Forever Chemicals
Author: Laura Anderko PhD RN
What synthetic chemical helps keep people dry, often travels in water, and may lead to a host of health problems?
Per- and polyfluoroalkyl substances (PFAS) are a large group of environmentally persistent synthetic chemicals used in industrial and consumer products.
How do PFAS affect health?
Most adults and children in the U.S. have some level of PFAS in their bodies, according to the Agency for Toxic Substances and Disease Registry. Exposure is common, and there is growing evidence that exposure can lead to adverse health outcomes.
Elevated PFAS concentrations in the blood have been associated with an increased risk of more severe COVID-19 cases. High concentrations have also been shown to increase the risks of some cancers, cholesterol levels, and interfere with the body’s immune system.
Fetuses and children may also bear an impact from this pervasive chemical. Developing fetuses can be exposed when PFAS in maternal blood crosses the placenta and reaches umbilical cord blood. PFAS exposure may affect growth, learning, and behavior of children. Exposure to PFAS during pregnancy may also increase the blood pressure of the mother.
Data from human studies suggest that some PFAS can take years to be cleared from the body with estimated half-lives—the time required to reduce the quantity in half its initial value—which can range from two to nine years. These long half-lives result in body burdens that persist for years, even after identified exposure sources have been reduced.
How are people exposed to PFAS?
PFAS are grease- and water-resistant substances used in many consumer products such as non-stick cookware, stain-resistant carpeting, raingear, cosmetics, and food packaging.
Drinking water is the most common exposure to PFAS. 16.5 million people rely on water supplies in the U.S. that had detectable PFAS. For example, PFAS is found in aqueous film-forming foam, a fire-fighting substance often used on military bases. Once applied, the foam can enter drinking water in nearby communities.
Other important exposure pathways include breastmilk, dust, food (e.g., fish), and garden soil.
PFAS levels in humans can differ by occupation, gender, race/ethnicity, and age. This suggests that lifestyle differences may impact exposure and highlights the importance of identifying exposure sources in order to reduce the impact.
Workers in industries that manufacture or use materials/products containing PFAS may have even greater exposure than the general public.
How may exposure be prevented?
Major manufacturers of two of the most commonly used PFAS chemicals joined with the Environmental Protection Agency (EPA) to phase out production of these agents in the United States. However, PFAS is still produced internationally and can be imported to the United States in consumer goods such as carpet, leather and apparel, textiles, paper and packaging, coatings, rubber, and plastics. Therefore, multiple PFAS can still be found in drinking water, food, dust, and personal care products, and a person can be concurrently exposed to a variety of PFAS.
Since drinking water is a primary exposure pathway, considering options to lower concentrations of PFAS in the drinking water supply is essential. Public water systems can treat source water with activated carbon or high-pressure membrane systems (e.g., reverse osmosis) to remove PFAS from drinking water. Some home filters can also be effective at reducing PFAS using granular activated carbon and/or reverse osmosis.
At a national level, the Environmental Protection Agency does not regulate PFAS in drinking water. More than six million people had PFAS concentrations above the EPA’s Lifetime Health Advisory. However, Lifetime Health Advisories are non-regulatory recommendations and not legally enforceable. Without EPA regulation or established standards for testing and treatment, prevention of exposure is key to reducing negative health impacts.
Public health personnel and health care providers play an important role in educating communities on how to reduce the risk of exposure. The National Academies of Sciences, Engineering and Medicine is conducting a study to explore the health outcomes associated with PFAS exposure, develop recommendations for potential changes to clinical guidance regarding PFAS testing, and how test results should inform clinical care. These include patient follow-up and care specific to PFAS-associated health outcomes based on known or suspected exposure to PFAS. Recommendations will also include risk reduction strategies.