This spring, the U.S. Environmental Protection Agency (EPA) ruled that municipal utilities across the country must detect and eliminate harmful per-and polyfluoroalkyl substances (PFAS) from water sources, a move that is expected to reduce exposure to nearly 100 million people.
“We’re finally addressing water, and that’s a good thing,” says Ned Calonge, MD, MPH, associate professor of family medicine at the University of Colorado School of Medicine and associate dean for public health practice in the Colorado School of Public Health. Calonge also serves as the chief medical officer for the Colorado Department of Public Health and Environment (CDPHE) and chair of a National Academies of Sciences, Engineering, and Medicine committee that in 2022 called for expanded PFAS testing for people with a history of elevated exposure.
PFAS, often called “forever chemicals” because they break down very slowly over time in the environment, end up in water sources a multitude of ways, mainly through firefighting chemicals that seep into the groundwater or by manufacturers who dump the chemicals into waterways.
PFAS have been used in a variety of products, including non-stick cookware and water or stain-repellent fabrics, because they have properties that repel water and oil, reduce friction, and resist temperature changes. Exposure to these chemicals have been linked to cancers, liver and heart conditions, and developmental impacts for babies and children.
“I’m hopeful that industries are being more responsible and trying to find alternatives,” Calonge says, but adds that there’s more work to do to continue to ensure public health and safety.
Why drinking water matters
Researchers like Calonge have long been interested in PFAS in drinking water because of the health risks associated with the chemicals.
“There are a number of cancers where there is at least a moderate degree of evidence of an association,” Calonge says. Among those with the highest associations is kidney cancer, which researchers believe may be due to the organ’s role in clearing toxins from the blood.
After reaching the same conclusions about PFAS and kidney cancer associations as independent researchers, EPA labeled PFAS as a carcinogen, meaning there is no acceptable level in drinking water. New EPA regulations for PFAS chemicals are set at either 4 parts per trillion and 10 parts per trillion depending on the chemical.
“This number is the least detectable amount of PFAS given our current technology to find it,” Calonge says. “This isn’t necessarily a health-based standard, but a technology-based standard.”
He adds that length of exposure is also an important factor in health risks, but researchers are still learning more about that piece of the puzzle.
Researchers estimate that at least 45% of the nation’s tap water has one or more types of PFAS chemicals, but not all 12,000 types can be detected with the current level of technology.
“When I started this work, I felt like we would end up having a low level of confidence to make health risk associations, but I was surprised by the amount of data that was,” Calonge says.
He expects more data and technology to develop as time goes on, allowing researchers the ability to learn more about the best ways to reduce health risks.
Looking toward a brighter future
While wading through PFAS news and information can be daunting for the average American, Calonge says there’s also reason to be hopeful.
“There is progress being made, here in Colorado and at the national level,” he says, highlighting legislation that limits or bans products made with PFAS chemicals and the new federal water guidelines.
For those who are concerned about health effects of high exposure, Calonge recommends looking up PFAS levels on the state health department website. “That may influence whether you want to use a water filter,” he says.
PFAS level screenings are also available, but Calonge says they’re only recommended in cases where exposure is thought to be high.
“I wouldn’t tell people to ignore the realities of PFAS chemicals, but I also don’t think they should let this become something that really drives their entire life,” he says.
“Think about this risk in the context of other health risks. Do you wear your seatbelt? Do you wear a bike helmet? Do you smoke? Of course, these risks are made through a conscious decision and exposure to PFAS is not, but it’s still a good way to look at how worried you should be about risks to your health.”
