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Cited by 77Per- and polyfluoroalkyl substances researchFluoride Effects and RemovalSynthesis and properties of polymers

Per-and poly-fluoroalkyl substances (PFAS) exposure and risk of kidney, liver, and testicular cancers: A systematic review and meta-analysis

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Seyyedsalehi, Monireh Sadat, Boffetta, Paolo·2023·La Medicina del Lavoro
DOI 10.23749/mdl.v114i5.15065PMC PMC10627102
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Abstract

Introduction: Per- and poly-fluoroalkyl substances (PFASs) are a large, complex group of synthetic chemicals humans can be exposed to from occupational or environmental sources. In this systematic review and meta-analysis, we examined the association between PFAS exposure, particularly Perfluorooctanoic Acid (PFOA), and Perfluorooctane Sulfonic Acid (PFOS), and risk of kidney, liver, and testicular cancer. Methods: We systematically searched PubMed to identify cohort and case-control studies reported after the Monograph of the International Agency for Research on Cancer and the Toxicological Profile of the Agency for Toxic Substances and Disease Registry. We assessed the quality of the studies by using a modified version of the Newcastle-Ottawa Scale (NOS). Forest relative risk (RR) plots were constructed for liver, kidney, and testicular cancer. We conducted stratified analyses by geographic region, study design, quality score, outcome, years of publication, exposure source, and PFAS type. A random-effects model was used to address heterogeneity between studies. Results: Fifteen studies, including ten cohort studies, three case-control studies nested in a cohort, and two case-control studies were included after removing duplicate and irrelevant reports. We found an association between overall PFAS exposure and the risk of kidney cancers (RR=1.18, 95% CI =1.05-1.32; I =52.8%, 11 studies). Also, we showed an association between high-level exposure to PFAS and kidney cancer (RR=1.74, 95% CI =1.23-2.47; p=0.005) and testicular cancer (RR=2.22, 95% CI =1.12-4.39; p=0.057). There was no association with liver cancer. We found no heterogeneity by geographical region, PFAS type, study design, outcome, quality score, year of publication, or exposure source. Only two studies reported results among women. Conclusions: We detected an association between overall PFAS exposure and kidney cancer and high doses of PFAS with testicular cancer. However, bias and confounding cannot be excluded, precluding a conclusion in terms of causality.

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  • PFAS exposure is associated with testicular and breast cancer, with high risk in adults.

    “| Cancer Risk | testicular, breast cancer. | High | Adults | Long-term cancer risk | [234,235] |”

    From Industrial Applications, Environmental Fate, Human Exposure, and Health Effects of PFAS (2025) · cites this paper as [235]

    The Abstract Results and Conclusions report an association between high-level PFAS exposure and testicular cancer. The Discussion mentions some evidence concerning breast cancer, but the review did not analyze breast cancer risk, and these passages do not establish the table’s blanket “High” risk rating for adults. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Seyyedsalehi, M. S., & Boffetta, P.
Affiliations
University of Bologna (IT)
Corresponding author
Boffetta, Paolo
ORCID
Venue
La Medicina del Lavoro
Publisher
Mattioli1885
Published
2023-10-24
Volume
114
Issue
5
Pages
e2023040
ISSN
  • 0025-7818 (ISSN-L)
  • 2532-1080
DOI
10.23749/mdl.v114i5.15065
PMC
PMC10627102
OpenAlex
W4387931094
Cited by
77
References
3
Citations by year
2026: 13 · 2025: 39 · 2024: 25
FWCI
1.78
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • La Medicina del Lavoro (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc)
Topics
  • Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
  • Physical Sciences › Environmental Science › Water Science and Technology › Fluoride Effects and Removal
  • Physical Sciences › Materials Science › Polymers and Plastics › Synthesis and properties of polymers
Keywords
per- and polyfluoroalkyl substances, PFAS exposure, kidney cancer, liver cancer, testicular cancer, perfluorooctanoic acid, PFOS, cancer risk, occupational exposure, environmental exposure
MeSH terms
Carcinoma, Renal Cell, Female, Fluorocarbons, Humans, Kidney, Kidney Neoplasms, Liver, Male, Neoplasms, Germ Cell and Embryonal, Testicular Neoplasms

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