Epidemiologic Evidence on the Health Effects of Perfluorooctanoic Acid (PFOA)

Steenland, Kyle; Fletcher, Tony; Savitz, David A.

doi:10.1289/ehp.0901827

Cited by 660Per- and polyfluoroalkyl substances researchToxic Organic Pollutants ImpactFluoride Effects and Removal

Epidemiologic Evidence on the Health Effects of Perfluorooctanoic Acid (PFOA)

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Steenland, Kyle, Fletcher, Tony, Savitz, David A.·2010·Environmental Health Perspectives

DOI 10.1289/ehp.0901827PMC PMC2920088

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Abstract

UNLABELLED: OBJECTIVE AND SOURCES: We reviewed the epidemiologic literature for PFOA. DATA SYNTHESIS: Perfluorooctanoic acid (PFOA) does not occur naturally but is present in the serum of most residents of industrialized countries (U.S. median, 4 ng/mL). Drinking water is the primary route of exposure in some populations, but exposure sources are not well understood. PFOA has been used to manufacture such products as Gore-Tex and Teflon. PFOA does not break down in the environment; the human half-life is estimated at about 3 years. PFOA is not metabolized in the body; it is not lipophilic. PFOA is not directly genotoxic; animal data indicate that it can cause several types of tumors and neonatal death and may have toxic effects on the immune, liver, and endocrine systems. Data on the human health effects of PFOA are sparse. There is relatively consistent evidence of modest positive associations with cholesterol and uric acid, although the magnitude of the cholesterol effect is inconsistent across different exposure levels. There is some but much less consistent evidence of a modest positive correlation with liver enzymes. Most findings come from cross-sectional studies, limiting conclusions. Two occupational cohort studies do not provide consistent evidence for chronic disease; both are limited by sample size and reliance on mortality data. Reproductive data have increased recently but are inconsistent, and any observed adverse effects are modest. CONCLUSIONS: Epidemiologic evidence remains limited, and to date data are insufficient to draw firm conclusions regarding the role of PFOA for any of the diseases of concern.

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PFAS exposure is linked to immune dysfunction, metabolic disturbances, reproductive toxicity, and carcinogenicity.
“Emerging evidence has linked PFAS exposure to a range of health concerns, including immune dysfunction, metabolic disturbances, reproductive toxicity, and carcinogenicity [6,7,8].”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [8]
The Immune function and Reproductive and Developmental Outcomes sections report immune effects and adverse developmental outcomes in animals, while the Lipids section reports associations between PFOA and cholesterol in humans. The paper also discusses suggestive carcinogenicity evidence. However, it focuses chiefly on PFOA, not PFAS as a class, and says human evidence is insufficient to assess immune suppression and too sparse and inconsistent for conclusions about cancer. (LLM, conf=0.86)
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Authors: Steenland, K., Fletcher, T., & Savitz, D. A.
Affiliations: Emory University (US)
University of London (GB)
Icahn School of Medicine at Mount Sinai (US)
Corresponding author: Steenland, Kyle
ORCID: Steenland, Kyle
Fletcher, Tony
Savitz, David A.
Venue: Environmental Health Perspectives
Publisher: American Chemical Society (ACS)
Published: 2010-04-27
Volume: 118
Issue: 8
Pages: 1100-1108
ISSN: 0091-6765 (ISSN-L)
1552-9924
DOI: 10.1289/ehp.0901827
PMC: PMC2920088
OpenAlex: W2000476420
Cited by: 660
References: 88
Citations by year: 2026: 42 · 2025: 48 · 2024: 39 · 2023: 47 · 2022: 53 · 2021: 51 · 2020: 43 · 2019: 46 · 2018: 36 · 2017: 37 · 2016: 27 · 2015: 41 · 2014: 46 · 2013: 39 · 2012: 35
FWCI: 4.18
Type: journal article
Language: en
Open access: gold
doi.org
Licence: public-domain
creativecommons.org/licenses/by/4.0/ (vor, 2803 d)
Locations: Environmental Health Perspectives (publishedVersion, public-domain)
PubMed Central (publishedVersion, public-domain)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Topics: Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Toxic Organic Pollutants Impact
Physical Sciences › Environmental Science › Water Science and Technology › Fluoride Effects and Removal
Keywords: perfluorooctanoic acid, perfluorinated compounds, human health effects, drinking water exposure, exposure sources, half-life, genotoxicity, cancer risk, neonatal death, immunotoxicity, liver enzymes, cholesterol, uric acid, reproductive effects, occupational cohort studies, environmental toxins
MeSH terms: Caprylates, Cardiovascular Diseases, Cerebrovascular Disorders, Diabetes Mellitus, Environmental Monitoring, Environmental Pollutants, Female, Fluorocarbons, Humans, Immune System, Kidney, Liver, Male, Reproduction, Gonadal Steroid Hormones, Uric Acid, Fetal Development, Lipid Metabolism, Epidemiological Monitoring

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Epidemiologic Evidence on the Health Effects of Perfluorooctanoic Acid (PFOA)

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