or new report from the National Academy of Sciences offers new recommendations for how doctors should treat patients who have been exposed to PFAS, a group of man-made chemicals that were widely used in consumer products such as nonstick cookware and stain-resistant fabrics.
PFAS contamination has affected communities across New Hampshire, with contamination hotspots in the Merrimack area, from Saint-Gobain manufacturing facilityand in Sea coastfrom the former Pease Air Force Base.
The report lays out the health effects associated with PFAS exposure, provides guidance for clinicians on how to understand risk levels associated with blood test results and how to treat patients who test at higher levels, and recommends blood testing for humans with a prolonged history of higher exposure. .
This is a major milestone for many advocates for PFAS-affected communities, who have long advocated for more accessible testing, said Andrea Amico, who reviewed a draft copy of the report before it was released.
Amico co-founded Testing for Pease to protect her family and others affected by PFAS contamination from firefighting foam used at Pease.
“That’s where Testing for Pease came from,” Amico said. “We wanted the blood test for our community and it took a lot of support to make it happen.”
Barriers to blood analysis
Amico said the group had to organize testing efforts through the state health department because blood testing for individuals was not readily available. It was complicated for doctors to order tests, and there were only a few labs in the country that would perform those tests.
National guidelines have historically not recommended testing for all patients with a prolonged history of high exposure. A 2019 clinical guideline sheet from the Agency for Toxic Substances and Disease Registry encourages doctors to tell their patients that blood tests will not provide information to predict health problems or information for treatment and that PFAS testing is most useful when it is part of a study research.
At a community meeting after the Pease contamination was discovered, advice from state officials echoed that document. Amico said officials recommended against blood testing, saying it would not provide information about where the PFAS in a person’s blood came from or whether it would cause a health effect.
Eventually, she said, the state agreed to offer a blood testing program. But it took work to convince them it was worth it and to find labs that could handle the testing.
More than 2,800 sites across the U.S. have documented PFAS contamination, and the National Academy of Sciences report says many community members who participated in town halls led by the committee that wrote the report were strongly in favor of PFAS testing and have experienced frustration trying to enter. that in the past.
Recommendations for doctors
The report was commissioned by the Agency for Toxic Substances and Disease Control (ATSDR) and the National Institute of Environmental Health Sciences. It recommends changing ATSDR guidelines to include offering testing to those with prolonged high exposure and monitoring patients who test at high levels for health issues.
There is evidence that exposure to PFAS is linked to kidney cancer, decreased antibody response, high cholesterol and decreased growth in infants and fetuses, the report says. Patients testing between 2 and 20 nanograms per liter for PFAS in the blood may face the potential for adverse effects, and patients testing above 20 nanograms per liter may face higher risk.
Medical monitoring guidelines and clear screening levels included in the report were another priority for which affected communities have advocated, Amico said.
“This puts the blood test results into more context. This helps patients and doctors identify what category their patients are in and simply helps them make more informed decisions about health monitoring over time,” she said.
In Amico’s experience, doctors have not had the knowledge or tools to treat those with PFAS exposure. Most have not heard of PFAS, or the health effects associated with exposure, she said. She doesn’t blame them, acknowledging that many doctors don’t get much training in environmental health, but says it’s important that more comprehensive guidelines are coming.
“From the moment I found out my family was exposed to PFAS, the first questions that came to mind were: Is their health affected by this? And how will their health be affected by this over time?” Amico said. “I’m not saying that this report or these recommendations will answer all of these questions … but they are big milestones in the right direction.”
Access remains a challenge
In New Hampshire, insurance providers are required to cover the PFAS blood test. But this is not the case in every state, and in many people they don’t have insurance or relationships with clinical care providers who may order blood tests.
The report says that in the current healthcare landscape, access to PFAS testing may remain a problem – it’s expensive, and demographic factors such as age and race have affected whether people are able to access clinical services.
“Encouraging testing primarily among people with relatively stable access to care may have the unintended effect of exacerbating disparities in PFAS exposure, a serious disadvantage of encouraging testing without a funded, national PFAS testing program,” it says. report.
The authors say the recommendations would be more effective if they were part of a larger national effort to increase PFAS monitoring and promote environmental health education. One of their recommendations is that labs share PFAS test results with state public health officers to improve knowledge about exposure.
Nearly 100% of people in the United States have been exposed to at least one PFAS chemical, but exposure levels are not consistently documented, the report says.
“The recommendations open up bigger questions and bigger challenges,” Amico said. “Now, lowering the barriers to access what these recommendations say is the next challenge and making sure that the solutions we find are inclusive of everyone, regardless of their ability to pay or their insurance status.”
