PFOA and Kidney Cancer: The Slippery Slope from Tap to Tumor

by | Jun 13, 2022 | ACKC Investigates

It was 2014. Michael Hickey wanted to sleep at night. He had uncovered a terrible truth that meant accusing the biggest employer, Saint-Gobain Performance Plastics, in the small, upstate New York town of Hoosick Falls, of polluting their drinking water. His friends and neighbors might lose their jobs, but the cost of doing nothing meant that many people in the area would continue to have harmful health effects and possibly die from serious illnesses like kidney cancer that had killed his own father. Hear Michael Hickey in his own words.

Ed. Note: In the above recording, Michael Hickey refers to a woman who died a year after his father, but the recording is garbled at that point. The woman, Isabel McGuire, a math teacher at Hoosick Falls High School, died from Melanoma at age 48.

Current Status of Hoosick Falls Drinking Water

The NYS Department of Environmental Conservation announced, in December 2021[1], that, after having its drinking water filtered by granular activated carbon for five years to filter out the PFOA in the village’s groundwater, two new uncontaminated wells south of the village will be used to supply the village with water. Close to $10 million will be invested by the companies that polluted the groundwater and wells with PFOA, to build a transport system that will feed into the village’s current water filtration system in order to filter out any ambient organic material from the new unpolluted source of water.

What are PFOA and PFOS?

PFOA and PFOS belong to a class of chemicals called PFAS (per-and polyfloroocatanoic substances), which are synthetic compounds that are created in a laboratory and not found in nature. Chemists take an organic molecule that is found in nature, one that has both carbon and hydrogen atoms, and they replace the hydrogen atoms with fluorine atoms, creating a PFAS molecule. This process was discovered accidentally in a lab in 1938. PFASs have been in production since the 1950s, being led by PFOA and PFOS. Depending upon whom you speak with, there are between 5000 and 9000 individual chemicals that are considered part of the PFAS family. Although there are thousands of PFASs in existence, the chemical industry claims that only a few hundred PFASs are actually in production. Nevertheless, only a few of the PFASs in production have been thoroughly researched for toxicity.

PFASs have engendered a major industry primarily due to their properties. They are both hydrophobic and oleophobic, that is, they repel both water and oil. These qualities make them very attractive to chemists looking to make new, innovative products such as wearing apparel like Gore-Tex that repels rain and is also breathable, or take-out containers whose lining prevents grease from seeping through the container. PFASs are slippery, which gave rise to Teflon and other non-stick cookware. PFASs are also surfactants, that is, they reduce the surface tension of liquids, which enables detergents to work more effectively, and can turn liquid into foam used to extinguish petroleum fires. The latter function is used by the military and fire departments as an efficient fire suppressor agent.

Some consumer products that contain PFASs include[2]:

  • Grease-resistant paper, fast food containers/wrappers, microwave popcorn bags, pizza boxes, and candy wrappers
  • Nonstick cookware
  • Stain-resistant coatings used on carpets, upholstery, and other fabrics
  • Water-resistant clothing
  • Cleaning products
  • Personal care products (shampoo, dental floss) and cosmetics (nail polish, eye makeup)
  • Paints, varnishes, and sealants
  • Fish caught in contaminated bodies of water
  • Food grown in fields irrigated by contaminated water or the meat of animals that eat feed containing PFASs

For a comprehensive list of industrial, commercial, and consumer products that contain PFASs, see https://www.oecd.org/chemicalsafety/portal-perfluorinated-chemicals/aboutpfass.

Of course, it is important to distinguish between the exposure to PFASs found in trace quantities in consumer products and the much greater exposure of people who work in plants that manufacture or process PFASs, and people who live in communities whose drinking water supply has been contaminated by PFASs that have been dumped, or otherwise, leach into the water sources. The latter two groups are much more likely to suffer adverse health effects than are consumers. Yet it has been estimated that over 100 million Americans have been impacted by PFAS-contaminated drinking water[3]

Characteristics of PFAS

Resistance to breakdown and persistence in the environment. PFAS chemicals have at their core a fluorine-carbon bond that is one of the strongest bonds known to chemistry.  As such, they degrade very slowly, both in drinking water and in the human body. PFASs were long considered to be very stable, inert molecules. Due to their lack of degradability, many PFASs, especially PFOA and PFOS, have been called “forever chemicals. However, since PFASs are disposed of by the body in urine, the effects of the chemicals are somewhat mitigated, unless people continue to drink contaminated water, in which case, their concentration is increased. It is important to remember that the higher the exposure, the greater the risk of developing serious illnesses.

Ubiquitous. Given their nature, PFASs readily spread throughout the environment, especially in water where they travel long distances with the current. PFASs are found on every continent, even polar bears in the Arctic are known to have PFASs in their bodies.

David Bond, Associate Director of the Center for the Advancement of Public Action, Bennington College, VT.

Toxicity of PFASs

PFOA and PFOS are by far the most studied chemicals in the family of PFASs and they have been linked to a number of diseases. Of the 770 chemicals that are included in the Environmental Protection Agency’s (EPA) Toxics Release Inventory[4] (TRI) Program, 172 of them are PFAS, which were just added in 2020. To be included in the TRI, the chemical must either be considered a carcinogen or otherwise cause adverse human health effects or adverse environmental effects. The TRI Program was created by the Emergency Planning and Community Right-to-Know Act (EPCRA), signed by President Reagan in 1986 “In response to growing concerns about local preparedness for chemical emergencies and the lack of availability of information on hazardous substances.”  Under the law, a facility that manufactures or processes a certain threshold amount of a TRI-listed chemical must annually report the amount of toxic chemicals released into the air, water, and off-site transfer, with this information being released to the public. As of 2021, over 2800 facilities in all 50 states have filed reports.

PFOA, which was phased out of production in the U.S. in 2015, and PFOS, which was phased out in 2002, are on the TRI list.[5] However, according to Robert Hayes, Director of the Clean Water Program of Environmental Advocates in New York State, Chemours, DuPont and 3M “have tweaked the formula to create new PFASs”, so the effect is always the same: they are similarly toxic, similarly persistent, similarly mobile in ground water.”

Evidence for PFOA As a Renal Carcinogen

In 2018, the International Agency of Research in Cancer (IART) classified PFOA as a possible carcinogen based in part on studies showing an association with kidney cancer. The most recent study, conducted in 2020, found the clearest evidence to date that PFOA is a renal carcinogen. Researchers at the National Cancer Institute looked at blood serum samples of 234 individuals who, many years later, were diagnosed with kidney cancer and a matched set of 234 healthy controls.  Their findings were striking.  “We found in our study group that for each doubling of serum concentrations of PFOA, there was a 70% increased risk of developing kidney cancer, and those with the highest concentrations of PFOA were twice as likely to develop kidney cancer compared with the lowest” says NCI investigator, Dr. Jonathan Hofmann. “I do think that our findings add to the weight of evidence that PFOA is a renal carcinogen and may have important public health implications for the many individuals exposed to this ubiquitous and highly persistent chemical worldwide.”[6] Dr. Hoffman and his colleagues plan to conduct additional studies that will include more racially and ethnically diverse populations.  “We know the incidence of kidney cancer differs by race with the highest incidence among Afro-Americans. I don’t believe there is an excess of PFOA among the black population, but there may be other PFASs.”

Mechanism of Action

There is evidence in animal studies that PFOA is found primarily in the kidneys, liver and blood serum. In one autopsy study of 20 individuals, PFOA was detected in 95% of kidney samples. But the exact mechanism by which PFOA might cause kidney cancer is still unknown.  “It is important to note that there is a need to better understand the underlying biological means by which PFOA may influence the risk of kidney cancer,” says Dr. Hofmann. This is also true of all other PFASs, and it has been shown that different PFASs accumulate in different organ groups.

Environmental Protection Agency (EPA)

The EPA, based on evidence of another drinking water contamination case in Parkersburg, WV, knew in the early 2000s, that PFOA is toxic and was found in drinking water sources. The EPA pressured DuPont and seven other manufacturers to join their PFOA Voluntary Stewardship Program in 2006 and to agree to phase out PFOA by 2015, which they did. Thus, a toxic chemical that was found in the water that supplied a town of 70,000 people took nine years to be phased out of production. Moreover, it wasn’t until 2020 that the EPA added PFOA to their Toxics Release Inventory (TRI). The EPA says that it doesn’t have the authority to ban the chemical due to restrictions in the Toxic Substance Control Act (TSCA). In 2016, the TSCA was amended by Congress to give the EPA greater enforcement power.

In 2016, ten years after the agency established their Stewardship Program with DuPont and other chemical companies, the EPA established a health advisory level for the concentration of PFOA and/or PFOS in drinking water at 70 parts per trillion (ppt)[7]. To put the advisory level into perspective, 70 ppt is equivalent to 3½ drops of PFOA in an Olympic sized swimming pool. The EPA’s safety level is still above that of several states, including California and New York. On February 22, 2021, the EPA announced that it will set a Maximum Contaminant Level (MCL) for PFOA and PFOS in drinking water under the Safe Drinking Water Act, which is enforceable. However, the EPA has two years to propose such a level, which is followed by a comment period of 18 months. Unless this process is expedited, the EPA will not be able to enforce PFOA and PFOS concentration levels in the nation’s drinking water until the summer of 2024. By then, it is possible that a new administration could cut the whole program. It is also unknown whether the EPA will determine any of the other PFASs to be hazardous substances and subject to regulation.

Environmental Working Group

The Environmental Working Group (EWG) is an environmental research and advocacy group based in Washington, DC, which covers a broad range of issues including contaminated drinking water.  Robert Bilott, who sued DuPont over PFOA contamination in the drinking water in the Parkersburg, WV area (see ACKC’s accompanying article on Parkersburg), said that EWG “…is a nongovernmental organization run by scientists, policy experts, lawyers, and communications experts who gather and vet the science on issues related to human health and the environment[8].” Following is an EWG map of PFAS Contamination. The interactive map can be found at https://www.ewg.org/interactive-maps/pfas_contamination/map/.

Final Thoughts

The kidneys are the body’s organs that filter and eliminate toxic substances. Because of this, a number of chemicals such as cadmium, trichloroethylene (an industrial solvent), perchloroethylene (a dry cleaning solvent), arsenic, asbestos, and now PFOA and PFOS are known risk factors for kidney cancer. Since there is currently no requirement that new chemicals be tested for toxicity, we don’t know how many of the nearly 90,000 listed chemicals may be carcinogenic. Unfortunately, it is typically not until a chemical makes its way into a municipality’s water supply, and then subsequently correlates to clusters of cancer or other serious diseases, is that chemical even tested for possible toxicity. ACKC believes that all new chemicals like PFASs be tested for toxicity before they are put into production. To accomplish this, the EPA must be given the authority, independence, and resources to properly regulate such chemicals.

Researched, interviews by, and co-written by Carol Kahn.

[1] Albany Times Union Dec 3, 2021 https://www.timesunion.com/news/article/DEC-selects-new-Hoosick-Falls-water-supply-system-16673188.php#photo-21262757

[2] ATSDR Agency for Toxic Substances and Disease Registry https://www.atsdr.cdc.gov/pfas/health-effects/exposure.html

[3] “Report: Up to 110 Million Americans Could Have PFAS-Contaminated Drinking Water” from EWG

https://www.ewg.org/research/report-110-million-americans-could-have-pfas-contaminated-drinking-water

[4] https://www.epa.gov/toxics-release-inventory-tri-program/what-toxics-release-inventory

[5] However, there is no restriction on the importing of goods and apparel that contain PFAS.

[6] Serum Concentrations of Per- and Polyfluoroalkyl Substances and Risk of Renal Cell Carcinoma https://academic.oup.com/jnci/article/113/5/580/5906528

[7] EPA Fact Sheet: PFOA & PFOS Drinking Water Health Advisories; https://www.epa.gov/sites/default/files/2016-06/documents/drinkingwaterhealthadvisories_pfoa_pfos_updated_5.31.16.pdf

[8]Exposure: Poisoned water, corporate greed, and one lawyer’s twenty-year battle against DuPont” by Robert Bilott
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