Widespread PFAS exposure, but cancer risk ‘low,' experts confirm
However, after thoroughly reviewing the evidence, experts say the health effects appear to be small and individual blood testing offers no clear medical benefit.
The NSW Health Expert Advisory Panel on PFAS (per- and polyfluoroalkyl substances) has released its final report, delivering clear guidance on the health effects of these widely found 'forever chemicals', the value of blood testing, and the best ways to communicate risks to communities.
PFAS have been used since the 1940s in products resistant to heat, stains, grease, and water, but concerns have grown worldwide about their presence in the environment and potential health impacts.
The panel, made up of leading clinical experts across toxicology, oncology, cardiology, public health, and risk communication, evaluated the latest Australian and global research to inform health advice.
While acknowledging the body of research for health effects related to PFAS is 'large and still growing', the panel concluded that the health effects of PFAS 'appear to be small'.
It noted links between PFAS exposure and conditions including high cholesterol, reduced kidney function, immune system changes, hormone alterations, liver enzyme changes, menstruation issues, lower birthweight, pregnancy high blood pressure, and some cancers.
However, the panel stressed the evidence was inconsistent, with 'limited evidence of a dose-response relationship' and difficulty separating PFAS effects from other factors that can affect health, especially in studies with PFAS levels similar to the general population. It also highlighted the influence of bias and confounding factors such as smoking, diet, and age.
Addressing widespread public concern about cancer, the panel said it remained confident that the absolute cancer risk from PFAS was low based on the human epidemiological studies and levels of exposure in the Australian population.
The panel noted that while the International Agency for Research on Cancer (IARC) classified PFOA as 'cancer causing' and PFOS as 'possibly cancer causing', IARC's findings didn't specify safe exposure levels, how much exposure increases risk, or how big that risk might be.
PFOA (perfluorooctanoic acid) and PFOS (perfluorooctane sulfonate) are specific types of PFAS.
The panel stressed that, despite these hazard classifications, the actual cancer risk from PFAS in Australia was low based on studies and typical exposure levels.
One of the panel's strongest messages is that there is 'no clinical benefit' for an individual to have a blood test for PFAS.
The report stated that PFAS chemicals appeared in more than 95 per cent of people tested, showing widespread exposure from multiple sources.
Because PFAS are so common, the expert panel said blood tests were hard to interpret and didn't predict health outcomes, so it didn't recommend individual testing.
Although levels have been declining over the past 20 years, high background exposure makes studying health effects challenging. The panel supports ongoing population monitoring to track changes
This stance differs from 2022 guidance by the US National Academies of Science, Engineering, and Medicine (NASEM), which suggested blood testing might guide clinical care.
The NSW panel pointed out limitations in NASEM's approach, including reliance on studies with small effects and possible bias, and noted that US agencies like the CDC and ATSDR have not adopted NASEM's recommendations for individual blood testing.
The panel also advised against interventions such as phlebotomy or cholesterol-lowering medications to reduce PFAS in the blood, calling their benefits 'uncertain' and warning they 'may cause harm' like anaemia or medication interactions.
Instead, clinicians are urged to focus on 'usual preventative health interventions' to support patients.
Recognising 'genuine concern' in parts of the community about exposure to PFAS and the potential health impacts, the panel stressed that risk communication must be 'tailored to the diverse levels of concern' and continued transparency maintained.
The panel stated that reliable epidemiological studies required 'well characterised' exposures, measured confounders, and sufficiently large populations; conditions 'not currently met in the Blue Mountains population or in other communities in NSW'.
It urged authorities to avoid using currently available human epidemiological studies to derive threshold levels due to the higher risk of bias and confounding.
Instead, it supported continuing Australia's conservative approach of setting exposure limits based on animal studies with safety factors, such as those by the National Health and Medical Research Council.
NSW chief health officer Kerry Chant said updated NSW Health advice provided consumers with guidance on how to reduce PFAS exposure.
'There is considerable concern, particularly in the Blue Mountains community, about exposure to PFAS through drinking water, and NSW Health takes these concerns very seriously,' Dr Chant said.
'NSW Health will continue to support local clinicians with information for GPs who may be managing patients with concerns about PFAS exposure, including evidence about potential adverse health effects, counselling patients, the utility of blood tests for PFAS and the role of further investigations.'
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Perth Now
16 minutes ago
- Perth Now
Female-founded AI tool aims to transform women's health
Women are taking control of their health with a game-changing artificial intelligence tool to help navigate a medical system that has historically gaslit, dismissed and ignored their symptoms. More than half of Australian women live with a chronic health condition and wait years to be diagnosed, often as a result of being dismissed by health professionals. Mary Spanos first started experiencing painful symptoms of endometriosis when she was 12 years old but was not officially diagnosed until she was in her 20s. "It's a ridiculously long time to be experiencing those debilitating symptoms and there were countless emergency room visits and specialist appointments where I was completely dismissed," she tells AAP. Ms Spanos is one of countless women who have suffered in silence. "I honestly thought it was all in my head and had so many negative thoughts because the people who were supposed to know what was going on medically were telling me it was fine," she says. It's a similar story for Grace Lam, who started to experience debilitating health symptoms as she approached 50. A former senior fashion editor of Vogue China, Ms Lam was used to thriving in fast-paced, high-powered environments. Yet seemingly overnight, she began to experience insomnia, low libido, extreme brain fog and driving anxiety. "My symptoms hit me like a rocket overnight ... it felt like every day my brain was outside my body and I would wake up feeling so strange," Ms Lam says. "The rage was also something else. I am a feisty Asian woman, so that's nothing new, but this type of rage was just very different." When she raised these symptoms with her GP, the doctor prescribed her sleeping pills but would not discuss any management plans for perimenopause. "I didn't want to rely on the sleeping pills, so that's when I went down the rabbit hole of perimenopause symptoms online," Ms Lam says. "I learnt more about perimenopause online than from my doctor." A newly launched AI health partner Ovum wants to disrupt the health landscape and end gender health inequity across Australia. The app has been four years in the making, with two clinical trials at The Royal Hospital for Women and St George Hospital. It was founded by Ariella Heffernan-Marks, who had the idea while training as a doctor and witnessing the healthcare issues facing women. "I observed the structural barriers in our health care and realised we needed to look at integrated data rather than having it spread across multiple physicians and specialists," she says. "Women are feeling the bias in the healthcare system ... they have not been included in clinical trials for decades and this is impacting diagnostics and treatment." After suffering chronic migraines during medical school, Dr Heffernan-Marks personally experienced being dismissed by specialists and decided something needed to change. "We need to redefine women's health to not just be about reproductive health because there are so many chronic conditions facing women," she says. "All the fem-tech tools on the market are not catering to what women actually need." The AI behind Ovum draws from female-centric medical literature to understand and learn from a wide range of health factors. It helps identify patterns, log symptoms, collate reports and create questions for women to raise with their doctors at their next appointment. It is not a diagnostic tool but rather provides a starting point for discussion with a medical professional. Users can opt to share their information anonymously as part of a wider database researchers can use to develop new medications and treatments or better understand conditions. With access to sensitive personal data, Dr Heffernan-Marks says Ovum is nationally and globally compliant with stringent standards to protect users. "Ovum is really about addressing the structural, integrated and research barriers ... we have decades (of medical research) to catch up on and AI will help us do that," she says. "We are creating a safe space for women and solving the health data gap by feeding information back into the research."
West Australian
16 minutes ago
- West Australian
Female-founded AI tool aims to transform women's health
Women are taking control of their health with a game-changing artificial intelligence tool to help navigate a medical system that has historically gaslit, dismissed and ignored their symptoms. More than half of Australian women live with a chronic health condition and wait years to be diagnosed, often as a result of being dismissed by health professionals. Mary Spanos first started experiencing painful symptoms of endometriosis when she was 12 years old but was not officially diagnosed until she was in her 20s. "It's a ridiculously long time to be experiencing those debilitating symptoms and there were countless emergency room visits and specialist appointments where I was completely dismissed," she tells AAP. Ms Spanos is one of countless women who have suffered in silence. "I honestly thought it was all in my head and had so many negative thoughts because the people who were supposed to know what was going on medically were telling me it was fine," she says. It's a similar story for Grace Lam, who started to experience debilitating health symptoms as she approached 50. A former senior fashion editor of Vogue China, Ms Lam was used to thriving in fast-paced, high-powered environments. Yet seemingly overnight, she began to experience insomnia, low libido, extreme brain fog and driving anxiety. "My symptoms hit me like a rocket overnight ... it felt like every day my brain was outside my body and I would wake up feeling so strange," Ms Lam says. "The rage was also something else. I am a feisty Asian woman, so that's nothing new, but this type of rage was just very different." When she raised these symptoms with her GP, the doctor prescribed her sleeping pills but would not discuss any management plans for perimenopause. "I didn't want to rely on the sleeping pills, so that's when I went down the rabbit hole of perimenopause symptoms online," Ms Lam says. "I learnt more about perimenopause online than from my doctor." A newly launched AI health partner Ovum wants to disrupt the health landscape and end gender health inequity across Australia. The app has been four years in the making, with two clinical trials at The Royal Hospital for Women and St George Hospital. It was founded by Ariella Heffernan-Marks, who had the idea while training as a doctor and witnessing the healthcare issues facing women. "I observed the structural barriers in our health care and realised we needed to look at integrated data rather than having it spread across multiple physicians and specialists," she says. "Women are feeling the bias in the healthcare system ... they have not been included in clinical trials for decades and this is impacting diagnostics and treatment." After suffering chronic migraines during medical school, Dr Heffernan-Marks personally experienced being dismissed by specialists and decided something needed to change. "We need to redefine women's health to not just be about reproductive health because there are so many chronic conditions facing women," she says. "All the fem-tech tools on the market are not catering to what women actually need." The AI behind Ovum draws from female-centric medical literature to understand and learn from a wide range of health factors. It helps identify patterns, log symptoms, collate reports and create questions for women to raise with their doctors at their next appointment. It is not a diagnostic tool but rather provides a starting point for discussion with a medical professional. Users can opt to share their information anonymously as part of a wider database researchers can use to develop new medications and treatments or better understand conditions. With access to sensitive personal data, Dr Heffernan-Marks says Ovum is nationally and globally compliant with stringent standards to protect users. "Ovum is really about addressing the structural, integrated and research barriers ... we have decades (of medical research) to catch up on and AI will help us do that," she says. "We are creating a safe space for women and solving the health data gap by feeding information back into the research."
Sydney Morning Herald
2 hours ago
- Sydney Morning Herald
‘Treated like a hysterical mother': Assaulted by her son, Alison's pain was ignored until she collapsed
Alison Beatty's adult son was in the midst of a 48-hour schizophrenic episode when he threw her against the wall of their family home. When she next went to the bathroom she noticed blood in her urine, so immediately took herself to Katoomba Hospital's emergency department. There, she was treated by a young male doctor who suspected a broken rib and sent her home without completing tests that would have discovered the internal injuries. 'The doctor basically sighed and looked up and said, 'Well, blood in your urine is common for women your age',' Beatty, then aged 59, said. She went home and that night had dinner at a restaurant for her birthday. Her symptoms worsened – she developed pain in her shoulder and found it hard to breathe. Her friend and qualified nurse Jennifer Douglas was present and insisted she return to emergency that night. 'Alison is a stoic lady, she's not a complainer,' Douglas said. 'You could see she was really trying to enjoy the occasion, to put aside the pain, but I could tell she wasn't right.' They went to the same emergency room and were again dismissed. No pain medication was issued nor tests performed – until Beatty collapsed. 'She actually started going into shock,' Douglas said. 'All of a sudden they thought, 'we better do something here'.' Loading Beatty was intubated, put on life support and rushed in a critical condition by ambulance to Penrith Hospital. An ultrasound finally revealed the assault injury had caused her lungs to fill with blood. 'By then, because it had been so long, the blood had coagulated; I had to have a long operation where they removed all the blood,' Beatty said. 'I was in intensive care for a long time. The surgeon said, 'you're very lucky to have survived'. I sat on this for some time but I was angry about it.' After she recovered she complained to the hospital about how she was treated. 'When they looked at the notes, he'd written down: 'Mother has trouble controlling her child', as if I'd had a young child with a tantrum,' she said. 'I felt like I was being treated like a hysterical mother, or not knowing what I was talking about. Most of what I said wasn't heard. 'If someone's got blood in the urine, you don't just dismiss it as their age,' she said. 'They later apologised and said, 'we failed you'.' At the very least, Douglas said emergency doctors should have ordered an X-ray, which would have quickly revealed the problem. The near-death incident occurred in 2014 but, more than a decade on, both women are still furious and are speaking up to stop others suffering the same fate. 'They didn't listen. They did not take a proper history. It was appalling,' Douglas said. 'I'm just so glad I was there, otherwise she wouldn't have been here today.' Beatty was one of more than 2000 women who participated in a survey by The Age and The Sydney Morning Herald documenting experiences as part of an investigation into medical misogyny in Australian healthcare. More than 300 of the respondents described experiences of the gender bias in emergency departments, where diagnostic decisions in busy hospitals can have life-and-death consequences. The investigation into medical misogyny has previously revealed disturbing cases of this bias right across the healthcare system, including women being incorrectly admitted to mental health wards or cancer diagnoses being missed. The women, doctors and experts who are speaking out are not seeking to lay blame at the feet of clinicians but to lay bare entrenched, structural problems disadvantaging women in a health system that historically evolved to reflect the needs of men. Dr Clare Skinner, a Sydney-based emergency physician, said the gender bias is baked into the medical canon, particularly with how pain is treated in men and women. 'For women, we're too quick to leap to say, 'that's not serious',' she said. 'If a man says they have pain they're taken seriously … There's the idea that women are more likely to overstate their pain. 'This all plays out along gender lines but also intersectional lines,' she said, explaining women of colour experience greater discrimination. However, Skinner, who is president of the Australasian College for Emergency Medicine, said enormous work has been done over the past decade, including the introduction of specific training to recognise and address bias. 'I am proud that my specialty has really taken on this notion that we work in an environment where quick judgments are necessary and we have to actually train to make sure our quick judgments are the best, least-biased ones possible.' Delays, dismissed In emergency departments, doctors must make quick diagnostic decisions based on little information and rely on guidelines in the triage system for how to prioritise urgency. Studies have shown throughout history that women who present to emergency departments are less likely to be given pain medication, or experience delays in receiving it, compared with men. One American study from 2008 found women who presented with abdominal pain at emergency departments with similar pain levels as men were up to 11 per cent less likely to be given pain medication. More recently, similar results were published in a 2023 study by Australasian Emergency Care, which looked at a cohort of patients presenting similar levels of abdominal pain and found 14.5 per cent of women were given pain medication versus 26 per cent of men. The same study found the average time from presenting to the emergency department and receiving pain relief was 80 minutes for men, compared with 94 minutes for women. MEDICAL MISOGYNY: A CALL TO ACTION The Sydney Morning Herald and The Age last year launched an investigation into medical misogyny: ingrained, systemic sexism across Australia's healthcare system, medical research and practice. More than 2000 women shared their experiences as part of our crowd-sourced investigative series, which prompted a national outpouring of grief and frustration as women described feeling gaslit, dismissed or being told their pain was 'all in their heads'. We call on the federal government to boost Medicare funding for GP appointments that last more than 20 minutes to improve care for women and others with complex health conditions. The Albanese government and the Coalition have promised to pour $8.5 billion into Medicare to make GP visits more affordable and improve bulk-billing rates, but longer, 20-minute appointments will receive a smaller proportional funding increase. Doctors have warned that these policies could further disadvantage women by continuing to incentivise shorter consultations, which don't give GPs enough time to address menopause, pelvic pain and other women's health issues. The Australasian Triage Scale (ATS) is a clinical tool used by emergency doctors and nurses to sort patients into five categories, from Category 1, which means life-threatening and requiring immediate care, to Category 5, which is non-urgent and where patients can wait up to 120 minutes. In July, registered nurse Amanda Dumesny posted on LinkedIn the ATS recommends initial decisions have to be made within two or three minutes. However, Dumesny said there is 'growing concern' that training to prioritise care on clinical urgency 'may inadvertently perpetuate gender biases'. 'These biases result in men's symptoms being more frequently classified as urgent, while women's symptoms, even when potentially more serious, are downplayed,' she wrote. 'Although the ATS update in 2024 appears intended to address certain biases by clarifying triage protocols for historically under-triaged cohorts, such as pregnant women, the elderly, paediatric patients, First Nations people, and those experiencing mental health crises, it stops short of recognising that systemic gender bias is rooted in how symptoms are assessed and determined as being more or less critical.' She wrote there needed to be 'systemic changes and focused education' to improve gender bias in the ATS and ensure all patients receive equitable care. Sydney-based Kate Vinen believes her own delays in receiving pain medication and an accurate diagnosis were driven by medical misogyny in the triage system. In her 20s, about 12 years ago, she presented to emergency with irregular periods but said male doctors sent her away without any investigation. She pushed for tests to be completed and eventually, years later, it was discovered she had uterine cancer. 'By the time I got a diagnosis it was too late. I had to have my uterus removed and lost my ability to have children. It felt like being let down by the system but I was too young,' Vinen said. 'I was dismissed over a period of time, not just once but a handful of times, to get answers for why I wasn't getting regular periods. They couldn't find an easy answer. I was dismissed. The problem got bigger over time and resulted in when I was finally diagnosed by a woman with uterine cancer.' Vinen had a hysterectomy and went into remission but even since then she has found doctors are quick to label her concerns as gynaecological. 'It sounds terrible but it's helpful in a way that now I don't have ovaries or a uterus,' she said. In 2014 she went to the emergency department at a major Sydney hospital with a throbbing pain in her shoulder, vomiting and loss of consciousness. The doctors completed an internal vaginal examination. 'I knew it wasn't in that area. I was so out of [it] that I let them do it. But I clearly articulated my main symptom – excruciating pain in my left shoulder,' she said. 'They went straight to gynaecological.' 'I was projectile vomiting from how much pain I was in. My friend said it looked like a scene from The Exorcist.' Kate Vinen Vinen was first diagnosed with a burst cyst, and says every time she told the doctors the pain was in her shoulder she was dismissed. 'I knew it wasn't that kind of pain,' she said. Eventually, doctors discovered Vinen's spleen had ruptured – one of the most common symptoms being shoulder pain. 'I was projectile vomiting from how much pain I was in. They hadn't given me any serious pain medication. My friend said it looked like a scene from The Exorcist,' she said. 'An earlier diagnosis would have meant faster and bigger pain treatment.' 'Traumatic, awful' Over interviews with women who responded to this investigation's survey, several described presenting to hospital emergency departments with abdominal pain – which was treated as gynaecological when the problem was gastrointestinal. One woman described presenting to emergency with severe and escalating abdominal pain, which was first diagnosed as an ovarian cyst. 'I'd had an ovarian cyst before but this was different,' she said. 'I was screaming at the top of my lungs.' It turned out the woman's bowel had twisted and turned necrotic – resulting in surgery to remove 20 centimetres of bowel. 'As time went on, the tissue was expanding, literally blowing up inside of me,' she said. 'Had it been diagnosed earlier, it's likely that I wouldn't have had to have that removed.' Another woman was discharged from hospital after her second C-section birth and experienced pain she had never experienced before, describing it as 'red-hot, like I was being burned with a poker'. She presented at the emergency department with excruciating pain but was sent home and told to take more painkillers. Five weeks later she presented again, and this time was rushed to emergency surgery. As it transpired, her wounds had broken down internally and caused her bowels to start dying. 'I probably would have died if I hadn't had emergency surgery that day,' she said. 'It was pretty traumatic and awful. It was dismissive of someone presenting in pain who knows their own body.' Loading Emergency physician and federal AMA Emergency Medicine representative Dr Sarah Whitelaw agreed evidence shows that medical misogyny is impacting decisions in emergency departments. 'It's now well-known that women have different symptoms to men in some cases,' she said, particularly heart attacks. 'As a woman you're less likely to be recognised in terms of the need for urgent care, which means you take longer to be seen … and it will take longer to get you the treatment that's needed. 'We know, in the emergency department, women are often given a lower pain rating, and it takes us longer to get them effective pain relief, and we don't often give them as much pain relief as we do with men describing similar pain levels.' Whitelaw said these issues were compounded by overcrowding and understaffing across the healthcare system, which puts pressure on the time that emergency workers can spend with patients. She stressed the entire healthcare system, not just emergency wards, needed to be reviewed to find solutions to the problems – including greater Medicare rebates for GP clinics and other wraparound services. 'We've incentivised really short, high-volume numbers of patients that they see every day, instead of rewarding the time that's often needed, particularly for women's health [issues] that are particularly complicated,' Whitelaw said. Back in the Blue Mountains, Beatty agrees. Under the normal procedures, Beatty said the emergency ward should have alerted the police or social worker after the mental health system failed to take her calls for help with her son seriously in the lead-up to the assault. This would have prevented the cascading medical failures, she said. 'Katoomba is an underfunded, small hospital,' she said. 'But I think it's important to point out for the sake of the medical fraternity, and for other women, how these sometimes fatal mistakes can occur.' A spokesperson for the Nepean Blue Mountains Local Health District said, 'we sincerely apologise' to Beatty, and pledged to deliver 'respectful, evidence-based and equitable care'. A spokesperson for NSW Health said healthcare workers are trained to 'address unconscious bias to ensure all patients have equitable access to healthcare' and pointed to the investment of 'half a billion dollars' into emergency departments. 'We acknowledge more work can always be done to tackle health inequalities.'
