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Review
. 2019 Mar;29(2):131-147.
doi: 10.1038/s41370-018-0094-1. Epub 2018 Nov 23.

A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects

Elsie M Sunderland  1   2 , Xindi C Hu  3   4 , Clifton Dassuncao  3   4 , Andrea K Tokranov  4 , Charlotte C Wagner  4 , Joseph G Allen  3
Affiliations
Review

A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects

Elsie M Sunderland et al. J Expo Sci Environ Epidemiol. 2019 Mar.

Abstract

Here, we review present understanding of sources and trends in human exposure to poly- and perfluoroalkyl substances (PFASs) and epidemiologic evidence for impacts on cancer, immune function, metabolic outcomes, and neurodevelopment. More than 4000 PFASs have been manufactured by humans and hundreds have been detected in environmental samples. Direct exposures due to use in products can be quickly phased out by shifts in chemical production but exposures driven by PFAS accumulation in the ocean and marine food chains and contamination of groundwater persist over long timescales. Serum concentrations of legacy PFASs in humans are declining globally but total exposures to newer PFASs and precursor compounds have not been well characterized. Human exposures to legacy PFASs from seafood and drinking water are stable or increasing in many regions, suggesting observed declines reflect phase-outs in legacy PFAS use in consumer products. Many regions globally are continuing to discover PFAS contaminated sites from aqueous film forming foam (AFFF) use, particularly next to airports and military bases. Exposures from food packaging and indoor environments are uncertain due to a rapidly changing chemical landscape where legacy PFASs have been replaced by diverse precursors and custom molecules that are difficult to detect. Multiple studies find significant associations between PFAS exposure and adverse immune outcomes in children. Dyslipidemia is the strongest metabolic outcome associated with PFAS exposure. Evidence for cancer is limited to manufacturing locations with extremely high exposures and insufficient data are available to characterize impacts of PFAS exposures on neurodevelopment. Preliminary evidence suggests significant health effects associated with exposures to emerging PFASs. Lessons learned from legacy PFASs indicate that limited data should not be used as a justification to delay risk mitigation actions for replacement PFASs.

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Conflict of interest statement

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Overview of PFAS exposure pathways for different human populations outside of occupational settings.
Figure 2.
Figure 2.
Discovery of sites contaminated by PFASs leading to elevated concentrations in drinking water across the United States. Figure adapted from data compiled by Northeastern University’s Social Science Environmental Health Research Institute (SSEHRI) that was last updated 12/17/17. Colors of circles represent different types of pollution source, and magnitudes indicate sizes of local communities.
Figure 3.
Figure 3.
PFOS discharges from wastewater treatment plants into streams and rivers across the United States in 1995 and 2005. Adapted from data presented in Zhang et al.
See this image and copyright information in PMC

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