Background

The C8 Science Panel was composed of three epidemiologists charged with studying the possible health effects of PFOA in a highly exposed population in the mid-Ohio Valley. The Panel determined in 2012 there was a ‘probable link’ (i.e., more probable than not based on the weight of the available scientific evidence) between PFOA and high cholesterol, thyroid disease, kidney and testicular cancer, pregnancy-induced hypertension, and ulcerative colitis.

Objective

Here, former C8 Science Panel members and collaborators comment on the PFOA literature regarding thyroid disorders, cancer, immune and auto-immune disorders, liver disease, hypercholesterolemia, reproductive outcomes, neurotoxicity, and kidney disease. We also discuss developments regarding fate and transport, and pharmacokinetic models, and discuss causality assessment in cross-sectional associations among low-exposed populations.

Discussion

For cancer, the epidemiologic evidence remains supportive but not definitive for kidney and testicular cancers. There is consistent evidence of a positive association between PFOA and cholesterol, but no evidence of an association with heart disease. There is evidence for an association with ulcerative colitis, but not for other auto-immune diseases. There is good evidence that PFOA is associated with immune response, but uneven evidence for an association with infectious disease. The evidence for an association between PFOA and thyroid and kidney disease is suggestive but uneven. There is evidence of an association with liver enzymes, but not with liver disease. There is little evidence of an association with neurotoxicity. Suggested reductions in birthweight may be due to reverse causality and/or confounding. Fate and transport models and pharmacokinetic models remain central to estimating past exposure for new cohorts, but are difficult to develop without good historical data on emissions of PFOA into the environment.

Conclusion

Overall, the epidemiologic evidence remains limited. For a few outcomes there has been some replication of our earlier findings. More longitudinal research is needed in large populations with large exposure contrasts. Additional cross-sectional studies of low exposed populations may be less informative.

中文翻译：

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审查：根据C8科学小组的评估，有关PFOA和健康的证据的演变。

背景

C8科学小组由三名流行病学家组成，负责研究在俄亥俄州中部高暴露人群中PFOA可能对健康产生的影响。专家小组在2012年确定PFOA与高胆固醇，甲状腺疾病，肾脏和睾丸癌，妊娠高血压和溃疡性疾病之间存在“可能的联系”（即，可能比不基于现有科学证据的权重更大）。结肠炎。

目的

在这里，前C8科学小组成员和合作者对PFOA文献发表了评论，这些文献涉及甲状腺疾病，癌症，免疫和自身免疫疾病，肝病，高胆固醇血症，生殖结果，神经毒性和肾脏疾病。我们还将讨论有关命运和运输以及药代动力学模型的发展，并讨论低暴露人群之间横断面关联中的因果关系评估。

讨论区

对于癌症，流行病学证据仍对肾脏和睾丸癌有支持作用，但尚不确定。有一致的证据表明PFOA与胆固醇之间存在正相关，但没有证据表明与心脏病有关。有证据表明与溃疡性结肠炎有关，但与其他自身免疫性疾病无关。有充分的证据表明PFOA与免疫反应有关，但与感染性疾病有关的证据不均衡。PFOA与甲状腺和肾脏疾病之间存在关联的证据提示但不均衡。有证据表明与肝酶有关，但与肝病无关。几乎没有证据表明与神经毒性有关。建议降低出生体重可能是由于反向因果关系和/或混淆。

结论

总体而言，流行病学证据仍然有限。对于一些结果，我们的早期发现已有一些重复。具有较大暴露对比的大量人群需要更多的纵向研究。对低暴露人群的其他横断面研究可能提供的信息较少。