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van Gerwen M, Chung T, Monaghan M, Vermeulen R, Petrick L, Leung AM. Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer: Systematic review and meta-analysis. Toxicol Lett 2024; 399:52-58. [PMID: 39047923 DOI: 10.1016/j.toxlet.2024.07.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/11/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) exposure is a potential risk factor for thyroid cancer and may be a contributor to the increasing thyroid cancer incidence rates. A systematic review and meta-analysis was performed to summarize all human studies to date investigating the association between PFAS exposure and thyroid cancer. A search of the National Library of Medicine and National Institutes of Health PubMed and Scopus databases was done to identify relevant articles published in English through January 2024. Studies reporting the association between PFAS exposure and thyroid cancer using odds ratios (OR) were included in the meta-analysis with summary estimate calculated using a random effects model (n=5). Perfluorooctanoic acid (PFOA) was the most investigated PFAS. Results of the included studies varied, ranging from significant positive to significant negative associations with thyroid cancer incidence for different PFAS. Meta-analyses of PFOA, Perfluorooctanesulfonic acid (PFOS), perfluorononanoic acid (PFNA), perfluorohexanesulfonic acid (PFHxS) were not significant. This comprehensive review of the current literature highlights the limited knowledge and inconsistent results of this association. Large longitudinal cohort studies with varying time between sample collection and thyroid cancer diagnosis are needed to better understand the role of PFAS exposure on thyroid carcinogenesis.
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Affiliation(s)
- Maaike van Gerwen
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Tony Chung
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mathilda Monaghan
- Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roel Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Department of Population Health Sciences, Utrecht University, Utrecht, the Netherlands
| | - Lauren Petrick
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai New York, NY, 10029USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Bert Strassburger Metabolic Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine; David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Stingone JA, Geller AM, Hood DB, Makris KC, Mouton CP, States JC, Sumner SJ, Wu KL, Rajasekar AK. Community-level exposomics: a population-centered approach to address public health concerns. EXPOSOME 2023; 3:osad009. [PMID: 38550543 PMCID: PMC10976977 DOI: 10.1093/exposome/osad009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Environmental factors affecting health and vulnerability far outweigh genetics in accounting for disparities in health status and longevity in US communities. The concept of the exposome, the totality of exposure from conception onwards, provides a paradigm for researchers to investigate the complex role of the environment on the health of individuals. We propose a complementary framework, community-level exposomics, for population-level exposome assessment. The goal is to bring the exposome paradigm to research and practice on the health of populations, defined by various axes including geographic, social, and occupational. This framework includes the integration of community-level measures of the built, natural and social environments, environmental pollution-derived from conventional and community science approaches, internal markers of exposure that can be measured at the population-level and early responses associated with health status that can be tracked using population-based monitoring. Primary challenges to the implementation of the proposed framework include needed advancements in population-level measurement, lack of existing models with the capability to produce interpretable and actionable evidence and the ethical considerations of labeling geographically-bound populations by exposomic profiles. To address these challenges, we propose a set of recommendations that begin with greater engagement with and empowerment of affected communities and targeted investment in community-based solutions. Applications to urban settings and disaster epidemiology are discussed as examples for implementation.
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Affiliation(s)
- Jeanette A. Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Andrew M. Geller
- Office of Research and Development, Environmental Protection Agency, RTP, NC, USA
| | - Darryl B. Hood
- Division of Environmental Health Sciences, The Ohio State University, Columbus, OH, USA
| | - Konstantinos C. Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Charles P. Mouton
- Department of Family Medicine, University of Texas Medical Branch Galveston, TX, USA
| | - J. Christopher States
- Center for Integrative Environmental Health Sciences, Department of Pharmacology and Toxicology University of Louisville School of Medicine, Louisville, KY, USA
| | - Susan J. Sumner
- Department of Nutrition, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - K. Lily Wu
- California Environmental Protection Agency—Office of Environmental Health Hazard Assessment, Sacramento, CA, USA
| | - Arcot K Rajasekar
- School of Information and Library Science, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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Davidson LM, Boland MR. Investigating Three Classification Methods for Per/Poly-Fluoroalkyl Substance (PFAS) Exposure from Electronic Health Records And Potential for Bias. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2023; 2023:52-61. [PMID: 37350909 PMCID: PMC10283112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Per-/poly-fluoroalkyl substances (PFAS) are a group of manmade compounds with known human toxicity and evidence of contamination in drinking water throughout the US. We augmented our electronic health record data with geospatial information to classify PFAS exposure for our patients living in New Jersey. We explored the utility of three different methods for classifying PFAS exposure that are popularly used in the literature, resulting in different boundary types: public water supplier service area boundary, municipality, and ZIP code. We also explored the intersection of the three boundaries. To study the potential for bias, we investigated known PFAS exposure-disease associations, specifically hypertension, thyroid disease and parathyroid disease. We found that both the significance of the associations and the effect size varied by the method for classifying PFAS exposure. This has important implications in knowledge discovery and also environmental justice as across cohorts, we found a larger proportion of Black/African-American patients PFAS-exposed.
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Affiliation(s)
- Lena M Davidson
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania
- Institute for Biomedical Informatics, University of Pennsylvania
- Center for Excellence in Environmental Toxicology, University of Pennsylvania
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
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Mu H, Li J, Chen L, Hu H, Wang J, Gu C, Zhang XX, Ren HQ, Wu B. Distribution, source and ecological risk of per- and polyfluoroalkyl substances in Chinese municipal wastewater treatment plants. ENVIRONMENT INTERNATIONAL 2022; 167:107447. [PMID: 35940032 DOI: 10.1016/j.envint.2022.107447] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/23/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
Municipal wastewater treatment plants (WWTPs) are sinks of per- and polyfluoroalkyl substances (PFASs) generated by human activities and are also sources of PFASs in aquatic environment. This study analyzed distribution, source and ecological risk of 14 PFASs in influent and effluent samples from 148 Chinese municipal WWTPs. Composition and concentrations of PFASs in the influents and effluents had obvious spatial differences. Fluoropolymer processing aids/wrappers and textile treatments/coatings were found to be the dominant sources in WWTP influents, which accounted for 78.34% of all sources. Consumption structure and metal and transportation equipment manufacturing affected the spatial differences of PFASs in WWTPs. Further, mean removal rate of total PFASs in all WWTPs was -5.45%. The conventional treatment processes can not effectively remove PFASs and no significant difference was found among different treatment processes. However, risk quotient values of PFASs in effluents were all below 0.1, indicating low risk or no risk to aquatic organisms. It should be noted that the composition, source and ecological risk of PFASs in east China were different from the other regions, which need more attentions. This study sheds insights into occurrencesof PFASs in municipal WWTPs, which should be helpful for their control strategy development.
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Affiliation(s)
- Hongxin Mu
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Jiahao Li
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Ling Chen
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Haidong Hu
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Jinfeng Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Cheng Gu
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Xu-Xiang Zhang
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Hong-Qiang Ren
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China
| | - Bing Wu
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environment, Nanjing University, Nanjing 210023, PR China.
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Ward-Caviness CK, Moyer J, Weaver A, Devlin R, Diaz-Sanchez D. Associations between PFAS occurrence and multimorbidity as observed in an electronic health record cohort. Environ Epidemiol 2022; 6:e217. [PMID: 35975166 PMCID: PMC9374186 DOI: 10.1097/ee9.0000000000000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/14/2022] [Indexed: 01/06/2023] Open
Abstract
Per and polyfluoroalkyl substances (PFAS) are associated with health outcomes ranging from cancer to high cholesterol. However, there has been little examination of how PFAS exposure might impact the development of multiple chronic diseases, known as multimorbidity. Here, we associated the presence of one or more PFAS in water systems serving the zip code of residence with chronic disease and multimorbidity.
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