By Francisco R. Velázquez, M.D., S.M., FCAP
Most of us have heard the term “forever chemicals,” particularly in recent times. This is a common term used to describe the many substances classified as per- and polyfluoroalkyl substances, commonly known as PFAS. Since their inception in the 1930s and their broad use in multiple industries, health regulatory agencies have learned through research that long-term exposure may have equally long-term health impacts.
Here in Spokane County, we are seeing the impacts of PFAS exposure firsthand. There are an estimated 2,854 sites in all 50 states and two territories where contamination of water sources have occurred. One of those sites identified is the West Plains area in Spokane County, including the city of Airway Heights.
Before addressing how PFAS contamination is seen locally, I’d like to share a brief background on how PFAS came to be used so widely. The most common questions revolve around their origin, the numerous applications of PFAS in many industries, and the potential impact on people exposed.
It is historically interesting that the first compound, known as polytetrafluoroethylene, was the unexpected result of a chemistry experiment in 1938. This substance was slick and resilient to a level not seen at the time. The substance was trademarked in 1945 as Teflon. Since then, thousands of substances with similar carbon fluorine bonds in their chemical composition have been produced. The replacement of carbon hydrogen bonds with carbon fluorine bonds generated one of the strongest compounds in organic chemistry, resistant to heat, acid, water and physiological filtration. These characteristics found applications in the aerospace, construction, electronics and consumer products industries. The common use of PFAS in firefighting foams and the discharge from industrial sites has led to widespread PFAS contamination in the global water supply. People have also been exposed to PFAS through products in everyday living, including nonstick cookware and food wrappers, as well as stain-resistant clothes and furniture.
Since the early 2000s, concerns regarding potential long-term impact of exposure to PFAS on humans have resulted in extensive research and numerous regulatory actions in a variety of countries. Research conducted by scientists from the Centers for Disease Control and Prevention’s Division of Laboratory Sciences, using samples from 1990-2002, established that approximately 98% of the population older than 12 had some exposure to PFAS compounds. Subsequent studies demonstrated a decrease in the amounts present in the population, in part due to the voluntary phase-out of PFAS compounds in industry.
There is increased awareness about the potential health impact of PFAS and its presence, particularly, in drinking water. Various animal studies and epidemiological research have linked exposure to dyslipidemias, such as high levels of serum cholesterol, thyroid dysregulation, lower antibody response to vaccines and a small decrease in birth weight. Other studies have described a possible increased risk for testicular and kidney cancer from occupational or industrial exposure.
Locally, a 2017 test of Airway Heights drinking water detected statistically elevated levels, compared to national geometric means, of at least three of the most common PFAS. In March 2022, a report from the CDC’s National Center for Environmental Health Agency for Toxic Substance and Disease Registry reported that blood levels in the Airway Heights participants are higher than national levels. Residents in the affected areas have been advised to test their water sources and install the appropriate filtration systems. There is an ongoing investigation assessment and continued research in this area, where contamination could potentially impact numerous households.
Given the information available to the community, it is important that we all have some knowledge of the basic facts. For example, at this time, PFAS potential toxicity is not associated with characteristic signs or symptoms. In addition, diagnostic tools such as blood testing for PFAS levels are not widely available, may only test for some PFAS, and ultimately only provide information relative to the time it was collected. It will not tell if levels were higher before, nor will it identify when and how exposure occurred. In addition, it will not tell you if a current clinical condition is directly associated with past PFAS exposure.
On Jan. 18, the Agency for Toxic Substance and Disease Registry and CDC released the publication, “PFAS Information for Clinicians.” This follows the 2022 release of the National Academies of Sciences, Engineering, and Medicine report, “Guidance on PFAS Exposure, Testing, and Clinical Follow-Up.” These publications are aimed at providing general recommendations and guidance for providers who see patients in the many areas of the United States where PFAS contamination, particularly of water sources, has been identified. You can find these reports and more information about PFAS on Spokane Regional Health District’s website, www.srhd.org (search for “PFAS”).
Since the discovery of PFAS contamination in the West Plains, public health and environmental partners have put actions in place to help address the issue. The Washington State Department of Ecology, the Environmental Protection Agency, the Washington State Department of Health, and SRHD are all working together to ensure people are drinking clean water until the investigation and cleanup of PFAS sources provides more permanent solutions. More information about details specific to contamination in Airway Heights can be found on the West Plains Water Coalition’s website: www.westplainswater.org.
If you have any concerns, it is important that you share those with your primary care provider. They will help determine your risk for exposure, and based on your history, how it may have occurred. This will assist your provider in offering guidance on possible exposure mitigation strategies or any other diagnostic testing that may be clinically indicated based on your current clinical picture. A lot is known, but there is still a lot more to learn about PFAS exposure and the potential impact on human health.
Francisco R. Velázquez, M.D., S.M., FCAP, is health officer for the Spokane Regional Health District.