Arming doctors with knowledge about PFAS pollution
By Courtney Carignan, Esmé Getto, Phil Brown, Laurel Schaider, Andrea Amico, Emily Donovan and Alissa Cordner for the Environmental Health News
A report released in July and new courses for medical
professionals aim to change that. The National Academies of Sciences,
Engineering and Medicine report recommends offering per- and polyfluoroalkyl
substances, commonly known as PFAS, blood testing to individuals likely to have
had elevated exposure and prioritizes certain types of medical screening for
affected individuals. In addition, in October 2022, our team launched a
free Continuing Medical Education course,
initiated by and including perspectives from community activists, along with
a Clinician Resources webpage on
the PFAS Exchange.
These recommendations and resources are urgent: PFAS—used to
impart stain, water, grease and heat-resistance to many common consumer
products—are persistent in the environment and our bodies and have likely
impacted the drinking water of more than 200 million Americans.
PFAS have been linked to far-ranging health effects, including high
cholesterol, immune suppression, thyroid disease and cancer.
Our aim to increase the medical community’s knowledge and
resources in addressing PFAS is gaining traction. These efforts are part of a
growing recognition of the need for more health professional education and
guidance on health implications of PFAS exposure, obtaining and interpreting
PFAS blood testing and improving patient care.
PFAS testing can save lives
The importance of clinician education regarding PFAS is demonstrated in the lives of those affected by these chemicals. Michigan resident Sandy Wynn-Stelt learned in 2017 that she and her late husband Joel had consumed highly contaminated water for over a decade prior to his fatal liver cancer diagnosis. Her quest for answers led her to get tests — both her blood and her private well had extremely high levels.
She shared her test
results with her doctor along with information about PFAS health effects. This
information likely saved her life: Wynn-Stelt’s physician monitored her health
and was able to make an early diagnosis of thyroid cancer based on the results
of her PFAS blood test and other information.
Related: Where did the PFAS in your blood come from? These
computer models offer clues
Similarly, Ayesha Khan became concerned about PFAS after her firefighter husband Nate Barber was diagnosed with testicular cancer in 2019 and she learned that PFAS exposure is a risk factor for the condition. PFAS contamination was discovered in groundwater near the Nantucket Airport close to their home around that time and she was additionally concerned to learn that firefighters are exposed to PFAS from firefighting foam, as well as their protective gear.
In 2020, she and her close friend Jaime Honkawa
founded the Nantucket PFAS Action Group, a community organization that educates
firefighters and the public about the risks of PFAS — and helps them take
protective action.
Our new course was prompted by a request from the Nantucket
Cottage Hospital to the Nantucket PFAS Action Group to develop training for
their medical professionals about PFAS exposure. The Nantucket PFAS Action
Group worked with the PFAS-REACH collaborative team and the Mid-America
Pediatric Environmental Health Specialty Unit to develop the course.
Released this October through Children’s Mercy Hospital, the
course features both scientific experts as well as people who’ve experienced
contamination. It was designed to be useful to all health professionals, and
especially those in PFAS-impacted areas or whose patients have been
occupationally or otherwise exposed. It can be accessed via the Children’s
Mercy Hospital website or on the Clinician Resources page of the PFAS Exchange
website.
Testing
individuals for PFAS
In the past, the federal Agency for Toxic Substances and Disease Registry and other health agencies have emphasized the benefits of testing at the population, rather than individual, level. So the National Academies of Sciences, Engineering and Medicine report’s recommendation to offer PFAS blood testing to individuals who have likely experienced elevated exposures is noteworthy.
The report highlighted the importance of patient autonomy with
informed, shared decision making between clinicians and patients about PFAS
blood testing and medical screening with discussion of its benefits, harms and
limitations. It noted how testing can help people feel empowered in managing
their own health and can relieve the stress of not knowing one’s exposure.
For patients with moderately elevated PFAS blood levels, the report recommends that clinicians focus on screening for high blood pressure, pregnancy induced hypertension and breast cancer based on age and other risk factors.
For patients with higher total PFAS in their blood, the report
additionally recommends that clinicians test for thyroid function and assess
for signs of ulcerative colitis as well as kidney and testicular cancer.
The recommendations have been well received by those impacted by PFAS contamination. Andrea Amico of Testing for Pease in New Hampshire called the report’s recommendations “huge milestones in the right direction,” and Emily Donovan of the community action group Clean Cape Fear in North Carolina wrote that the new report is “an important first step for our community” and that it “allows us to begin the process of caring for the elevated disease burdens our region is experiencing.”
Amico, Donovan and many others from PFAS-impacted communities across the country provided valuable input for the report.
Taking
action on PFAS pollution
PFAS science and activism have expanded enormously in less than
a decade and engagement of medical professionals has not kept pace. Now, the
combination of the National Academies of Sciences, Engineering, and Medicine
report and our Continuing Medical Education course opens up new avenues to
address health effects and should spur health professionals to join in work to
halt the upstream production and emissions of PFAS.
If you are a resident of a PFAS-impacted community, you can
share our Resources for Clinicians page
with your medical providers and explore our PFAS
Exchange website. If you are a medical professional, please
consider enrolling in our course and sharing the information with your network
of medical and public health organizations.
Together, we can empower PFAS-affected people and help tackle
this insidious pollution.
For more information:
Download the National Academies of Sciences, Engineering and
Medicine report
Access our free Continuing Medical Education (CME)
Training at the Children’s Mercy Hospital Continuing Medical Education page.
Check out our Resources for Clinicians,
which includes video of the training, a link to feedback survey, and medical
screening guidance
PFAS-REACH (Research, Education, and Action for Community
Health) is a collaboration among Silent Spring Institute, Northeastern
University, Michigan State University, Testing for Pease, Massachusetts Breast
Cancer Coalition, and Slingshot. We acknowledge the work of Elizabeth Friedman,
MD and Alan Ducatman, MD who are responsible for the medical content of the CME
course.