PFAS: What we know, what we don’t, and where we go from here

Published February 16, 2024

For decades, PFAS have silently shaped everyday life with their unique qualities.¹ From the nonstick pan to the stain-free carpet and even firefighter turnout gear,² PFAS have made their way into countless products as a benefit to everyday comfort and convenience. But the very durability that make PFAS so useful now raises questions about just how durable they truly are.¹

What are polyfluorinated alkyl substances? And where do they come from?

Before things get too scientific (and hard to pronounce), let's explore the details to better understand these chemicals.

First things first—how do you even pronounce them and what do they mean?

Polyfluorinated (pronounced polly-floor-uh-nay-tid) alkyl (pronounced al-kil) substances or PFAS (pronounced pea-fass) for short.

• Poly = many
• Fluorinated = to combine with fluorine
• Alkyl = a chain of carbon atoms

Put it all together and you get PFAS—a group of human-made chemicals that make everyday items work better and last longer.¹ All PFAS share one common trait: a strong carbon–fluorine bond that doesn't degrade naturally.³ And it’s this bond that allows them to linger in the environment. PFAS have become part of our daily lives, and today, they are present in water, air, and soil worldwide.³

What are PFAS used for?

Because of their unique properties, PFAS have found their way into a wide range of items since the 1940s.² Since PFAS chemicals have a special bond of carbon and fluorine atoms, it makes them incredibly strong and resistant to heat, water, oil, and dirt. And because they are so good at this, PFAS became popular for³:

• Nonstick cookware
• Stain-resistant fabrics
• Water-repellent clothing
• Firefighting foams and gear
• Carpets
• Cosmetics

The strength and durability of PFAS were once considered a benefit. But now, there are concerns about how they build up in the environment and affect ecosystems and human health. Because the same carbon–fluorine bond that makes PFAS extremely strong also makes it extremely hard to break down.

Why are they called “forever chemicals?”

PFAS have entered the environment through manufacturing sites, tossed-away products, and even firefighting efforts. Today, there are more than 12,000 types of PFAS. But they don’t all act the same way. Some stick around in our bodies and the environment, while others break down more easily. But even those that break down don’t disappear completely. Due to the strength of their carbon–fluorine bond, they stay together and change into other PFAS chemicals. And because of this, PFAS are known as "forever chemicals." As their nickname suggests, PFAS stubbornly remain in the environment and cause widespread contamination.³

Why is exposure to PFAS a concern?

PFAS are found in the blood of humans and animals globally, and some PFAS can build up over time with repeated exposure.⁵ PFAS have also been found in the water and soil of all 50 states, and it’s estimated that 100% of the US population has measurable levels of PFAS in their blood.⁴

After reviewing existing research and large-scale studies in areas heavily contaminated with PFAS,⁶⁻⁹ the National Academies of Sciences, Engineering, and Medicine (NASEM) determined that there’s sufficient evidence of an association between high PFAS exposure and an increased risk for³:

• Lower immune system response (children and adults)
• Unhealthy levels of cholesterol or fats in the blood (children and adults)
• Decreased infant and fetal growth
• Kidney cancer (adults)

While the science surrounding potential health effects of PFAS levels is still developing, several governmental agencies and organizations have conducted PFAS research. Based on this research, NASEM reported that various researchers concluded that there was “sufficient evidence of an association” between PFAS and certain health conditions, including³:

• Decreased response in the immune system
• Higher than normal lipid levels (dyslipidemia)
• Decreased growth in unborn babies and infants
• Increased risk of kidney cancer in adults 

It’s important to understand that although exposure to PFAS can impact health, it doesn't automatically mean that exposure to any amount, including high amounts, will cause illness. There’s still a lot to learn about PFAS and how it affects overall health, but researchers are looking into how different levels of exposure are linked to an increased risk of other health conditions.¹ ¹⁰ 

How can I avoid PFAS?

It's challenging to avoid PFAS completely; however, there are some ways you can limit your exposure to them. This includes³:

• Minimizing or avoiding using nonstick cookware that contain PFAS
• Limiting the consumption of packaged foods
• Being cautious when using products labeled as water-resistant or stain-resistant
• Using water filters that are certified to remove PFAS from drinking water 

Who is the PFAS (Forever Chemicals) Test Panel recommended for?

Testing may be right for people who likely have had elevated exposure to PFAS. The National Academies of Sciences, Engineering, and Medicine (NASEM) indicates certain groups of people may be at higher risk of health impacts from elevated PFAS levels.³ People who may be more likely to have had elevated exposure to significant PFAS levels include, but are not limited to:

• Anyone who may have been exposed on the job, such as firefighters
• Anyone who uses a water supply, including water for drinking, cooking, cleaning, and/or bathing, that’s near a commercial or industrial location. These locations could include airports, military bases, manufacturing plants, or sewage plants
• Anyone living near a facility that manufactures fluorochemicals
• Anyone living near areas of documented PFAS environmental contamination

If you have elevated levels of PFAS in the body, talk with your physician. Only a physician can diagnose a health condition or outcome.

What types of PFAS are included in Quest’s PFAS (Forever Chemicals) Test Panel?

There are many types of PFAS. And although each PFAS is different in its makeup and possible health effects, people are usually exposed to multiple types. This makes it challenging to pinpoint which PFAS is responsible for specific health concerns. The Quest PFAS (Forever Chemicals) Test Panel measures the levels of 9 PFAS chemicals in the blood (listed in the table). These 9 chemicals were identified by the NASEM Report as associated with certain health risks. The test provides the overall level of PFAS in a person’s blood at that time. Specifically, it measures levels of [³ ¹²]:

The 9 most common types of PFAS [³ ¹²]:

1. MeFOSAA Methylperfluorooctane sulfonamidoacetic acid
2. PFSxS Perfluorohexanesulfonic acid
3. Linear PFOA Perfluorooctanoic acid (n-PFOA)
4. Branched PFOA Perfluorooctanoic acid isomers (Sb-PFOA)
5. PFDA Perfluorodecanoic acid
6. PFUnDA Perfluoroundecanoic acid
7. Linear PFOS Perfluorooctane sulfonic acid (n-PFOS)
8. Branched PFOS Perfluoromethylheptane sulfonic acid isomers (Sm-PFOS)
9. PFNA Perfluorononanoic acid

What will the PFAS (Forever Chemicals) Test Panel results show (and not show)?

The results of the PFAS test will tell you if you have PFAS levels that may be associated with certain health conditions.

PFAS blood testing does not identify the sources of exposure or predict future health outcomes. The test only assesses PFAS levels at the time of the blood sample collection.

This test is not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, or treatment of any disease or condition. This test is not appropriate for forensic use.

How often should I be tested for PFAS levels?

Regular testing can help people and their healthcare providers work together to keep track of PFAS levels and check any health risks. If your PFAS levels are higher than normal, it’s best to talk with a doctor. Only a doctor can diagnose a health condition or outcome. 

What should I do if my levels are elevated?

Only a physician can provide information on a relationship between certain diseases or medical conditions due to the presence of PFAS and what you should and should not do if your results show PFAS in your blood at any level.

If your NASEM summation result value is high (>20ng/mL), you will receive an alert call from an independent physician’s group to discuss your results. If your NASEM summation result value is not in the high range (>20ng/mL), you will still have the option to speak with an independent physician to discuss your results. Your physician may provide guidance that includes steps to reduce sources of exposure.

No doctor visit is required to buy your own lab test at questhealth.com. PWNHealth and its affiliates review your purchase to ensure it is medically appropriate before submitting the test order for processing. PWNHealth also reviews your test results and will contact you directly if they require prompt attention. Included in each purchase is the option to discuss your test results with an independent physician; however, you are also encouraged to speak with your primary healthcare provider.

References

1. Environmental Protection Agency (EPA). Our current understanding of the human health and environmental risks of PFAS. Accessed December 20, 2023. https://www.epa.gov/pfas/our-current-understanding-human-health-and-environmental-risks-pfas. 
2. Centers for Disease Control and Prevention (CDC). What are PFAS? Accessed December 20, 2023. https://www.atsdr.cdc.gov/pfas/health-effects/overview.html. 
3. National Academies of Sciences, Engineering, and Medicine (NASEM). 2022. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. Washington, DC: The National Academies Press (US); 2022. doi:10.17226/26156
4. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Survey Data. 2017-2018 Laboratory data - continuous NHANES. Accessed December 20, 2023. https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Laboratory&CycleBeginYear=2017. 
5. Agency for Toxic Substances and Disease Registry (ATSDR). PFAS chemicals overview. Reviewed November 1, 2022. Accessed December 20, 2023. https://www.atsdr.cdc.gov/pfas/health-effects/overview.html. 
6. International Agency for Research on Cancer (IARC) Working Group. 2016. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Some Chemicals Used as Solvents and in Polymer Manufacture. Vol. 110. Lyon, France. Accessed December 20, 2023. https://monographs.iarc.who.int/wp-content/uploads/2018/06/mono110.pdf. 
7. Environmental Protection Agency (EPA). 2016. Health effects support document for perfluorooctanoic acid (PFOA). Washington, DC: U.S. Environmental Protection Agency. Accessed December 20, 2023. https://www.epa.gov/sites/default/files/2016-05/documents/pfoa_hesd_final-plain.pdf. 
8. Agency for Toxic Substances and Disease Registry (ATSDR). 2021. Toxicological profile for perfluoroalkyls. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services, Public Health Service. Updated March 2020. Accessed December 20, 2023. https://www.atsdr.cdc.gov/toxprofiles/tp200.pdf. 
9. C-8 Medical Monitoring Panel. Information on the C-8 (PFOA) medical monitoring program screening tests. Published November 18, 2013. Accessed December 20, 2023. http://www.c-8medicalmonitoringprogram.com/docs/med_panel_education_doc.pdf. 
10. Schrenk D, Bignami M, Bodin L, et al. Risk to human health related to the presence of perfluoroalkyl substances in food. EFSA Journal. 2020;18(9). doi:10.2903/j.efsa.2020.6223
11. Agency for Toxic Substances and Disease Registry (ATSDR). What are the health effects of PFAS? Reviewed November 1, 2022. Accessed December 20, 2023. https://www.atsdr.cdc.gov/pfas/health-effects/index.html. 
12. Agency for Toxic Substances and Disease Registry (ATSDR). How can I be exposed? Reviewed November 1, 2022. Accessed December 20, 2023. https://www.atsdr.cdc.gov/pfas/health-effects/exposure.html

Source

1. National Academies of Sciences, Engineering, and Medicine. About us. Accessed December 20, 2023. https://www.nationalacademies.org/about.