WHAT ARE PFAS ?

Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. National Academies of Sciences, Engineering, and Medicine 2022. Washington, DC: The National Academies Press. 299 page report. https://www.cmbg3.com/library/NAS-PFAS-Report.pdf

Contents ACRONYMS AND ABBREVIATIONS ............................................................................................... xvii

SUMMARY

................................................................................................................................................. 1 1 INTRODUCTION ............................................................................................................................ 17 Sociohistorical Timeline of PFAS, 18 Environmental Justice, 21 PFAS Contamination and Routes of Exposure, 26 Policies That Could Reduce Exposure to PFAS, 28 Providing Clinical Advice in Communities Exposed to PFAS, 29 Committee’s Task and Approach, 30 Organization of the Report, 35 References, 35

2 PRINCIPLES FOR DECISION MAKING UNDER UNCERTAINTY ..................................... 41 Development of the Committee’s Principles, 41 Principles Put Forward by the Committee, 42 Committee’s Considerations in Developing Its Principles, 47 Conclusion, 52 References, 53

3 POTENTIAL HEALTH EFFECTS OF PFAS .............................................................................. 56

Overview of Evidence Review Approach, 57 Committee’s Conclusions, 61 Summary and Rationale for the Committee’s Conclusions by Human Health Outcomes, 62 Evidence Gaps, 85 References, 87

4 PFAS EXPOSURE REDUCTION ................................................................................................ 101 Sources and Routes of Exposure to PFAS, 102 Approach to Determining Advice on PFAS Exposure Reduction, 103 Contribution of Individual Exposure Sources to Human Exposure, 103 Medical Interventions for Potentially Reducing PFAS Body Burden, 106 Existing Advice on PFAS Exposure Reduction, 108 PFAS-REACH, 108 Findings and Recommendations, 110 References, 111

5 PFAS TESTING AND CONCENTRATIONS TO INFORM CLINICAL CARE OF EXPOSED PATIENTS ........................................................................................................... 118 Options and Considerations to Guide Decision Making for PFAS Testing, 118 Strategies for Interpreting Biomonitoring Data, 126 Conclusion, 136 References, 136

6 GUIDANCE FOR CLINICIANS ON EXPOSURE DETERMINATION, PFAS TESTING, AND CLINICAL FOLLOW-UP ............................................................................... 141 Criteria for Screening, 141 PFAS-Associated Health Outcomes, 142 Recommendations for Patient Follow-Up, 147 Applying the Committee’s Exposure, Testing, and Clinical Follow-Up Recommendations, 148 Conclusion, 150 References, 150

7 REVISING ATSDR’S PFAS CLINICAL GUIDANCE ............................................................. 152 Recommendations for Changes to ATSDR’S Clinical Guidance, 152 Writing and Design of ATSDR’S Clinical Guidance, 154 Disseminating and Implementing ATSDR’S Clinical Guidance, 154

Conclusion, 156 References, 156

8 IMPLEMENTING THE COMMITTEE’S RECOMMENDATIONS TO IMPROVE PUBLIC HEALTH .................................................................................................... 158 Biomonitoring and Surveillance, 158 Environmental Health Education, 159 Barriers to Implementation, 162 Moving Forward, 163 References, 164

APPENDIXES A COMMITTEE MEMBER, STAFF, AND COMMUNITY LIAISON BIOGRAPHIES ..... 166 B SUMMARY OF THE COMMITTEE’S TOWN HALLS ...................................................... 183 C PUBLIC MEETING AGENDAS .............................................................................................. 213 D EVIDENCE REVIEW: METHODS AND APPROACH ....................................................... 221 E WHITE PAPER: REVIEW OF THE PFAS PERSONAL INTERVENTION LITERATURE ........................................................................................................................... 238

Agency for Toxic Substances and Disease Registry (ATSDR) -PFAS: An Overview of the Science and Guidance for Clinicians on Per- and Polyfluoroalkyl Substances

https://www.atsdr.cdc.gov/pfas/docs/clinical-guidance-12-20-2019.pdf

To help clinicians respond to patient concerns about PFAS exposure, Agency for Toxic Substances and Disease Registry, ATSDR, published "PFAS:

An Overview of the Science and Guidance for Clinicians on Per- and Polyfluoroalkyl Substances." This guidance summarizes general information about PFAS and PFAS health studies and suggests answers to example patient questions.

However, the ATSDR guidance does not provide specific recommendations on when to test for PFAS, how to order the tests, how to interpret the results, or what clinical follow-up based on PFAS exposure might look like. Interpretation of PFAS blood or urine results is challenging because the specific level of exposure at which harms may occur is unknown, and the science on the potential health effects of exposure to PFAS is advancing quickly, making it difficult to provide advice to clinicians about what follow-up tests might be helpful.

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