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Testing for forever chemicals and PFAS health effect

The medical community has a watchful eye on per- and polyfluoroalkyl substances (PFAS), a class of thousands of manufactured chemicals that have been infiltrating nearly every aspect of daily life since the 1940s.

Used in many industry and consumer products, PFAS are now commonly known as “forever chemicals” because they break down extremely slowly and can gradually build up in people, animals, and the environment. The potential health effects of PFAS have only been recognized in recent years, with both the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) issuing guidelines regarding PFAS in 2024.1,2

In fact, the CDC guidelines outline the value of PFAS blood testing in assisting healthcare providers and their patients in identifying existing levels of chemicals in the bloodstream, avoiding further exposure, and taking preventive care measures for overall health and well-being.

In this article:

Clinical challenge | Why it matters | Ordering recommendations | Interpreting test results | Next steps | Supporting resources

 

Clinical challenge: Identifying PFAS health risks

More research is still underway to better understand PFAS health effects, but the buildup of certain PFAS in blood and organs has already been associated with the risk of developing various medically related issues. The National Academies of Sciences, Engineering, and Medicine (NASEM) found correlation between PFAS exposure and the following health problems, among others.3

  • Decreased immune system response
  • Higher-than-normal dyslipidemia
  • Decreased fetal and infant growth
  • Increased kidney cancer risk in adults
  • Thyroid dysfunction

The likelihood of these conditions being a direct result of PFAS exposure depends on 3 types of factors.1

Exposure factors such as exposure levels, frequency, duration, and route (how the person was exposed)

Individual factors such as existing chronic diseases

Social determinants of health such as access to safe water

High-risk populations

Anyone can be exposed to forever chemicals by consuming PFAS-contaminated water or food, using products made with PFAS, or breathing PFAS-contaminated air. However, several populations are considered at higher risk of health impacts from elevated PFAS levels, including those who3

  • May have been exposed on the job, such as firefighters
  • Use a water supply near a commercial or industrial location, including airports, military bases, manufacturing plants, or sewage plants
  • Live near a facility that manufactures fluorochemicals
  • Live near areas of documented PFAS environmental contamination

CDC guideline

To address the strong connection between PFAS and patient health, the CDC now recommends providers screen higher-risk patients. This includes taking an exposure history and conducting PFAS blood testing from a CLIA-certified laboratory.1

Why it matters: Forever chemicals are everywhere and in everyone

The chemicals in PFAS offer some functional benefits, such as temperature-, water-, and oil-resistance in cookware, textiles, cosmetics, protective equipment, and fire-fighting foams. However, the carbon-fluorine bond characteristic of PFAS chemicals do not naturally break down.3 Thus, the apt name “forever chemicals.”

As their name also implies, the health impacts of forever chemicals aren’t going away any time soon. Even as manufacturers phase out the use of PFAS, the chemicals are already embedded in nearly everyone’s blood and organs,3 as well as in the environment at large. This means that the value and importance of understanding PFAS toxicity on patients is likely to increase in the coming years.

Their widespread use has led to PFAS being found in water, food, soil, and air. Multiple studies reveal that 45% of US tap water is contaminated with PFAS4-6—directly impacting more than 200 million Americans across all 50 states.7

One sobering statistic from the CDC and National Health and Nutrition Examination Survey (NHANES), shows that 97% of Americans have PFAS in their blood.3 Additionally, NASEM reports that as much as 9% of the US population is in the upper range of PFAS levels.3

 

Real-world impact of forever chemicals

45%

of US tap water is contaminated with PFAS, affecting 200M Americans4-6

50

US states have PFAS-contaminated drinking water sites7

97%

of Americans have PFAS in their blood3

9%

of Americans have PFAS levels of ≥20 ng/mL3

Ordering recommendations: PFAS environmental toxin testing

Not every patient will benefit from a PFAS blood test. When deciding whether testing for these environmental toxins is indicated, healthcare providers should keep the following considerations in mind.8

  • A patient’s exposure history from their environment and occupation
    • Consider using the I PREPARE mnemonic (Investigate potential exposures; ask questions about Present work, Residence, Environmental concerns, Past work, and Activities; provide Referrals and resources, and Educate) to inquire about potential exposure history9
  • Results of PFAS testing from the patient’s local water supply, food sources, or other exposure routes
  • Whether results can guide exposure reduction and health promotion

There are currently no symptoms associated with PFAS, so gauging risk is the only method to assess whether or not to test.

 

Recommended test: PFAS (Forever Chemicals) 9 Panel

The PFAS blood test panel from Quest Diagnostics measures the levels of the 9 PFAS chemicals that are most likely associated with health risks, according to NASEM guidelines.1

The chemicals tested in the panel and their median concentration levels are

PFAS common abbreviation

PFAS full name

Median concentration levels, ng/mL8

MeFOSAA

 Methylperfluorooctane sulfonamidoacetic acid 0.70
PFHxS Perfluorohexanesulfonic acid 1.00
Linear PFOA (n-PFOA) Perfluorooctanoic acid 1.30
Branched PFOA (Sb-PFOA) Perfluorooctanoic acid isomers 0.07
PFDA Perfluorodecanoic acid 0.20
PFUnDA Perfluoroundecanoic acid 0.10
Linear PFOS (n-PFOS) Perfluorooctane sulfonic acid 2.70
Branched PFOS (Sm-PFOS) Perfluoromethylheptane sulfonic acid isomers 1.10
PFNA Perfluorononanoic acid 0.50
NASEM recommended summation 7.04

Note: PFAS (Forever Chemicals) 9 Panel components cannot be ordered separately.

 

Follow-up tests

For individuals with elevated PFAS levels, Quest offers these follow-up tests for related health risks:

Lipid Panel, Standard to assess dyslipidemia

  • Test code: 7600
  • CPT code: 80061

Note: Components of panels can be ordered separately. 

Components of lipid panel, standard: Total cholesterol (334), triglycerides (896), HDL cholesterol (608), calculated LDL cholesterol, cholesterol/HDL ratio, and non-HDL cholesterol

TSH to assess thyroid function

  • Test code: 899
  • CPT code: 84443

Urinalysis, Macroscopic to assess kidney disease

  • Test code: 6448
  • CPT code: 81003

Note: The CPT codes provided are based on American Medical Association guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party.  Please direct any questions regarding coding to the payer being billed.

 

Interpreting PFAS blood test results: Opportunities and limitations

Results of the PFAS (Forever Chemicals) 9 Panel can indicate:

  • A baseline to monitor changes over time
  • How much PFAS has entered a patient’s body over time, as measured from an initial baseline test
  • Insights to support provider-patient conversations about related health risks
  • Insights on strategies to reduce PFAS exposure and monitor a patient’s health

Clinical consideration for children

Children can have higher PFAS exposures through ingestion than adults, since they eat and drink more relative to their body weight and are more likely to ingest dust or dirt containing PFAS.3

Limitations of PFAS blood testing

A PFAS blood test cannot determine:

  • 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
  • How likely a patient is to develop certain health problems in the future

 

Next steps: Clinical follow-up guidance

The greater the levels of PFAS exposure found in blood testing, the more follow-up testing is recommended. NASEM encourages the following protocol.3

Summed PFAS serum levels <2 ng/mL 2 ng/mL-20 ng/mL >20 ng/mL
Follow-up recommendations No adverse effects expected from PFAS exposure

Reduce exposure

Screen for these related conditions:

  • Dyslipidemia
  • Hypertensive disorders of pregnancy
  • Breast cancer

Reduce exposure

Screen for these related conditions:

  • Dyslipidemia
  • Hypertensive disorders of pregnancy
  • Breast cancer
  • Thyroid function
  • Signs and symptoms of kidney cancer (including urinalysis)
  • Signs and symptoms of testicular cancer
  • Ulcerative colitis

If a patient’s results are in the upper range (≥20 ng/mL), they meet the NASEM threshold for clinical concern. These levels may indicate past or ongoing significant exposure with potential health risks.3

Under the guidance of their provider, these patients should take steps to identify PFAS sources and reduce exposure, continue periodic blood testing to monitor PFAS levels over time, monitor for NASEM-identified health conditions, and speak to their doctor about emerging therapies that may help to reduce PFAS in the body.

 

Supporting resources

PFAS web page
PFAS test summary
PFAS infographic
PFAS brochure
Forever chemicals white paper

Clinical Education Center resources

Pathology & Laboratory Medicine
Audio Podcast
PFAS: Understanding the Risks and the Role of Testing
Prescription Drug Monitoring
Conference Presentation
Correlation Between PFAS Forever Chemical Concentrations in Remnant Serum and Public Drinking Water
Prescription Drug Monitoring
Conference Presentation
Development and Validation of the 9 NASEM PFAS Analytes in Serum and NASEM Recommended Summation PFAS Results in Donor Specimens
View all articles

References:

1. CDC. PFAS information for clinicians—2024. Published November 12, 2024. Accessed October 25, 2025. https://www.atsdr.cdc.gov/pfas/hcp/clinical-overview/clinical-evaluation-management.html

2. FDA. Market phase-out of grease-proofing substances containing PFAS. Published January 3, 2025. Accessed October 25, 2025. https://www.fda.gov/food/process-contaminants-food/market-phase-out-grease-proofing-substances-containing-pfas

3. 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;2022. doi:10.17226/26156

4. Perkins T. Chemical companies’ PFAS payouts are huge—but the problem is even bigger. The Guardian. Published August 2, 2023. Accessed October 25, 2025. https://www.theguardian.com/environment/2023/aug/03/chemical-companies-pfas-payouts-forever-chemicals

5. USGS. Tap water study detects PFAS ‘forever chemicals’ across the US. Published July 5, 2023. Accessed October 25, 2025. https://www.usgs.gov/news/national-news-release/tap-water-study-detects-pfas-forever-chemicals-across-us

6. Smalling KL, Romanok KM, Bradley PM, et al. Per- and polyfluoroalkyl substances (PFAS) in United States tap water: comparison of underserved private well and public-supply exposures and associated health implications. Environ Int. 2023;178:108033. doi:10.1016j.envint.2023.108033

7. Thompson A. Nearly half of people in the US have toxic PFAS in their drinking water. Scientific American. Published March 28, 2025. Accessed October 25, 2025. https://www.scientificamerican.com/article/pfas-found-in-nearly-half-of-americans-drinking-water/

8. 2017-2018 Laboratory data - continuous NHANES. Centers for Disease Control and Prevention. Published November 2020. Accessed October 11, 2023. https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Laboratory&CycleBeginYear=2017

9. Paranzino GK, Butterfield P, Nastoff T, Ranger C. I PREPARE: development and clinical utility of an environmental exposure history mnemonic. AAOHN J. 2005;53(1):37-42. doi:10.1177/216507990505300108

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