestines and lungs; bind to serum and tissue proteins; most not metabolized; half-lives range from a few days to 8+ years

• Nearly all people in the U.S. have had exposure to PFAS
• PFOS, PFOA, and PFHxS exposure is decreasing in the U.S. population, in part because of production phase-outs
• Population exposures to substitute PFAS (e.g., GenX) are not well studied
• Communities with PFAS contamination of water or food are often near facilities that have manufactured, used, or handled PFAS
• Ingestion of PFAS in water and food is a main route of exposure; ingestion of dust and residue from PFAS-containing products can also result in exposure
• Inhalation is not a typical route of exposure for the general population but can occur with PFAS-containing dust, aerosols, or fumes
• Children can be exposed by drinking formula mixed with PFAS-containing water, drinking breastmilk from persons exposed to PFAS, ingesting dust or dirt, and through hand to mouth behaviors with textiles treated with stain protectants
• Some PFAS cross the placenta and enter umbilical cord blood

• Research is ongoing to understand the mechanisms of PFAS toxicity
• The epidemiological evidence suggests associations between increases in exposure to (specific) PFAS and certain health effects
  • Increases in cholesterol levels (PFOA, PFOS, PFNA, PFDA)
  • Small decreases in birth weight (PFOA, PFOS)
  • Lower antibody response to some vaccines (PFOA, PFOS, PFHxS, PFDA)
  • Kidney and testicular cancer (PFOA)
  • Pregnancy-induced hypertension or preeclampsia (PFOA, PFOS)
  • Changes in liver enzymes (PFOA, PFOS, PFHxS)
• The risk of health effects associated with PFAS depends on
  • Exposure factors (e.g., dose, frequency, route, and duration)
  • Individual factors (e.g., sensitivity and chronic disease burden)
  • Other determinants of health (e.g., access to safer water and quality healthcare)

• Main goals are to
  • Identify and reduce PFAS exposures
  • Promote standard age-appropriate preventive care measures for physical health, mental health, and wellness
• Clinical presentation: PFAS toxicity is not associated with characteristic signs or symptoms
• Taking an exposure history can help identify PFAS exposures and determine actions to reduce exposures; ask about possible current and past PFAS exposure sources, durations, frequency, and magnitude
• Exposure reduction strategies follow from the exposure history; examples include
  • Installing water filtration system or using an alternative water source
  • Limiting or avoiding consumption of contaminated fish, meat, eggs, or dairy
  • Choosing products without PFAS when possible
• Breastfeeding is optimal due to its many benefits; clinicians can assist patients in their decision to breastfeed based on factors specific to the patient and child
• Clinicians can counsel patients on whether to pursue blood testing with an understanding of the benefits and limitations of PFAS testing:
  • Results (current levels of PFAS in the blood) could reflect recent exposures or past exposures in the case of PFAS with long half-lives
  • PFAS blood test results do not identify sources of exposure
  • Results do not indicate whether a current illness can be attributed to PFAS exposure or predict future health problems
  • Comparing PFAS results across laboratories can be difficult
  • Potential relief from psychological distress if PFAS levels are normal
  • Having information that could guide exposure reduction decisions
  • Potential for false positives from screening based on PFAS blood test results and iatrogenic complications from additional evaluation and treatment
• ATSDR has not developed health-based screening blood levels for PFAS
• No approved medical treatments are available to remove PFAS from the body

• Other professionals can help with exposure histories and reduction methods, and patient evaluation and monitoring/treatment plans:
  • Board-certified clinicians specializing in occupational and environmental medicine, medical toxicology, and pediatric environmental health
  • Occupational health clinicians
  • State or local health/environmental departments

• ATSDR PFAS Information for Clinicians (full document)
• American College of Medical Toxicology
• American College of Occupational and Environmental Medicine
• ATSDR Toxicological Profile for PFAS
• ATSDR PFAS and Your Health
• ATSDR PFAS Blood Level Estimation Tool
• ATSDR Minimal Risk Levels for PFAS
• CDC’s Breastfeeding: Why it Matters
• CDC National Report on Human Exposure to Environmental Chemicals
• EPA’s Meaningful and Achievable Steps You Can Take to Reduce Your Risk
• NASEM Guidance on PFAS Testing and Health Outcomes
• National Institute for Occupational Safety and Health PFAS webpage
• Pediatric Environmental Health Specialty Units

Acronyms: