The association between per- and polyfluoroalkyl substances (PFASs) and brain, esophageal, melanomatous skin, prostate, and lung cancer using the 2003-2018 US National Health and Nutrition Examination Survey (NHANES) datasets

Exposure to per- and polyfluoroalkyl substances in residential settled dust and risk of childhood acute lymphoblastic leukemia

Per- and polyfluoroalkyl substances (PFAS) are ubiquitous. Young children are commonly exposed to these chemicals via ingestion of settled dust. Several PFAS have been associated with cancers in adults, yet little is known about the risk in children. We investigated whether PFAS concentrations in residential dust were associated with childhood acute lymphoblastic leukemia (ALL). Vacuum bags were collected in homes of 178 children diagnosed with ALL and 204 healthy controls (age 0-7 years) residing in California (2001-2007). Dust samples were sieved and analyzed for 19 PFAS using targeted liquid chromatography mass spectrometry analysis. The effects of individual PFAS and PFAS mixtures were estimated for eight PFAS with at least 50% above the limit of quantification (LOQ) using logistic regression, G-computation, and generalized additive modeling (GAM). In the model mutually adjusting for eight PFAS, a statistically significant association was seen only for N-ethyl perfluorooctane sulfonamido acetic acid (EtFOSAA) (ORcontinuous = 1.40, 95% CI = 1.05-1.86 andOR 4 th vs . 1 st quartile = 2.58 , 95% CI = 1.16-5.71). Using G-computation, the eight PFAS mixture was positively associated with childhood ALL (OR = 1.60, 95% CI = 1.15-2.24), with positive weights for EtFOSAA, perfluoro-n-hexanoic acid (PFHxA), perfluoro-1-decanesulfonate (PFDS), and perfluoro-1-octanesulfonate (PFOS), and negative weights for perfluoro-1-hexanesulfonate (PFHxS) and bis(1H,1H,2H,2H-perfluorooctyl)phosphate (6:2 diPAP). Using GAM, the OR for the mixture reached a maximum of 2.24, at the highest value of log10 EtFOSAA and lowest value of log10 PFHxS. Exposure to a mixture of PFAS in settled dust was associated with an overall elevated risk of childhood ALL, with EtFOSAA and PFHxS being the main contributors to the positive and negative weights, respectively.

Association between exposure to perfluoroalkyl substances (PFASs) and risk of hyperemesis gravidarum

The fluctuation of endocrine hormones during early pregnancy plays an important role in the pathogenesis of hyperemesis gravidarum (HG). As an endocrine disrupting chemical (EDC), perfluoroalkyl substances (PFASs) exert an impact on pregnancy-related complications by altering hormone balances throughout gestation. Despite this potential impact, the relationship between serum PFAS levels in early pregnancy and the risk of HG has not been previously investigated. A total of 98 HG cases and 495 controls were included in this study from the Xi'an Birth Cohort Study. In total, serum levels of 10 PFASs were measured using High Performance Liquid Chromatography with tandem Mass Spectrometry (HPLC-MS/MS) during early pregnancy. Binary logistic models were applied to evaluate the associations between individual PFAS levels and HG. Weighted quantile sum (WQS) regression models and Bayesian kernel machine regression (BKMR) models were performed to test the overall effect of the PFAS mixture on HG. After adjusting for confounding variables, the highest tertile concentrations of perfluoroundecanoic acid (PFUnDA) (OR: 3.49, 95 %CI: 1.31-9.29), and perfluorododecanoic acid (PFDoA) (OR: 3.13, 95 % CI: 1.40-6.98) were significantly associated with a higher risk of HG, while highest tertile of perfluorohexanoic acid (PFHxA) (OR: 0.34; 95 % CI: 0.16-0.73), and PFOS (OR: 0.35; 95 % CI: 0.13-0.97) were inversely associated with HG. The WQS index showed a positive correlation with HG risk (β = 0.80; 95 % CI: 0.02, 1.57), with notable contributions from PFDoA (0.952), PFUnDA (0.159), and perfluorobutanoic acid (PFBA) (0.146). In addition, the joint effect of the PFAS mixture was positively associated with HG, with PFDoA (posterior inclusion probability (PIP) = 0.78) and PFUnDA (PIP = 0.75) being identified as the primary contributors. Our findings indicate that exposure to PFAS mixture during early pregnancy was associated with an increased risk of HG, with PFDoA and PFUnDA being the major contributors.

Associations between per-and polyfluoroalkyl substances (PFAS) and county-level cancer incidence between 2016 and 2021 and incident cancer burden attributable to PFAS in drinking water in the United States

BACKGROUND

Exposure to per- and polyfluoroalkyl substances (PFAS) has been linked with various cancers. Assessment of PFAS in drinking water and cancers can help inform biomonitoring and prevention efforts.

OBJECTIVE

To screen for incident cancer (2016-2021) and assess associations with PFAS contamination in drinking water in the US.

METHODS

We obtained county-level age-adjusted cancer incidence (2016-2021) from the Surveillance, Epidemiology, and End Results (SEER) Program. Data on PFAS levels in public drinking water systems were obtained from the Third (UCMR3; 2013-2015) and Fifth (UCMR5; 2023-2024) Unregulated Contaminant Monitoring Rule. UCMR3 measured PFOS, PFOA, PFNA, PFHxS, PFHpA, and PFBS. UCMR5 expanded measurements to include PFBA, PFHxA, PFPeA, and PFPeS. We created indicators of PFAS detection and, for UCMR5, concentrations above Maximum Contaminant Levels (MCLs). MCLs for PFOA and PFOS are 4 ng/L, and for PFNA and PFHxS are 10 ng/L. We used Poisson regression models to assess associations between PFAS detection or MCL violation and cancer incidence, adjusting for potential confounders. We estimated the number of attributable cancer cases.

RESULTS

PFAS in drinking water was associated with increased cancer incidence in the digestive, endocrine, oral cavity/pharynx, and respiratory systems. Incidence rate ratios (IRRs) ranged from 1.02 to 1.33. The strongest association was observed between PFBS and oral cavity/pharynx cancers (IRR: 1.33 [1.04, 1.71]). Among males, PFAS was associated with cancers in the urinary, brain, leukemia, and soft tissues. Among females, PFAS was associated with cancers in the thyroid, oral cavity/pharynx, and soft tissue. PFAS in drinking water is estimated to contribute to 4626 [95% CI: 1,377, 8046] incident cancer cases per year based on UCMR3 data and 6864 [95% CI: 991, 12,804] based on UCMR5.

IMPACT STATEMENT

The ecological study examined the associations between PFAS in drinking water measured in two waves (2013-2015 and 2023-2024) and cancer incidence between 2016 and 2021. We found that PFAS in drinking water was associated with cancers in the organ system including the oral cavity/pharynx, lung, digestive system, brain, urinary system, soft tissue, and thyroid. Some cancers have not been widely studied for their associations with PFAS. We also observed sex differences in the associations between PFAS and cancer risks. This is the first ecological study that examined PFAS exposure in drinking water and various cancer risks.

Exposure to Per- and Polyfluoroalkyl Substances and the Risk of Prostate and Ovarian Cancer: An Epidemiologic Meta-Analysis

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants. Previous research has linked PFAS exposure to prostate and ovarian cancer risk, however, the conclusions have been inconsistent. This research purpose was to determine the relationship between PFAS exposure and prostate and ovarian cancer at the population level.

METHODS

We systematically reviewed three databases-PubMed, Web of Science, and Embase-for research from when these databases were established to April 15, 2024. The quality of the retrieved research was evaluated using the Newcastle-Ottawa Scale (NOS) quality measurement tool. Meta-analysis of the extracted data was conducted using Stata 18. We also conducted sensitivity and subgroup analyses, as well as Begg's and Egger's tests.

RESULTS

Twelve publications were involved in the analysis for prostate cancer, and six were included for ovary cancer. The outcomes indicated that PFOS exposure was positively related to prostate cancer (OR: 1.13, 95% CI: 1.00-1.28), while mixed PFAS exposure was positively related to ovarian cancer (OR: 1.63, 95% CI: 1.49-1.78). The source of heterogeneity identified in the subgroup analysis was primarily attributable to variations in study design. No significant study bias was detected in the analysis.

CONCLUSION

The study demonstrated an association between PFAS exposure and both prostate and ovarian cancers. Further investigation is required to clarify the underlying mechanisms and potential associations.

Exposure to per- and poly-fluoroalkyl substances and lung, head and neck, and thyroid cancer: A systematic review and meta-analysis

Recent evidence suggests that exposure to per- and polyfluoroalkyl substances (PFAS) may increase the risk of different cancer types, such as kidney and testicular cancers. Instead, evidence for lung, head and neck, and thyroid cancer is sparse. Hence, we aimed to summarize available literature on the topic. We searched Pubmed and Scopus in January 2024 to retrieve relevant studies and estimated pooled relative risks (RRs) and 95% confidence intervals (CIs) for lung, head and neck, and thyroid cancers according to PFAS exposure using restricted maximum likelihood method. Pooled RRs for occupational or environmental PFAS exposure were 1.20 (95% CI: 1.12-1.28; I2 = 0.0%, phet = 0.9; n. studies = 9), 1.15 (95% CI: 0.96-1.37; I2 = 0.0%, phet = 0.7; n. studies = 3), and 1.54 (95% CI: 0.86-2.78; I2 = 69.0%, phet = 0.02; n. studies = 4) for lung, head and neck, and thyroid cancer, respectively. We did not find compelling evidence of publication bias for lung cancer (p = 0.3). Studies on statistically modelled serum PFAS levels did not support associations with these cancers. We found no positive associations between measured serum levels of 6 different types of PFAS and thyroid cancer. However, the pooled RR of two case-control studies nested within cohorts on the association between natural log-unit increase of perfluorooctanesulfonic acid (PFOS) and thyroid cancer was 1.51 (95% CI: 1.11-2.05; I2 = 21.1%, phet = 0.3). PFAS exposure may be associated with lung and thyroid cancer. Due to the limited number of studies and their limitations, further prospective studies with appropriate account of co-exposure with other carcinogens and detailed exposure assessment are needed to establish causality of observed associations.

Construction of the cancer patients' database based on the US National Health and Nutrition Examination Survey (NHANES) datasets for cancer epidemiology research

BACKGROUND

The US National Health and Nutrition Examination Survey (NHANES) dataset does not include a specific question or laboratory test to confirm a history of cancer diagnosis. However, if straightforward variables for cancer history are introduced, US NHANES could be effectively utilized in future cancer epidemiology studies. To address this gap, the authors developed a cancer patient database from the US NHANES datasets by employing multiple R programming codes.

METHODS

To illustrate the practical application of this methodology to a real-world problem, the authors extracted the R codes applied in an academic paper published in another journal on January 30th, 2024 ( https://doi.org/10.1016/j.heliyon.2024.e24337 ). This paper will focus on the construction of the database and analysis using R codes. Entire.

RESULTS

In the first example, the urine concentration of monocarboxynonyl phthalate, monocarboxyoctyl phthalate, mono-2-ethyl-5-carboxypentyl phthalate, and mono-2-hydroxy-iso-butyl phthalate (all ng/mL) were used as the independent variable, instead of the serum concentration of perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA), respectively. In the second example, the serum concentration of 2,3,3',4,4'-Pentachlorobiphenyl (PCB105), 2,3,4,4´,5-Pentachlorobiphenyl (PCB114), 2,3',4,4',5-Pentachlorobiphenyl (PCB118), and 2,2',3,4,4',5'- and 2,3,3',4,4',6-Hexachlorobiphenyl (PCB138) were used as the independent variable, instead of the serum concentration of PFOA, PFOS, PFHxS, and PFNA, respectively.

DISCUSSION

This research offers a comprehensive set of R codes aimed at creating a single, user-friendly variable that encapsulates the history of each type of cancer while also considering the age at which the diagnosis was made. The US NHANES provides a wealth of critical data on environmental toxicant exposures. By employing these R codes, researchers can potentially discover numerous new associations between environmental toxicant exposures and cancer diagnoses. Ultimately, these codes could significantly advance the field of cancer epidemiology in relation to environmental toxicant exposure.

Perfluoroalkyl and polyfluoroalkyl substances and Cancer risk: results from a dose-response Meta-analysis

Background

Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are persistent organic pollutants in the environment. While some studies suggest that PFASs may contribute to cancer development, the link between PFAS exposure and cancer risk remains debated.

Methods

This dose-response meta-analysis explores the relationship between PFASs and cancer. It employs odds ratio (OR) and standardized mean difference (SMD), along with their 95% confidence interval (CI), to assess the effects of PFASs on cancer risk. Relevant studies were sourced from Web of Science, PubMed, Embase, Medline, and CNKI databases. The dose-response relationship was assessed by the fixed-effects model and least-squares regression.

Results

Forty studies, involving a total of 748,188 participants, were included in this meta-analysis. Out of these, 13 studies were specifically analyzed for the dose-response relationship. Findings revealed that exposure to PFASs, especially PFDA, significantly raises the risk of genitourinary cancers, and PFDA exposure shows a dose-dependent increase in overall and breast cancer risk. Additionally, PFOS exposure is associated with an increased cancer risk, and elevated PFOA levels were significantly observed in breast cancer patients.

Conclusions

The findings suggest that PFAS exposure is a potential cancer risk factor, with the carcinogenic potential of PFDA being dose-dependent.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-024-00899-w.

Organic food and internal exposure to pollutants among Flemish adolescents

Contrary to the initial hypothesis, Flemish adolescents who reported consuming organic food at least 7.5 times per week did not exhibit reduced internal exposure to the tested recently used pesticides. After adjustment for gender, age, country of origin, socioeconomic status, body mass index, consumption of high-fat foods and foods linked to organic food consumption, and concerning organochlorine derivatives and lead, additional adjustment for the duration of breastfeeding expressed in weeks, they displayed slightly elevated internal exposure to organochlorine derivatives, lead, methyl arsenate, and toxic relevant arsenic. A comparison was also made between the correlation of internal exposure to pollutants with the frequency of organic food consumption on one hand and the total consumption of equivalent products from all sources on the other. Regarding potatoes, vegetables, and fruits, no clear trends were observed. Regarding eggs, there was a trend towards higher internal exposures with organic food consumption, significant for trans-nonachlor, PCB118, and 2,4-dichlorophenoxyacetic acid, and marginally significant for glyphosate. For dairy, there was a trend towards higher internal exposures with organic food consumption, significant for perfluorononanoic acid and marginally significant for PCB153. Regarding nuts and seeds, the higher internal exposure to dichlorophenoxyacetic acid and the lower exposure to 3-phenoxybenzoic acid were marginally significant, while there was also a trend towards higher internal exposure to other pollutants with organic food consumption, significant for PCB118, PCB153, and sum PCBs, and marginally significant for trans-nonachlor. Concerning breakfast cereals and muesli, no clear trends were observed.

A toxicogenomics-based identification of potential mechanisms and signaling pathways involved in PFCs-induced cancer in human

Introduction

The number of new diagnosed cancer cases and cancer deaths are increasing worldwide. Perfluorinated compounds (PFCs) are synthetic chemicals, which are possible inducers of cancer in human and laboratory animals. Studies showed that PFCs induce breast, prostate, kidney, liver and pancreas cancer by inducing genes being involved in carcinogenic pathways.

Methodology

This study reviews the association between PFCs induced up-regulation/down-regulation of genes and signaling pathways that are important in promoting different types of cancer. To obtain chemical-gene interactions, an advanced search was performed in the Comparative Toxicogenomics Database platform.

Results

Five most prevalent cancers were studied and the maps of their signaling pathways were drawn, and colored borders indicate significantly differentially expressed genes if there had been reports of alterations in expression in the presence of PFCs.

Conclusion

In general, PFCs are capable of inducing cancer in human via altering PPARα and PI3K pathways, evading apoptosis, inducing sustained angiogenesis, alterations in proliferation and blocking differentiation. However, more epidemiological data and mechanistic studies are needed to better understand the carcinogenic effects of PFCs in human.

Per- and poly-fluoroalkyl substances (PFAS) effects on lung health: a perspective on the current literature and future recommendations

Per- and poly-fluoroalkyl substances (PFAS) are a broad class of synthetic compounds widely used in commercial applications. The persistent nature of PFAS in the environment has earned them the epithet "forever chemicals." Concerns arise from widespread exposure to PFAS from occupational, household, and environmental sources. This widespread use of PFAS is particularly concerning, as emerging epidemiological evidence highlights their adverse effects on lung health. Such adverse impacts include impaired fetal lung development, reduced immune function in children, and potential links to lung cancer. Both in vivo and in vitro studies illuminate potential mechanisms underlying such adverse health outcomes subsequent to PFAS inhalation exposure, which may include immunomodulation, oxidative stress, and disruptions to epithelial barriers. However, evidence-based information focusing on the mechanisms of PFAS-mediated lung injury is lacking. Additionally, the discrepancies between data collected from animal and epidemiological studies highlight the need for improved approaches to better understand the toxicity results of PFAS exposure. To address these gaps, we recommend leveraging route-to-route extrapolation for risk assessment, prioritizing research on understudied PFAS, and adopting physiologically relevant, high-throughput approaches. These strategies are aimed at enhancing our understanding of PFAS inhalation effects, aiding in more informed risk management decisions. In this review, we summarize the current literature on PFAS exposure, emphasizing its adverse effects on lung health, particularly through inhalation. We then discuss the current knowledge on mechanisms underlying tissue- and cellular-level adverse outcomes caused by PFAS.

Gut Microbiota, Human Blood Metabolites, and Esophageal Cancer: A Mendelian Randomization Study

BACKGROUND

Unbalances in the gut microbiota have been proposed as a possible cause of esophageal cancer (ESCA), yet the exact causal relationship remains unclear.

PURPOSE

To investigate the potential causal relationship between the gut microbiota and ESCA with Mendelian randomization (MR) analysis.

METHODS

Genome-wide association studies (GWASs) of 207 gut microbial taxa (5 phyla, 10 classes, 13 orders, 26 families, 48 genera, and 105 species) and 205 gut microbiota metabolic pathways conducted by the Dutch Microbiome Project (DMP) and a FinnGen cohort GWAS of esophageal cancer specified the summary statistics. To investigate the possibility of a mediation effect between the gut microbiota and ESCA, mediation MR analyses were performed for 1091 blood metabolites and 309 metabolite ratios.

RESULTS

MR analysis indicated that the relative abundance of 10 gut microbial taxa was associated with ESCA but all the 12 gut microbiota metabolic pathways with ESCA indicated no statistically significant association existing. Two blood metabolites and a metabolite ratio were discovered to be mediating factors in the pathway from gut microbiota to ESCA.

CONCLUSION

This research indicated the potential mediating effects of blood metabolites and offered genetic evidence in favor of a causal correlation between gut microbiota and ESCA.

Association between per- and polyfluoroalkyl substances exposure and prevalence of chronic obstructive pulmonary disease: The mediating role of serum albumin

BACKGROUND

No study has examined the association between per- and polyfluoroalkyl substances (PFAS) exposure and chronic obstructive pulmonary disease (COPD) risk. This study aims to explore this relationship.

METHODS

This study enrolled 4541 individuals who had available data on PFAS, COPD, and covariates from NHANES 2007-2018. Serum PFAS including perfluorohexane sulfonate (PFHxS), perfluorononanoic acid (PFNA), perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS) were analyzed, because of high detective rates. Considering the skew distribution of PFAS levels, the natural logarithm-transformed PFAS (Ln-PFAS) was used. Logistic regression analysis, restricted cubic spline (RCS), and weighted quantile sum (WQS) regression were performed to explore the single, nonlinear, and mixed effects. A mediating analysis was used to evaluate the mediated effects of albumin.

RESULTS

Individuals with COPD had higher levels of PFHxS, PFNA, PFOA, and PFOS compared to those without COPD. Ln-PFNA (OR males: 1.92, 95 % CI:1.31 to 2.80, P: <0.001; OR females: 1.07, 95 % CI: 0.81 to 1.40, P: 0.636) and ln-PFOA (OR males: 2.17, 95 % CI:1.38 to 3.41, P: <0.001; OR females: 1.49, 95 % CI: 1.08 to 2.05, P: 0.016) were associated with COPD risk especially in males. The interaction between PFNA exposure and sex on COPD risk was significant (P interaction: <0.001). The RCS curve demonstrated the nonlinear relationship between the ln-PFOA (P nonlinear:0.001), ln-PFNA (P nonlinear:0.045), and COPD risk in males. WQS analysis showed mixed PFAS exposure was correlated with COPD risk in males (OR: 1.44, 95 % CI:1.18 to 1.75, P: <0.001). Albumin mediated the relationship between PFOA and COPD (mediated proportion: -17.94 %).

CONCLUSION

This study concludes PFOA and PFNA are linked to a higher COPD risk in males, and serum albumin plays a mediating role in the relationship between PFOA and COPD. Thess findings are beneficial for the prevention of COPD. Further studies are required to explore potential mechanisms.

Extracorporeal Removal of Per- and Polyfluoroalkyl Substances by Hemoadsorption: In vitro Kinetic Model

INTRODUCTION

Per- and polyfluoroalkyl substances (PFAS) are known water pollutants leading to potential public health consequences. High blood levels of PFAS have been associated with several pathological conditions including testicular and kidney cancer. Classic extracorporeal therapies have demonstrated limited efficiency, and new approaches should be explored. In this study, we studied the possible role of hemoadsorption to achieve a fast, safe, and effective removal of PFAS from blood in patients with high blood levels.

METHODS

We developed an in vitro model of hemoadsorption to test the potential of PFAS removal by extracorporeal treatment. We recirculated a highly polluted batch of water (4 L) through a sorbent cartridge (Jafron Medical, Zhuhai, China) for 120 min at a flow of 150 mL/min. We collected samples at different time points and analyzed 39 different PFAS compounds.

RESULTS

For the PFAS compounds with concentrations significantly above normal, we observed a removal ratio close to 90% already within the first 60 min of circulation leading to almost complete elimination of all pollutants at 120 min.

CONCLUSIONS

The in vitro model of hemoadsorption suggests the possible application in vivo of this technique to reduce/normalize the concentrations of PFAS in patients exposed to water or environmental pollution.