NEHA June 2024 Journal of Environmental Health

ADVANCEMENT OF THE PRACTICE

Open Access

 DIRECT FROM ATSDR

PFAS Information for Clinicians From ATSDR

CAPT Arthur Wendel, MPH, MD

Linda Hansen, MPH, MD

Aaron Bernstein, MPH, MD

PFAS Background PFAS is a family of thousands of synthetic chemicals that all contain a partially or fully fluorinated carbon chain. Since 1999, the National Health and Nutrition Examination Survey (NHANES) has measured certain PFAS in blood samples from people living in the U.S. Nearly everyone in the U.S. has measurable amounts of PFAS in their blood; however, some communities with PFAS con- tamination of water or food can have higher average blood PFAS levels than the levels observed in NHANES (ATSDR, 2021, 2022). Communities near facilities that have manu- factured, used, or handled PFAS—including airports, factories, military bases, or incinera- tors—are often where elevated blood PFAS levels are found (ATSDR, 2021, 2022). In communities a ected by PFAS-contam- inated water, drinking water can be the main source of PFAS exposure. Food can also be contaminated, including food grown on farms where PFAS-contaminated sewage sludge was applied or fish from PFAS-contaminated water bodies. Ingesting residue or dust from PFAS-containing consumer products or other sources can also result in PFAS exposure. Most PFAS are not volatile, so inhalation is not a typical exposure route. Certain PFAS can transfer in utero through the placenta and breastmilk into infants and children. The PFAS Toxicological Profile from ATSDR (2021) provides a comprehensive evaluation and summary of toxicological and epidemiological information on PFAS. ATSDR evaluated the available epidemiologi- cal data and found that the preponderance of evidence suggested associations between cer- tain PFAS exposure and increases in choles- terol levels, small decreases in birth weights,

Editor’s Note: As part of our continued e ort to highlight innovative approaches to improve the health and environment of communities, the Journal is pleased to publish regular columns from the Agency for Toxic Substances and Disease Registry (ATSDR) at the Centers for Disease Control and Prevention (CDC). ATSDR serves the public by using the best science, taking responsive public health actions, and providing trusted health information to prevent harmful exposures and diseases related to toxic substances. The purpose of this column is to inform readers of ATSDR’s activities and initiatives to better understand the relationship between exposure to hazardous substances in the environment, its impact on human health, and how to protect public health. The findings and conclusions in this column are those of the author(s) and do not necessarily represent the ocial position of CDC or ATSDR. CAPT Arthur Wendel is a family medicine and preventive medicine physician who works in the Environmental Medicine and Health Systems Intervention Section within ATSDR. Dr. Linda Hansen serves as chief of the Environmental Medicine and Health Systems Intervention Section within ATSDR. Dr. Aaron Bernstein serves as director for the National Center for Environmental Health (NCEH)/ATSDR.

I ntroduction Communities around the U.S. have been concerned about possible health e ects from per- and polyfluoroalkyl sub- stances (PFAS) exposure. Individuals with PFAS-related concerns have sought support and guidance from healthcare providers. In response to these concerns, the Agency for Toxic Substances and Disease Registry (ATSDR) has developed many resources directed at PFAS exposures and health and is leading seminal research studies to better understand PFAS health e ects. In early 2024, ATSDR released PFAS Information for Clinicians. The informa-

tion is intended to enable more produc- tive conversations between clinicians and patients around PFAS exposures and pro- mote informed and individually tailored decisions around PFAS exposure reduction, PFAS blood testing, and clinical manage- ment of PFAS exposures (Agency for Toxic Substances and Disease Registry [ATSDR], 2024a). Drawing on PFAS Information for Clinicians, this column reviews PFAS properties and health e ects, raises con- siderations that clinicians might discuss with patients who have PFAS concerns, and explores the contributions that environmen- tal health professionals can make.

Volume 86 • Num)er 10