PFAS testing: A guide for firefighters

PFAS has been making headlines for all the wrong reasons. This huge family of industrial chemicals has been linked with a wide array of health issues from cancers to reproductive problems. Firefighters are at increased risk from PFAS because it is ubiquitous in their safety turnout gear and is a key ingredient in aqueous film-forming foams (AFFFs) used to fight fuel fires. Here, we explore the different types of PFAS test and give guidelines to consider when choosing a test provider. 

What is PFAS?

PFAS stands for per- and polyfluoroalkyl substances. These are a huge family of chemicals that have been extensively used in industry for the last 60+ years. Their popularity is due to their useful properties. This includes:

• Moisture shedding sprays for clothing
• Non-stick coatings for cookware
• Anti-grease coatings for takeout containers

PFAS compounds are a key component of current firefighter safety gear. They are also a key element in aqueous film-forming foam, or AFFF, used to fight fuel fires. 

What harm does PFAS cause?

PFAS has been linked with a huge range of different health risks. This is an extremely active field of research, and new results are released monthly. Some conditions appear to be strongly associated with PFAS exposure. These include:

• Dyslipidemia (a systemic imbalance in lipids like cholesterol)
• Thyroid function problems
• Cancers of the kidney and testes 
• Ulcerative colitis

There is also an apparent link with reproductive health and potentially with childhood development disorders.

How can I be tested for PFAS?

There are several options for PFAS testing. Which you choose will depend on several factors including availability in your area, how invasive the test is, whether the test is regulated or not, and what it costs.

Traditional blood testing

The traditional approach for PFAS testing requires a phlebotomist or nurse to do a blood draw. The vial of blood is then sent to a lab where it is separated into its constituent parts. Analysis can be done either on the serum (the fluid part of blood with all the clotting factors and cells removed) or the plasma. In both cases, the processed sample is then analyzed using gas or liquid chromatography coupled with high accuracy mass spectrometry. This approach looks for the presence and abundance of specific PFAS compounds.

Dried blood spot testing

Another approach involves a much less invasive process called dried blood spot (DBS) testing. This can even be done at home in some cases. You need to make a small prick with a lancet on a fingertip. Then you let a couple of drops of blood fall onto a special collection card. Once the blood has dried, the card is sent to a lab to be tested. At the lab, the technician will use a series of chemical processes to reconstitute the blood. The resulting sample can then be tested for PFAS in the same way as traditional blood testing. 

Other tests

PFAS can also be identified in urine, breast milk and hair. However, for most people, blood testing is recommended. This is because the rate at which PFAS is excreted varies from person to person. Thus, the results of these other tests are harder to compare between individuals.

Regulated vs unregulated labs

Commercial PFAS testing has only recently become mainstream. At present, there is no FDA-approved test available.. Reputable labs choose to license their tests under the CLIA Lab-Developed Test (LDT) route. CLIA, or the Clinical Laboratory Improvements Amendments, is the legislation governing commercial testing laboratories in the US. It requires laboratories to be quality certified by government agencies before they can accept human samples. 

Range of PFAS tested

There are thousands of different PFAS compounds in existence. However, a couple of dozen have been particularly widely used. These include a few well-known ones, such as PFOS, PFOA, and PFNA, which most commercial tests can identify. Over time, it is likely that tests will be able to identify more compounds relevant to specific workforces and the general population. At present, most tests can identify a handful of common PFAS compounds while others can accurately detect 20 or more types of PFAS.

Understanding PFAS test results 

There have been a lot of studies over the past decades linking PFAS with a variety of different health complaints and diseases. The National Academies of Science, Engineering, and Medicine (NASEM) was asked to establish guidelines for safe levels of several common PFAS compounds. Their report set the following guidelines:

• Levels of less than 2ng/mL of PFAS in blood serum are generally assumed to be safe. 
• Between 2-20ng/mL of PFAS is of concern, and at-risk people should seek additional testing and medical advice. 
• At levels over 20ng/mL, the NASEM recommends you seek additional testing for dyslipidemia, thyroid function, testicular cancer, kidney cancer, and ulcerative colitis.

Because the science is still evolving, many providers only give less precise results. For instance, detected or not detected, or low, medium and high.  

The Diagnose Early PFAS test for firefighters

Diagnose Early has been working closely with firefighters over several years. We are determined to help our heroic firefighters live longer and healthier lives. To meet this objective, we have developed our own CLIA LDT-certified dried blood spot test for PFAS. This can identify over 20 different PFAS compounds at levels that are meaningful from a health viewpoint. Our test is conducted in a CLIA certified laboratory in Reno, NV. We utilize the latest scientific assays alongside high performance laboratory equipment. 

Accessing our PFAS tests

At present, our test is only offered as part of Firefighter Health Plus annual physicals. This is designed to deliver the best preventative healthcare for firefighters, transforming fit for duty tests into fit for life. To find out more, please visit our website, or reach out to us.