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Per- and poly-fluorinated alkyl substances (PFAS)

Understanding the potential dangers of PFAS

PFAS, commonly referred to as “forever chemicals,” are man-made chemicals that have been used in industry and consumer products since the 1940s.1

People are most likely exposed to these chemicals by consuming PFAS-contaminated water or food, using products made with PFAS, or breathing contaminated air. In addition to drinking water, PFAS are found in2,5:

  • Nonstick cookware
  • Water-resistant clothing
  • Stain-resistant fabrics and carpets
  • Some cosmetics
  • Industrial agents, like firefighting foams

PFAS exposure may lead to health problems

While the science around the potential health impact of PFAS exposure is still emerging, evidence suggests that high PFAS exposure is associated with the following health problems, among others6,7:

 

  • Decreased response in the immune system
  • Higher-than-normal lipid levels
  • Decreased growth in unborn babies and infants
  • Increased risk of kidney cancer in adults
Pollution in the water

Who’s at higher risk for health impacts of PFAS?

Certain groups of people may be at higher risk for health impacts from PFAS levels, including4:

 

  • People who have been exposed on the job, such as firefighters
  • People who use a water supply near a commercial or industrial location
  • People who live near a facility that manufactures fluorochemicals
  • People who live near areas of documented PFAS environmental contamination
  • Children can have higher PFAS exposures through ingestion than adults
Water pollution

Podcast—PFAS: Understanding the Risks and the Role of Testing

In this episode of The Results Are In from Quest Diagnostics, host Dr Jack Kain speaks with Dr Sarah Bartock, National Science Director of Drug Monitoring & Toxicology at Quest. Together, they break down what PFAS are, how people are exposed, and the health conditions that have been linked to these chemicals. They also discuss how blood testing—including Quest's PFAS 9 panel—can help patients and providers better understand risk and make informed decisions about exposure reduction and health monitoring.

Listen to our new podcast—PFAS: Understanding the Risks and the Role of Testing

Listen now

 

 

PFAS drug testing: Why monitor your patients?

In January 2024, the Centers for Disease Control and Prevention (CDC) recognized the value of PFAS blood testing when conducted by a CLIA-certified laboratory.8

  • A PFAS blood test measures the levels of certain PFAS chemicals in a patient’s blood at the time of the test
  • Blood testing can help patients and clinicians monitor PFAS levels and assess whether there may be any potential health risks associated with high exposure
  • Residents of communities with local sources of contamination and people who may have been exposed to high levels of PFAS at their workplace may seek a PFAS blood test to learn more about their exposure8

In deciding whether to order PFAS testing, clinicians can consider9:

  • A patient’s exposure history
  • Results of PFAS testing from the patient’s water supply, food sources, or other exposure routes
  • Whether results can inform exposure reduction and health promotion

PFAS blood testing results can provide:

  • An indication of how much PFAS has entered a patient’s body over time, as measured from an initial baseline test
  • A baseline to monitor changes over time
  • Insights to support conversations about risk factors for associated health outcomes as well as ways to reduce PFAS exposure and monitor a patient’s health

A PFAS blood test cannot tell you:

  • Where the PFAS in a patient’s body came from
  • How long a patient has been exposed to PFAS
  • Whether any health condition was directly caused by PFAS exposure
  • Whether a person is likely to develop certain health problems in the future

Guidance on PFAS exposure, testing, and clinical follow-up

Risks are reported to increase with exposure

>2 ng/mL

2 ng/mL-20 ng/mL

>20 ng/mL

No adverse effects expected from PFAS exposure
  • Reduce exposure
  • Potentially screen for dyslipidemia, HT disorders of pregnancy, and breast cancer
  • Reduce exposure
  • Potentially screen for dyslipidemia, HT disorders of pregnancy, breast cancer, thyroid function, signs and symptoms of kidney cancer (including urinalysis), signs and symptoms of testicular cancer, and ulcerative colitis

For individuals with elevated PFAS, Quest offers these follow-up tests:

  • Lipid Panel, Standard (test code 7600) to assess dyslipidemia
  • TSH (test code 899) to assess thyroid function
  • Urinalysis, Macroscopic (test code 6448) to assess kidney disease

Quest Diagnostics offers a test for PFAS: The PFAS (Forever Chemicals) 9 Panel

The PFAS 9 Panel measures the levels of 9 PFAS chemicals that may be associated with certain health risks, per the National Academies of Sciences, Engineering, and Medicine (NASEM) guidelines.

The report provides the overall level and each of the 9 PFAS individual levels at the time of blood sample collection, as well as the health risk assessment (per NASEM) values and the US population median data. Results indicate how much PFAS has entered a patient’s body as of the present time.

PFAS analytes tested

Methylperfluorooctane sulfonamidoacetic acid

Perfluorohexanesulfonic acid

Perfluorooctanoic acid (n-PFOA)

Perfluorooctanoic acid isomers (Sb-PFOA)

Perfluorodecanoic acid

Perfluoroundecanoic acid

Perfluorooctane sulfonic acid (n-PFOS)

Perfluoromethylheptane sulfonic acid isomers (Sm-PFOS)

Perfluorononanoic acid

Panel components cannot be ordered separately.

References

  1. Perkins T. Chemical companies’ PFAS payouts are huge—but the problem is even bigger. The Guardian. August 2, 2023. Accessed May 28, 2025. https://www.theguardian.com/environment/2023/aug/03/chemical-companies-pfas-payouts-forever-chemicals
  2. USGS. Tap water study detects PFAS ‘forever chemicals’ across the US. July 5, 2023. Accessed May 28, 2025. https://www.usgs.gov/news/national-news-release/tap-water-study-detects-pfas-forever-chemicals-across-us
  3. Smalling KL, Romanok KM, Bradley PM, et al. Per- and polyfluoroalkyl substances (PFAS) in United States tapwater: comparison of underserved private-well and public-supply exposures and associated health implications. Environ Int. 2023;178:108033. doi:10.1016j.envint.2023.108033
  4. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division on Earth and Life Studies; Board on Population Health and Public Health Practice; Board on Environmental Studies and Toxicology; Committee on the Guidance on PFAS Testing and Health Outcomes. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. National Academies Press (US); 2022. doi:10.17226/26156
  5. EPA. Our current understanding of the human health and environmental risks of PFAS. Updated November 26, 2024. Accessed May 28, 2025. https://www.epa.gov/pfas/our-current-understanding-human-health-and-environmental-risks-pfas
  6. FDA. Market phase-out of grease-proofing substances containing PFAS. Updated January 3, 2025. Accessed May 28, 2025. https://www.fda.gov/food/process-contaminants-food/market-phase-out-grease-proofing-substances-containing-pfas
  7. Reese A. As PFAS restrictions advance, paper industry struggles to phase out use. April 3, 2023. Accessed May 28, 2025. Packaging Dive. https://www.packagingdive.com/news/pfas-packaging-paper-mill-effluent-epa-fda/646345/
  8. CDC. PFAS information for clinicians—2024. Updated November 12, 2024. Accessed May 28, 2025. https://www.atsdr.cdc.gov/pfas/hcp/clinical-overview/index.html
  9. CDC. Clinical evaluation and management: PFAS information for clinicians—2024. Updated November 12, 2024. Accessed May 28, 2025. https://www.atsdr.cdc.gov/pfas/hcp/clinical-overview/clinical-evaluation-management.html

Forever chemicals: Their health impact and the benefits of blood testing

Download our white paper and take a deeper dive into the prevalence of PFAS, the associated health problems, and using PFAS blood testing to detect risk.

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