PFAS Information for Healthcare Professionals

Patients may have questions about per- and polyfluoroalkyl substances (PFAS) after learning that PFAS have been detected in their drinking water. 

Healthcare professionals can help patients understand their exposure, reduce ongoing exposure, and address health concerns through routine care. More information is available at: PFAS Information for Clinicians (ATSDR). 

PFAS exposure pathways

PFAS exposure occurs mainly through drinking contaminated water and eating contaminated food, including but not limited to freshwater fish, organ meats (especially liver), and eggs. Other sources include household dust and certain consumer products, such as cosmetics, shampoos, and dental floss.

For reference, in Rhode Island, drinking water is supplied by public water systems or private wells, and PFAS monitoring and testing resources differ by source. Learn more about PFAS in public drinking water and PFAS testing for private wells.

PFAS may also be encountered through contaminated soil and air, while dermal absorption is generally considered a less significant exposure route. 

Because PFAS levels vary across foods and products, and science is still evolving, the contribution of individual sources to overall exposure remains uncertain. Read more under “What You Should Do” at: PFAS (Per- And Polyfluoroalkyl Substances) and find more information: Meaningful and Achievable Steps You Can Take to Reduce Your Risk (EPA).

Symptoms

While PFAS exposure does not cause a specific set of symptoms, and exposure alone does not mean a patient's health condition was caused by PFAS, associations between exposure to certain PFAS and health effects have been found. 

These symptoms include:

• Increased cholesterol;
• Small decreases in birth weight; 
• Lower antibody response to some vaccines in children;
• Kidney and testicular cancer;
• Pregnancy-induced hypertension or preeclampsia; and 
• Changes in liver enzymes. 

More information is available at: Human Exposure PFAS Information for Clinicians (ATSDR).

Testing and Diagnosis

There are currently no approved medical treatments to remove PFAS from the body. The most important step for people with ongoing exposure is to reduce exposure. Healthcare professionals should continue to provide routine preventive and medical care based on the patient's individual health needs.

Patients may benefit from discussing their PFAS exposure with their healthcare provider and have documented in their medical history for ongoing care. Routine testing, such as a lipid panel or liver function testing, may be appropriate based on the patient's individual health history and established clinical recommendations.

Blood testing can measure certain PFAS at a point in time, but results cannot identify the source or timing of exposure, determine whether PFAS caused a particular health condition, or predict whether a person will develop a disease. There is also no established PFAS blood level that can determine whether a person will become sick. 

PFAS blood serum tests can be ordered through a diagnostic laboratory (e.g. QuestDiagnostics). In some health systems, clinicians can order tests through their hospital laboratory. The number of analytes can vary across tests but should include, at a minimum, the nine NASEM-recommended analytes (i.e., NASEM-9). Insurance coverage varies and individual tests cost approximately $400-$600.  

Before ordering PFAS blood testing, healthcare professionals and patients should discuss what the results can and cannot tell, and how the results would be used.  The National Academies of Sciences, Engineering, and Medicine (NASEM) produced a resource discussing blood testing for per- and polyfluoroalkyl substances (PFAS) and provides related guidance, should a patient come in with blood test results.  More information is available at: Guidance on PFAS Exposure, Testing, and Clinical Follow-Up (NASEM).