“Firefighters are exposed to several hazardous, persistent and harmful organofluorine chemical compounds such as PFAS in their work environment,” said Dr. Caban-Martinez. “There is a critical need to educate and advocate for first responders about their workplace exposures and mechanisms to biomonitor their health.”

While PFAS are chemicals that are almost universally found in the United States, it is difficult to know who, when, and what to test, as well as what the risks of testing entail. A National Academies-led study will provide advice for clinicians about PFAS testing and how test results should inform clinical care. To aid in this process, its expert committee will consider existing evidence on the human health effects of PFAS. The National Academies will provide the Centers for Disease Control and Prevention (CDC), the Agency for Toxic Substances and Disease Registry (ATSDR), and the National Institutes of Environmental Health Sciences a review of the current evidence, specifically the PFAS being monitored in the CDC’s National Report on Human Exposure to Environmental Chemicals.

With the help of the committee members, the National Academies will also provide recommendations on changes to CDC and ATSDR clinical guidance on PFAS, including options and considerations to guide decision-making for testing in a patient’s blood or urine, PFAS concentrations that could inform clinical care of exposed patients, and appropriate patient follow-up and care specific to PFAS-associated health endpoints.

This information will be used to determine how communities and individuals exposed to PFAS could best be served by clinicians. According to the National Academies, the committee, which includes Dr. Caban-Martinez as community liaison, will undertake the following tasks:

• Assess the strength of evidence for the spectrum of putative health effects suggested by human studies to establish a basis for prioritized clinical surveillance or monitoring of PFAS health effects.
• Develop general principles for clinical evaluation or biological testing given substantial scientific uncertainty about health effects or the value of such measures in informing care. These principles should address reasons for testing, when to test, who to test, how to test, what to test for, risks of testing, and the related social and ethical implications of testing.
• Review current knowledge about the contribution of PFAS exposure sources to human exposure and develop principles clinicians can use to advise patients on exposure reduction.
• Advise whether changes to current CDC/ATSDR clinical recommendations on PFAS blood or urine testing are needed given the committee’s general principles and assessment of the associations between PFAS exposure and clinically relevant health outcomes.
• Outline a process by which the CDC/ATSDR PFAS clinical guidance can be effectively reviewed and revised over the next decade.

“It is a distinct honor to serve as a community liaison, representing the firefighter community on the (PFAS) Testing and Health Outcomes Committee that will ultimately shape PFAS testing guidance for the first responder workforce,” said Dr. Caban-Martinez.

Written by Amanda Torres

Published on April 20, 2021