A network of experts in reproductive and children’s environmental health

Per- and Polyfluoroalkyl Substances (PFAS)

A Resource for Health Professionals

Per- and polyfluoroalkyl substances, also known as “forever chemicals”, are a type of emerging contaminant that are gaining more attention around the United States. There is still a lot to learn about their health effects, but the PEHSUs are a leading source of information on this topic. Health professionals are encouraged to follow the guidance below to help navigate discussions with patients and families.

Region 3 PEHSU | Fact Sheet on Perfluorinated Chemicals (PFCs) for Health Professionals (2015)

 What are PFCs? posted on Mar 7, 2019
 Where are PFCs found? posted on Mar 6, 2019
 What are the potential health effects of PFCs? posted on Mar 5, 2019
 Is there medical testing for PFCs? posted on Mar 4, 2019
 How can people reduce exposures to PFCs? posted on Mar 3, 2019
 What are the current regulatory levels for PFCs? posted on Mar 2, 2019
 Where can I find more information? posted on Mar 1, 2019

To download this page as a fact sheet, click here.

Additional Resources for Health Professionals




PEHSU Resources 


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  3. Apelberg B.J., Goldman L.R., Calafat A.M., Herbstman J.B., Kuklenyik Z., Heidler J., et al. (2007). Determinants of fetal exposure to polyfluoroalkyl compounds in Baltimore, Marylan,d. Environ Sci Technol 41(11), 3891–3897.
  4. Barry, V., Winquist, A., Steenland, K. (2013). Perfluorooctanoic acid (PFOA) exposures and incident cancers among adults living near a chemical plant. Environmental Health Perspectives 121:1313–1318.
  5. Bartell, S.M., A.M. Calafat, C. Lyu, K. Kato, P.B. Ryan, and K. Steenland. (2010). Rate of decline in serum PFOA concentrations after granular activated carbon filtration at two public water systems in Ohio and West Virginia. Environmental Health Perspectives, 118 (2), 222---8.
  6. C---8 (PFOA) Medical Monitoring Program Coding. (2014). Health Smart. Retrieved from http://healthsmart.com/HealthSmartCustomers/Providers---Service- - - Locator/C---8--- Medical---Monitoring---Program.aspx.
  7. C8 Science Panel. (2011a). Status Report: PFOA (C8) Exposure and Pregnancy Outcome Among Participants in the C8 Health Project. http://www.c8sciencepanel.org/pdfs/Status_Report_C8_and_pregnancy_outcome_1 5July2011.pdf. C8 Science Panel. (2011b). Probable Link Evaluation of Pregnancy Induced Hypertension and Preeclampsia. http://www.c8sciencepanel.org/pdfs/Probable_Link_C8_PIH_5Dec2011.pdf.
  8. C8 Science Panel. (2011c). Status Report: Changes in Serum PFOA/PFOS and Serum Lipids Between2005 and 2010 in the Mid---Ohio Valley. http://www.c8sciencepanel.org/pdfs/Status_Report_C8_and_lipid_changes2_5Dec2011.pdf .
  9. Calafat, A. M., et al. (2007). Polyfluoroalkyl chemicals in the U.S. population: data from the National Health and Nutrition Examination Survey (NHANES) 2003---2004 and comparisons with NHANES 1999---2000. Environmental Health Perspectives, 115(11), 1596---602.
  10. Casals---Casas, C. & Desvergne, B. (2011). Endocrine Disruptors: From Endocrine to Metabolic Disruption Annu. Rev. Physiol., 73,135–62.
  11. Cui, L, Zhou, Q.F., Liao, C.Y., Fu, J.J., & Jiang, G.B. (2009). Studies on the toxicological effects of PFOA and PFOS on rats using histological observation and chemical analysis. Archives of Environmental Contamination and Toxicology, 56(2), 338---49.
  12. DeWitt, J.C. et al. (2012). Immunotoxicity of perflourinated compounds: Recent developments. Toxicol. Pathol. 40, 300---11.
  13. Ehgeghy, P. P., and M. Lorber. (2011). An assessment of the exposure of Americans to perfluorooctane sulfonate: A comparison of estimated intake with values inferred from NHANES data. Journal of Exposure Science and Environmental Epidemiology, 21 (2), 150---68.
  14. Fee C, et al. (2008). Fetal growth indicators and perflourinated chemicals: a study in the Danish National Birth Cohort. Am. J. Epidemiol., 168(1):66---72.
  15. Fuentes S., Colomina M.T., Rodriguez J., Vicens P., Domingo J.L. (2006). Interactions in developmental toxicology: concurrent exposure to perfluorooctane sulfonate (PFOS) and stress in pregnant mice. Toxicol. Lett. 164, 81–89.
  16. Fromme, Hermann, et al. (2009). Perfluorinated compounds: exposure assessment for the general population in western countries. International Journal of Hygiene and Environmental Health 212(3), 239---70.
  17. Grandjean P, Andersen EW, Budtz---Jørgensen E, Nielsen F, Molbak K, Weihe P, Heilmann C. (2012). Serum vaccine antibody concentrations in children exposed to perfluorinated compounds. JAMA, 307(4):391---397.
  18. Haug, Line S., et al. (2010). Diet and particularly seafood are major sources of perfluorinated compounds in humans." Environment International, 36(7), 772---78.
  19. Institute of Medicine (IOM). (2011). Breast cancer and the environment: A life course approach. Washington, DC: The National Academies Press.
  20. Lau C, Anitole K, Hodes C, Lai D, Pfahles---Hutchens A, Seed J. (2007). Perfluoroalkyl acids: a review of monitoring and toxicological findings. Toxicol Sci 99(2), 366–394.
  21. Lin, C.Y., Lin, L.Y., Chaing, C.K., Wang, W.J., Su, Y.N., et al. (2010). Investigation of the association between low---dose serum perfluorinated chemicals and liver enzymes in U.S. adults. American Journal of Gastroenterology, 105(6), 1354---63.
  22. Lindstrom, A. B., Strynar, M.J. & Libelo, L. (2011). Polyfluorinated Compounds: Past, Present, and Future. Environmental Science and Technology, 45 (19), 7954---61.
  23. Luebker D.J., York R.G., Hansen K.J., Moore J.A., Butenhoff J.L. (2005). Neonatal mortality from in utero exposure to perfluorooctanesulfonate (PFOS) in Sprague---Dawley rats: dose---response, and biochemical and pharamacokinetic parameters. Toxicology 215, 149–69
  24. Melzer O., et al. (2010). Association between serum PFOA and thyroid disease in the NHANES study. Environmental Health Perspectives, 118, 682---96.
  25. Moermond, C., Verbruggem, E., and C. Smit. (2010). Environmental Risk Limits for PFOS: A Proposal for Water Quality Standards in Accordance with the Water Framework Directive. National Institute for Public Health and the Environment. www.rivm.nl/bibliotheek/rapporten/601714013.pdf .
  26. National Institute of Environmental Health Sciences, (September 2012). Perflourinated chemicals. Accessed at: (https://www.niehs.nih.gov/health/materials/perflourinated_chemicals_508.pdf).
  27. Nelson, J.W., Hatch, E.E., Webster, T.F. (2010). Exposure to polyfluroalkyl chemicals and cholesterol, body weight, and insulin resistance in the U.S. general population. Environmental Health Perspectives, 118, 197–202.
  28. Olsen, G.W., J.M. Burris, D.J. Ehresman, J.W. Froehlich, A.M. Seacat, J.L. Butenhoff, and L.R. Zobel. (2007). Half---life of serum elimination of perfluorooctanesulfonate, perfluorohexanesulfonate, and perfluorooctanoate in retired fluorochemical production workers. Environmental Health Perspectives, 115 (9), 1298---305.
  29. Onischenko et al. (2010). Prenatal exposure to PFOS or PFOA alters motor function in mice in a sex---related manner. Neurotox. Research, 19, 452---61.
  30. Post G.B., Cohn P.D., Cooper K.R. (2012). Perfluorooctanoic acid (PFOA), an emerging drinking water contaminant: a critical review of recent literature. Environ Res. 116, 93---117.
  31. Rumsby P.C. et al. (2009). Perflourooctane sulfonate and perflourooctanoic acid in drinking and environmental waters. Philos. Transact. A Math. Phys. Eng. Sci., 367, 4119---36.
  32. Seals, R., Bartell, S.M. and Steenland, K. (2011). Accumulation and clearance of perfluorooctanoic acid (PFOA) in current and former residents of an exposed community. Environmental Health Perspectives 119(1),119---24.
  33. Shankar, A., Xiao, J., Ducatman, A. (2011a). Perfluroalkyl chemicals and elevated serum uric acid in US adults. Clinical Epidemiology, 3, 251---258.
  34. Shankar, A., Xiao, J., Ducatman, A. (2011b). Perfluroalkyl chemicals and chronic kidney disease in US adults. American Journal of Epidemiology. 174, 893---900.
  35. Shi Z, Zhang H, Liu Y, Xu M, Dai J. 2007. Alterations in gene expression and testosterone synthesis in the testes of male rats exposed to perfluorododecanoic acid. Toxicol. Sci. 98, 206–15.
  36. Shoeib, M., Haarne, T.M., Webster, G., & Lee, S.C. (2011). Indoor sources of poly--- and perflourinated compounds (PFCs) in Vancouver, Canada: Implications for human exposure. Environment, Science, and Technology 45, 7999---8005.
  37. Stein, C.R. et al. (2009). Serum levels of perflourooctanoic acid and perflourooctane sulfonate and pregnancy outcome. American Journal of Epidemiology, 170, 837---46.
  38. Steenland K, Fletcher T, Savitz D.A. (2010). Epidemiologic Evidence on the Health Effects of Perfluorooctanoic Acid (PFOA). Environmental Health Perspectives, 118(8), 1100--- 1108.
  39. Trudel, D., et al. (2008). Estimating consumer exposure to PFOS and PFOA. Risk Analysis 28 (2): 251---69.
  40. USEPA. (2006). Science Advisory Board of Review of EPA’s Draft Risk Assessment of Potential Human Health Effects Associated with PFOA and its Salts, May 30, 2006. http://yosemite.epa.gov/sab/sabproduct.nsf/A3C83648E77252828525717F004B9099/$File/sab_06_006.pdf
  41. USEPA. (2014). PFOA and Flourinated Telomers Progress Report. http://www.epa.gov/oppt/pfoa/pubs/stewardship/preports8.html.
  42. Velez M.P., Arbuckle T.E., & Fraser, W.D. (2015). Maternal exposure to perfluorinated chemicals and reduced fecundity: the MIREC study. Human Reproduction, 30(3), 701---709.
  43. Vieira, V.M., Hoffman, K., Shin, H., Weinberg, J.M., et al. (2013). Perfluorooctanoic Acid Exposure and Cancer Outcomes in a Contaminated Community: A Geographic Analysis. Environmental Health Perspectives 121:318–323.
  44. Washino N, et. al. (2009). Correlations between Prenatal Exposure to Perfluorinated Chemicals and Reduced Fetal Growth. Environmental Health Perspectives, 117(4), 660---667.
  45. Woodruff, T.J., Zota, A.R. & Schwartz, J.M.. (2011). Environmental Chemicals in Pregnant Women in the US: NHANES 2003---2004. Environmental Health Perspectives 119 (6), 878---85.
  46. Yoo, H., et al. (2011). Quantitative determination of perfluorochemicals and fluorotelomer alcohols in plants from biosolid---amended fields using LC/MS/MS and GC/MS." Environmental Science and Technology 45 (19), 7985---90.

This webpage was supported by the American Academy of Pediatrics (AAP) and funded (in part) by a cooperative agreement with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The U.S. Environmental Protection Agency (EPA) supports the PEHSUs by providing partial funding to CDC/ATSDR through an Inter-Agency Agreement. The findings and conclusions presented have not been formally disseminated by CDC/ATSDR or EPA and should not be construed to represent any agency determination or policy. Use of trade names that may be mentioned is for identification only and does not imply endorsement by the CDC/ATSDR or EPA. 

Last updated: August 2021