Four months have passed since the publication of Guidance on PFAS Testing and Health Outcomes, a study by the National Academies of Sciences, Engineering, Medicine, (National Academies). The National Academies are the premier American institutions created by President Lincoln in 1863 to investigate issues in science for the U.S. government.
The National Academies recommends blood tests and medical monitoring for people likely to have high exposure to the toxic chemicals known as per-and poly fluoroalkyl substances, (PFAS). The National Academies specifically addresses the urgent need to reach those who are exposed through occupational routes, particularly firefighters.
Is anyone paying attention?
PFAS bioaccumulate in our bodies, meaning they don’t break down and they don’t pass though us, like most other toxins. It’s what separates PFAS from so many other carcinogens in our environment.
Many firefighters, including individuals who retired years ago, are likely to have dangerously elevated PFAS levels in their blood from exposure to the carcinogens from turnout gear, firefighting foam, and the air and dust in fire stations and airport hangars.
PFAS exposure has been linked to the following cancers, while intensive studies are ongoing, (See the links below)
Bladder cancer y
Breast cancer z
Colon cancer y
Esophageal cancer y
Kidney Cancer x
Non-Hodgkin Lymphoma and Thyroid Cancer x
Ovarian and Endometrial Cancer x
Pancreatic cancer v
Prostate cancer x
Testicular cancer x
Thyroid cancer x
The National Academies study says patients with blood serum PFAS concentrations above 2 ng/ml ought to take immediate, precautionary steps to diminish the propensity to developing life-threatening illnesses, including a host of cancers.
It’s time to break this down for folks who don’t have medical degrees, a problem for most of us. Here’s a little bit of math. It’s rotten that we have to be our own advocates, but that’s the hand many of us have been dealt.
2 nanograms per milliliter (ng/mL) in your blood is the same as 2 micrograms per liter, (ug/l). Both ng/ml and ug/l are equal to 2 parts per billion, (ppb).
The study arrived at blood serum levels by adding seven different PFAS compounds: PFOS, PFOA, MeFOSAA, PFHxS, PFDA, PFUnDA, and PFNA. More than 12,000 PFAS compounds are known to exist and they are all believed to be threatening to our health.
A 2020 study published by Dr Graham F. Peaslee, et. al. in Environmental Science and Technology identified 13 different PFAS compounds in the turnout gear worn by firefighters. PFAS enters the body in several ways, including through dermal contact.
13 compounds identified by the Peaslee team:
PFBA, PFPeA, PFHxA, PFHpA, PFOA, PFNA, PFDA, PFUnA, PFDoA, PFBS, PFOS, 6:2 FTS, and 8:2 FTS.
(You can search for these chemicals at the NIH site,
Pub Chem to discover their impact on health. )
Just four of the above PFAS compounds identified by Peaslee: PFOS, PFOA, PFDA, and PFNA are included in the National Academies advice to clinicians. To complicate matters even further, aqueous film-forming foam (AFFF) may contain many other PFAS compounds that may find pathways to human exposure.
Clinical guidance for follow-up
with patients after PFAS testing
Serum PFAS concentration below 2 ng/ml
- Administer the usual standard of care.
Serum PFAS concentration above 2 ng/mL and less than 20 ng/mL
- Encourage PFAS exposure reduction if a source of exposure is identified, especially for pregnant persons.
- Prioritize screening for dyslipidemia with a lipid panel (once between 9 and 11 years of age, and once every 4 to 6 years over age 20)
- Screen for hypertensive disorders of pregnancy at all prenatal visits
- Screen for breast cancer based on clinical practice guidelines based on age and other risk factors
Serum PFAS concentration above 20 ng/mL
- Encourage PFAS exposure reduction if a source of exposure is identified, especially for pregnant persons.
- Prioritize screening for dyslipidemia with a lipid panel for patients over age two
- At all well visits - conduct thyroid function testing for patients over age 18 with serum thyroid stimulating hormone (TSH),
- Assess for signs and symptoms of kidney cancer (for patients over 45), including with urinalysis
- Assess for signs and symptoms of testicular cancer and ulcerative colitis for patients over 15.
To put these concentrations into perspective, the EPA says it is dangerous if we drink water that contains more than .004 part per trillion of PFOA and .02 part per trillion of PFOS. Over the years, firefighters have been exposed to massive levels of these chemicals, and more recently, they may have been exposed to a myriad of other potentially carcinogenic replacements.
Biomonitoring for PFAS in humans has been conducted by the Centers for Disease Control, (CDC) on serum for many years.
General U.S. Population, 2017-2018 (ng/mL)
The average American, according to this narrow snapshot, has blood serum totaling 6.8 ppt for just three PFAS compounds.
What’s in your blood?
With all of this, somehow, there’s a disconnect between many of the nation’s leading scientists and our local health care providers.
From my perspective in this Southern Maryland peninsula, formed by the confluence of the Potomac River and the Chesapeake Bay, two hours south of Washington, I asked four medical doctors, including my cardiologist, over the last year about PFAS and none of them had heard of PFAS. I don’t care to make enemies with these folks in my back yard so I’ll leave it there. My findings have been corroborated by many of my fellow community liaisons assembled by the National Academies. At my urging, my cardiologist wrote an order for PFAS blood testing but the local lab was clueless. I had to explain to them that there is a strong association between cardio-vascular disease and elevated PFAS levels in the blood. and that I had been eating large amounts of crabs, oysters, and rockfish from the St. Mary’s River that contained exorbitant PFAS levels in the tens of thousands of parts per trillion. Who knew?
I don’t know anyone who has been tested for PFAS in Southern Maryland. This is an area with a large military presence, including four large installations with documented PFAS contamination. The Patuxent River Naval Air Station and the Naval Research Laboratory-Chesapeake Bay Detachment contaminate the Chesapeake Bay, while the Indian Head Naval Surface Warfare Center and Joint Base Andrews poison the Potomac.
You’d think medical professionals here would have at least heard about PFAS by now, but the local media is reluctant to publish reports that might be interpreted to be critical of the military. When I asked medical professionals about PFAS blood testing I was told it wasn’t needed and that it’s not a normal procedure. Doctors have a way of putting you in your place, like what do I know? There are only a handful of labs certified to test for PFAS in blood across the country and the out-of-pocket cost for this test is prohibitive for most of us.
For its part, the Veterans Administration does not recommend blood tests to determine levels of PFAS in any veteran. They defend this outrageous position by stating, “Most people in the U.S. have measurable amounts of PFAS in their blood and normal ranges have not been established. Also, blood tests cannot be linked to current or future health conditions or guide medical treatment decisions.”
Many thousands of current and retired military firefighters are threatened while the liability facing the military is staggering.
The National Academies says PFAS blood testing does not identify the sources of exposure or predict future health outcomes; it only assesses body burden at the time of sample collection. They acknowledge that there are “deficiencies in the current cost payment model, and the availability of PFAS testing.” They also say health care facilities ought to be made aware of reimbursement policies and laboratory codes. PFAS testing can currently be ordered online without a provider, and the committee believes the testing and interpretation of its results are most beneficial if done with the guidance of a clinician.
The National Academies recommends that the Centers for Disease Control and Prevention (CDC), the Agency for Toxic Substances and Disease Registry, (ATSDR), and state and local public health departments support clinicians with educational materials about PFAS testing so they can discuss testing with their patients.
The National Academies hosted town hall meetings throughout 2021 that included presentations by 38 community liaisons from across the country. I was one of the community liaisons. Most of us described frustrating ordeals navigating PFAS exposure and related health issues and concerns. We cited an immediate need for accessible PFAS blood testing along with the need for action to support people like firefighters who are most vulnerable and disproportionately affected.
It was the consensus of these community leaders that local, state, and the federal governments must provide readily available, affordable PFAS blood testing. An aggressive testing regime would establish crucially important baselines of exposure. This is the very first step in protecting ourselves and those we love. Furthermore, many community liaisons stressed that testing must be free or financially accessible and covered by health insurance plans. Many suggested that exposed communities ought to be prioritized for PFAS blood testing.
Randy Krause, Fire Chief of the Port of Seattle Fire Department addressed the National Academies by describing his career as a firefighter, which included experience with the military, private industry, and a municipal fire department. Krause described fire training activities with the DoD that involved regular training with powerful military-grade aqueous film-forming foam (AFFF). Fires were ignited and AFFF was sprayed abundantly onto the training props and into the wider environment. Krause also related that these foams were used routinely to clean floors and wash trucks and were thrown on other firefighters during training exercises. When he moved to private industry, Krause found a similar approach to training, where an open pit was used to stage fire scenarios, and AFFF was used to douse the fires. Krause said that firefighters were assured these “mil-spec” foams were safe, biodegradable, and did not pose a risk to the environment. The military has known the threat posed to human health and the environment posed by AFFF containing PFAS since the 1970’s.
Andi Rich with the group Save Our Water offered insight as a community member from Marinette, Wisconsin, home to the Johnson Controls, Inc. (JCI) Fire Technology Center in Marinette, Wisconsin. Rich described the extent of contamination around the site, stating that PFAS levels in groundwater around the site reach 400,000 ppt, and the contamination plume has spread for miles around the site. Rich indicated that the community has been told that PFAS exposure does not equate to illness, that blood testing would not be useful, and that blood testing is not recommended. Rich pointed out that blood testing would be highly useful to ensure lawsuit payouts are based on internal exposure.
Military and civilian firefighters must look out for themselves and the first step is getting their blood tested.
The Downs Law Group in Miami, Florida has been offering free blood tests to firefighters across the country. They’ll perform a brief case evaluation and there is no commitment. It’s worth a try. What’s in your blood?