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Pages 1-17

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From page 1...
... PFAS are commonly used in thousands of products, from nonstick cookware to firefighting foams and protective gear, because they have desirable chemical properties that impart oil and water repellency, friction reduction, and temperature resistance. PFAS as a class have a wide variety of distinct chemical properties and toxicities; for example, some PFAS can bioaccumulate and persist in the human body and the environment, while others transform relatively quickly.
From page 2...
... Environmental Protection Agency; MRL = minimal risk limit; ng/L = nanograms per liter; NHANES = National Health and Nutrition Examination Survey; PFAS = per- and polyfluoroalkyl substances; PFC = perfluorochemicals; PFHxS = perfluorohexane sulfonic acid; PFNA = perfluorononanoic acid; PFOA = perfluorooctanoic acid; PFOS = perfluorooctane sulfonic acid. SOURCE: Committee generated based on slides included by Patrick N
From page 3...
... , "locations represented on the map are approximate and intended to portray the general area of a contamination site or a community water system. Locations were mapped using the best data available from official records, including data provided by tests of public drinking water systems, the Safe Drinking Water Information System and the Department of Defense report Addressing Perfluorooctane Sulfonate (PFOS)
From page 4...
... The Statement of Task asked the committee to recommend  options and considerations to guide decision making for PFAS 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 for those patients known or suspected to be exposed to PFAS. The committee also was asked to provide advice on changes to ATSDR's clinical guidance.
From page 5...
... FIGURE S-4 The committee's approach to the Statement of Task and the chapters and appendixes where the topics are discussed. NOTE: ATSDR = Agency of Toxic Substances and Disease Registry; CDC = Centers for Disease Control and Prevention; PFAS = per- and polyfluoroalkyl substances.
From page 6...
... TABLE S-1 PFAS Species Currently Included in the Centers for Disease Control and Prevention's National Report on Human Exposure to Environmental Chemicals Abbreviated Name Full Name CAS Registry No. MeFOSAA Methylperfluorooctane sulfonamidoacetic acid 2355-31-9 PFHxS Perfluorohexanesulfonic acid 355-46-4 perfluorohexane sulfonic acid n-PFOA (linear isomer)
From page 7...
... . The committee found limited or suggestive evidence of an association for the following diseases and health outcomes:  increased risk of breast cancer (in adults)
From page 8...
... If PFAS are in drinking water, switching to consumption of water lower in PFAS will reduce exposure. In general, however, it is difficult to reduce exposure to PFAS through personal behavior modifications.
From page 9...
... Authoritative sources include the Pediatric Environmental Health Specialty Units (PEHSUs) , the Agency for Toxic Substances and Disease Registry (ATSDR)
From page 10...
... . BOX S-2 Potential Harms and Benefits of PFAS Testing Potential Harms  Fear of blood draw  Small risk of injury or infection at draw site  Difficulties in interpreting results  Stress or concern about the health effects of exposure  Decreased property values resulting from identifying property contamination  Social isolation  Clinical consequences from medical follow-up as a result of exposure Potential Benefits  Increased awareness of exposure so it can be reduced  Empowerment of communities to respond to contamination  Relief from the stress of not knowing one's exposure level  Identification of the potential risk for health conditions associated with PFAS exposure, informing subsequent preventive care  Help in monitoring whether efforts to reduce exposure are working through the conduct of baseline and follow-up tests The German Human Biomonitoring Commission has risk-based guidance levels for two PFAS chemicals -- PFOS and PFOA.
From page 11...
...  Potential health effects of PFAS exposure and strategies for reducing exposure.  Limitations of PFAS blood testing: 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.
From page 12...
... The disadvantage would be compounded as PFAS testing services should be linked to counseling on steps to mitigate exposure and its impacts. Therefore, encouraging testing primarily among people with relatively stable access to care could have the unintended effect of aggravating disparities in exposure to PFAS absent a funded, national PFAS testing program with a counseling component.
From page 13...
... NOTE: MeFOSAA = methylperfluorooctane sulfonamidoacetic acid; PFDA = perfluorodecanoic acid; PFHxS = perfluorohexane sulfonic acid, PFNA = perfluorononanoic acid; PFOA = perfluorooctanoic acid; PFOS = perfluorooctanesulfonic acid; PFUnDA = perfluoroundecanoic acid.
From page 14...
... The sum thus derived should be compared against Figure S-6 to determine an appropriate clinical follow-up plan based on shared, informed decision making between patient and clinician. REVISING ATSDR'S PFAS CLINICAL GUIDANCE The committee recommends several changes to ATSDR's guidance to ensure consistency with the findings, conclusions, and recommendations presented in this report and improve the guidance's writing, design, dissemination, and implementation: Recommendation 7-1: The Agency for Toxic Substances and Disease Registry (ATSDR)
From page 15...
... NOTE: ATSDR = Agency for Toxic Substances and Disease Registry; MeFOSAA = methylperfluorooctane sulfonamidoacetic acid; PFDA = perfluorodecanoic acid; PFHxS = perfluorohexane sulfonic acid, PFNA = perfluorononanoic acid; PFOA = perfluorooctanoic acid; PFOS = perfluorooctanesulfonic acid; PFUnDA = perfluoroundecanoic acid.
From page 16...
... Clinicians and members of communities with elevated PFAS exposure should be engaged to inform the problem and review updated guidance. FIGURE S-8 Suggested framework for updating the Agency for Toxic Substances and Disease Registry's clinical guidance based on new evidence.
From page 17...
... The committee's recommendations will best protect the public health if they are part of a national effort focused on increased biomonitoring, exposure surveillance, and education of clinicians and public health professionals on environmental health issues: Recommendation 8-1: Laboratories conducting PFAS testing of serum or plasma should report the results to state public health authorities, following the respective states' statutes and reporting regulations. This reporting would improve PFAS exposure surveillance; it could be linked with the Centers for Disease Control and Prevention's (CDC's)


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