Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S 106-6, Atlanta, GA, 30341, USA.
Environ Res. 2021 Mar;194:110690. doi: 10.1016/j.envres.2020.110690. Epub 2020 Dec 30.
The number of studies addressing per- and polyfluoroalkyl substances (PFAS) and cancer is increasing. Many communities have had water contaminated by PFAS, and cancer is one of the important community concerns related to PFAS exposure.
We critically reviewed the evidence relating to PFAS and cancer from an epidemiologic standpoint to highlight directions for future research that would be the most likely to meaningfully increase knowledge.
We conducted a search in PubMed for studies of cancer and PFAS (through 9/20/2020). We identified epidemiologic studies that provided a quantitative estimate for some measure of the association between PFAS and cancer. Here, we review that literature, including several aspects of epidemiologic study design that impact the usefulness of study results.
We identified 16 cohort (or case-cohort) studies, 10 case-control studies (4 nested within cohorts and 6 non-nested), 1 cross sectional study and 1 ecologic study. The cancer sites with the most evidence of an association with PFAS are testicular and kidney cancer. There are also some suggestions in a few studies of an association with prostate cancer, but the data are inconsistent.
Each study's design has strengths and limitations. Weaknesses in study design and methods can, in some cases, lead to questionable associations, but in other cases can make it more difficult to detect true associations, if they are present. Overall, the evidence for an association between cancer and PFAS remains sparse. A variety of studies with different strengths and weaknesses can be helpful to clarify associations between PFAS and cancer. Long term follow-up of large-sized cohorts with large exposure contrasts are most likely to be informative.
研究全氟和多氟烷基物质（PFAS）与癌症之间关系的数量正在增加。许多社区的水都受到了 PFAS 的污染，癌症是与 PFAS 暴露相关的重要社区关注问题之一。
我们从流行病学角度批判性地回顾了与 PFAS 和癌症相关的证据，突出了未来最有可能有意义地增加知识的研究方向。
我们在 PubMed 中搜索了癌症和 PFAS 的研究（截至 2020 年 9 月 20 日）。我们确定了提供 PFAS 与癌症之间某种关联的定量估计的流行病学研究。在这里，我们回顾了该文献，包括影响研究结果有用性的几个流行病学研究设计方面。
我们确定了 16 项队列（或病例对照）研究、10 项病例对照研究（4 项嵌套队列和 6 项非嵌套队列）、1 项横断面研究和 1 项生态研究。与 PFAS 关联最密切的癌症部位是睾丸癌和肾癌。在一些研究中也有前列腺癌与 PFAS 相关的一些迹象，但数据不一致。
每项研究的设计都有其优点和局限性。研究设计和方法的弱点在某些情况下可能导致可疑的关联，但在其他情况下，如果存在关联，则可能更难以检测到真实的关联。总体而言，PFAS 与癌症之间关联的证据仍然很少。具有不同优势和局限性的各种研究可以帮助阐明 PFAS 与癌症之间的关联。具有大暴露对比的大型队列的长期随访最有可能提供信息。
