On July 28, 2022, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a report titled “Guidance on PFAS Exposure, Testing, and Clinical Follow-up.” This consensus study report was funded by the US Center for Disease Control and Prevention (CDC), the National Institutes of Environmental Health Sciences (NIEHS), the National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).
The NASEM Report
The National Academies of Sciences, Engineering, and Medicine provide independent, objective analysis and advice to the nation in relation to complex problems and inform public policy decisions. The 278-page technical report is intended to assist those who live, work, and play where PFAS contamination exists in order to help them protect themselves from the risks of PFAS exposure.
Many people across the nation have been exposed to PFAS contamination in their drinking water and in the soil around their homes for decades with no knowledge of the risks.
The National Academies of Sciences, Engineering, and Medicine set out to create guidance for these people to provide explicit directions on when to test for PFAS, how to order tests, how to interpret the results, and what clinical follow-up should be performed for varying levels of PFAS exposure.
This NASEM report is very detailed and worth the read if you enjoy technical subject matter. However, we would like to highlight the findings of one portion of the report, namely Who should have their blood tested and what do the results mean for clinical care.
PFAS Associated Conditions/Risks
The NASEM Committee after conducting an extensive literature review found sufficient evidence of an association between PFAS exposure and the following conditions:
- Decreased antibody response
- Decreased infant and fetal growth
- Increased risk of kidney cancer in adults
The NASEM Committee also found suggestive evidence of an association between PFAS exposure and the following conditions:
- Increased risk of breast cancer in adults
- Liver enzyme alterations
- Increased risk of pregnancy induced hypertension
- Increased risk of testicular cancer in adults
- Thyroid disease and dysfunction in adults
- Increased risk of ulcerative colitis (in adults)
PFAS Screening Guidelines
If you have any of these conditions or have ever lived, worked, or recreated in an area with known PFAS contamination, biomonitoring may provide important information about PFAS exposure levels and provide guidance for following up with doctors on treatment. PFAS levels in blood is important information, but cannot be used to predict the likelihood of any of the above conditions occurring.
Anyone who has a likely history of significant PFAS exposure should be offered PFAS testing, including:
- People who have had workplace exposure to PFAS containing products such as firefighters who worked with Firefighting Foam (AFFF).
- People who lived in communities where PFAS contamination has been documented, such as those living in any of the neighborhoods surrounding 3M PFAS manufacturing plant or military bases with identified PFAS contamination.
- People who lived in areas where PFAS contamination may have occurred such as neighborhoods near airports, military bases, wastewater treatment plants, landfills, or firefighting training facilities.
PFAS Exposure – Clinical Follow-up
For those that do have their blood tested, the NASEM Committee recommends that their physician use PFAS levels to inform clinical care with the following guidelines:
- Adverse health effects are not expected for persons with less than 2 nanograms per milliliter (ng/mL) of PFAS concentration in their blood.
- Potential for adverse effects is expected for persons with a PFAS concentration of between 2 and 20 ng/mL in their blood. This is especially true for sensitive populations.
- There is an increased risk of adverse effects for persons with a PFAS concentration above 20 ng/mL.
NASEM recommends persons with a PFAS concentration between 2 and 20 ng/mL, PFAS exposure reduction is encouraged. Persons in this category should also prioritize screening for dyslipidemia every 4-6 years. Pregnant women in this category should screen for hypertensive disorders at all prenatal visits. All women in this category should also be vigilant about screening for breast cancer based on age and risk factors as recommended by your physician.
NASEM recommends persons with higher than 20 ng/mL of PFAS concentration in their blood should immediately take actions to reduce their PFAS exposure. These persons also need to screen for dyslipidemia immediately and then at all well visits should, test thyroid function, screen for kidney cancer with urinalysis, and assess for signs of testicular cancer and ulcerative colitis.
The NASEM Study is an important step in providing standards for identification and treatment of PFAS related negative health outcomes. As more information about treatment of PFAS related illness is documented, the NASEM will update this publication.