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Curbside Consultation

Health Effects of Per- and Polyfluoroalkyl Substances

Marcus Cervantes, MD, MPH
Robert M. Gerbo, MD

American Family Physician. 2025;111(5):460-462.

Author disclosure: No relevant financial relationships.

MARCUS CERVANTES, MD, MPH, School of Public Health, Occupational and Environmental Medicine, Occupational Medicine, West Virginia University, Morgantown

ROBERT M. GERBO, MD, School of Public Health, Occupational Medicine, Faculty Athletics, West Virginia University, Morgantown

Address correspondence to Marcus Cervantes, MD, MPH, at Marcus.Cervantes@hsc.wvu.edu.

Author disclosure: No relevant financial relationships.

  1. 1.Sinclair GM, Long SM, Jones OAH. What are the effects of PFAS exposure at environmentally relevant concentrations? Chemosphere. 2020;258:127340.
  2. 2.Glüge J, Scheringer M, Cousins IT, et al. An overview of the uses of per- and polyfluoroalkyl substances (PFAS). Environ Sci Process Impacts. 2020;22(12):2345-2373.
  3. 3.National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Division on Earth and Life Studies; Board on Population Health and Public Health Practice; Board on Environmental Studies and Toxicology; Committee on the Guidance on PFAS Testing and Health Outcomes. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. National Academies Press; 2022.
  4. 4.Smalling KL, Romanok KM, Bradley PM, et al. Per- and polyfluoroalkyl substances (PFAS) in United States tapwater: comparison of underserved private-well and public-supply exposures and associated health implications. Environ Int. 2023;178:108033.
  5. 5.U.S. Department of Health and Human Services; Agency for Toxic Substances and Disease Registry. Toxicological profile for perfluoroalkyls; May 2021. Accessed March 19, 2025. https://www.atsdr.cdc.gov/toxprofiles/tp200.pdf
  6. 6.Botelho JC, Kato K, Wong LY, et al. Per- and polyfluoroalkyl substances (PFAS) exposure in the U.S. population: NHANES 1999–March 2020. Environ Res. 2025;270:120916.
  7. 7.Purdue MP, Rhee J, Denic-Roberts H, et al. A nested case-control study of serum per- and polyfluoroalkyl substances and testicular germ cell tumors among U.S. Air Force servicemen. Environ Health Perspect. 2023;131(7):77007.
  8. 8.Lewis RC, Johns LE, Meeker JD. Serum biomarkers of exposure to perfluoroalkyl substances in relation to serum testosterone and measures of thyroid function among adults and adolescents from NHANES 2011–2012. Int J Environ Res Public Health. 2015;12(6):6098-6114.
  9. 9.Rosato I, Bonato T, Fletcher T, et al. Estimation of per- and polyfluoroalkyl substances (PFAS) half-lives in human studies: a systematic review and meta-analysis. Environ Res. 2024;242:117743.
  10. 10.Sunderland EM, Hu XC, Dassuncao C, et al. A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects. J Expo Sci Environ Epidemiol. 2019;29(2):131-147.
  11. 11.Rogers RD, Reh CM, Breysse P. Advancing per- and polyfluoroalkyl substances (PFAS) research: an overview of ATSDR and NCEH activities and recommendations. J Expo Sci Environ Epidemiol. 2021;31(6):961-971.
  12. 12.Sonnenberg NK, Ojewole AE, Ojewole CO, et al. Trends in serum perand polyfluoroalkyl substance (PFAS) concentrations in teenagers and adults, 1999–2018 NHANES. Int J Environ Res Public Health. 2023;20(21):6984.
  13. 13.Jalilian H, Ziaei M, Weiderpass E, et al. Cancer incidence and mortality among firefighters. Int J Cancer. 2019;145(10):2639-2646.

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to afpjournal@aafp.org. Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.

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Transcutaneous Electrical Nerve Stimulation for Pain Control in Women With Primary Dysmenorrhea
May 2025
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Topical Testosterone for Menopausal Symptoms

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