An ad hoc committee appointed by the National Academies of Sciences, Engineering, and Medicine (the National Academies) will consider current evidence regarding human health effects of the most widely studied per- and polyfluoroalkyl substances (PFAS). The National Academies will provide the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry (CDC/ATSDR) and the National Institutes of Environmental Health Sciences (NIEHS) an objective and authoritative review of current evidence regarding human health effects of those PFAS being monitored in the CDC’s National Report on Human Exposure to Environmental Chemicals. The National Academies will also provide recommendations regarding potential changes to CDC/ATSDR PFAS clinical guidance including:

• Options and considerations to guide decision-making for PFAS testing in a patient’s blood or urine.
• PFAS concentrations that could inform clinical care of exposed patients.
• Appropriate patient follow-up and care specific to PFAS-associated health endpoints for those patients known or suspected to be exposed to PFAS.

This information will be used to inform how communities and individuals exposed to PFAS could be best served by clinicians. Specifically, the committee will undertake the following tasks:

1. Assess the strength of evidence for the spectrum of putative health effects suggested by human studies (including immune response, lipid metabolism, kidney function, thyroid disease, liver disease, glycemic parameters and diabetes, cancer, and fetal and child development) to establish a basis for prioritized clinical surveillance or monitoring of PFAS health effects. This assessment should characterize the likelihood of those health effects occurring (qualitative probability) given real world human exposures and identify the human populations at most risk (consider life stage, health status, exposure level). Data/evidence gaps that contribute to uncertainty about health effects of most concern should be annotated.
2. Develop general principles for clinical evaluation or biological testing given substantial scientific uncertainty about health effects or the value of such measures in informing care. These principles should address reasons for testing (e.g., opportunities to reduce morbidity and mortality), when to test, who to test, how to test, what to test for, risks of testing, and the related social and ethical implications of testing.
3. Review current knowledge about the contribution of PFAS exposure sources (i.e., drinking water, diet, the indoor environment, etc.) to human exposure and develop principles clinicians can use to advise patients on exposure reduction.
4. Advise whether changes to current CDC/ATSDR clinical guidance/recommendations on PFAS blood or urine testing are needed given the committee’s general principles and assessment of the associations between PFAS exposure and clinically relevant health outcomes. Ultimately, the goal is to provide guidance on how clinicians can advise patients on PFAS testing and health outcomes that may be associated with PFAS as well as what to advise patients regarding standard medical or preventive care and exposure reduction.
5. Outline a process by which the CDC/ATSDR PFAS clinical guidance can be effectively reviewed and revised over the next decade.