Case-Cohort Study of the Association between PFAS and Selected Cancers among Participants in the American Cancer Society’s Cancer Prevention Study II LifeLink Cohort
Open accessAbstract
BACKGROUND: Previous epidemiological studies found associations between exposure to per- and polyfluoroalkyl substances (PFAS) and some cancer types. Many studies considered highly exposed populations, so relevance to less-exposed populations can be uncertain. Additionally, many studies considered only cancer site, not histology. OBJECTIVES: We conducted a case-cohort study within the American Cancer Society's prospective Cancer Prevention Study II (CPS-II) LifeLink cohort to examine associations between PFAS exposure and risk of selected cancers, considering histologic subtypes. METHODS: ). PFAS concentrations [perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)] were measured in stored serum. We assessed associations between PFAS concentrations and incident cancers, by site and histologic subtype, using multivariable Cox proportional hazards models stratified by sex and controlling for age and year at blood draw, education, race/ethnicity, smoking, and alcohol use. RESULTS: Serum PFOA concentrations were positively associated with renal cell carcinoma of the kidney among women [hazard ratio (HR) and 95% confidence interval (CI) per PFOA doubling: 1.54 (95% CI: 1.05, 2.26)] but not men. Among men, we observed a positive association between PFHxS concentrations and chronic lymphocytic leukemia/small lymphocytic lymphoma [CLL/SLL, HR and 95% CI per PFHxS doubling: 1.34 (95% CI: 1.02, 1.75)]. We observed some heterogeneity of associations by histologic subtype within sites. DISCUSSION: This study supports the previously observed association between PFOA and renal cell carcinoma among women and suggests an association between PFHxS and CLL/SLL among men. Consideration of histologic subtypes might be important in future studies of PFAS-cancer associations. https://doi.org/10.1289/EHP13174.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Environmental and clinical investigations have revealed emerging links between PFAS exposure and childhood cancers and tumor-associated molecular disruptions.
“Environmental and clinical investigations into PFAS exposure have revealed emerging links to childhood cancers and tumor-associated molecular disruptions [102].”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [102]
The Introduction reports associations between PFAS exposure and several cancers, and the Discussion describes possible molecular mechanisms, including receptor activation and epigenetic changes. But the Methods describe an adult cohort (median age 70 at blood collection), not childhood cancers, and the Discussion says the relevance of some proposed mechanisms to human cancer is uncertain. The source therefore does not support the childhood-cancer link or an established link to tumor-associated molecular disruptions as phrased. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 96 · Cited by 75
Research works printed but not linked: 4
- [4]NASEM. 2022. Guidance on PFAS Exposure, Testing, and Clinical Follow-up. https://nap.nationalacademies.org/catalog/26156/guidance-on-pfas-exposure-testing-and-clinical-follow-up [accessed 26 October 2023]. 35939564
- [8]ATSDR (Agency for Toxic Substances and Disease Registry). 2021. Toxicological Profile for Perfluoroalkyls. https://www.atsdr.cdc.gov/ToxProfiles/tp200.pdf [accessed 25 October 2023]. 37220203
- [67]Chiu BC-H, Hou N. 2015. Epidemiology and Etiology of Non-Hodgkin Lymphoma. In: Non-Hodgkin Lymphoma: Pathology, Imaging, and Current Therapy. Evens AM, Blum KA, eds. New York, NY: Springer International Publishing, 1– 25.
- [78]Ackerman LV. 1989. Pancreas and periampullary region. In: Ackerman’s Surgical Pathology. Rosai J, ed. 7th ed. Maryland Heights, MO: The C. V. Mosby Company, 757– 788.
- Authors
- Winquist, A., Hodge, J. M., Diver, W. R., Rodriguez, J. L., Troeschel, A. N., Daniel, J., & Teras, L. R.
- Affiliations
- Centers for Disease Control and Prevention (US)
- American Cancer Society (US)
- Corresponding author
- Winquist, Andrea
- Venue
- Environmental Health Perspectives
- Publisher
- American Chemical Society (ACS)
- Published
- 2023-12
- Volume
- 131
- Issue
- 12
- Pages
- 127007-127007
- ISSN
- 0091-6765 (ISSN-L)
- 1552-9924
- PMC
- PMC10718084
- OpenAlex
- W4389687717
- Cited by
- 75
- References
- 96
- Citations by year
- 2026: 32 · 2025: 30 · 2024: 13
- FWCI
- 6.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- public-domain
- Locations
- Environmental Health Perspectives (publishedVersion, public-domain)
- PubMed Central (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- National Cancer Institute
- Agency for Toxic Substances and Disease Registry
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Physical Sciences › Environmental Science › Water Science and Technology › Fluoride Effects and Removal
- Keywords
- per- and polyfluoroalkyl substances, PFAS exposure, cancer risk, renal cell carcinoma, chronic lymphocytic leukemia, small lymphocytic lymphoma, perfluorooctanoic acid, PFHxS, sex differences, serum PFAS concentrations, Cancer Prevention Study II
- MeSH terms
- American Cancer Society, Caprylates, Carcinoma, Renal Cell, Environmental Pollutants, Female, Fluorocarbons, Humans, Kidney Neoplasms, Male, Sulfonic Acids, Cohort Studies, Leukemia, Lymphocytic, Chronic, B-Cell, Alkanesulfonic Acids
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
