Department of Environmental and Occupational Health, University of California, Irvine, CA, USA.
Department of Statistics, University of California, Irvine, CA, USA.
J Air Waste Manag Assoc. 2021 Jun;71(6):663-679. doi: 10.1080/10962247.2021.1909668.
The carcinogenicity of perfluorooctanoic acid (PFOA) has been reviewed previously by several different regulatory agencies and researchers, with contradictory conclusions-especially regarding epidemiological findings on kidney cancer and testicular cancer. In addition, previous dose-response assessments have focused primarily on evidence from animal studies. This critical review summarizes peer reviewed epidemiological studies on PFOA and cancers of the kidneys and testes, using modified Hill's criteria to assess the evidence for causation. We converted exposures to a common scale based on serum PFOA concentrations and applied meta-analysis to estimate the average increase in cancer risk reported by the studies with sufficient information to estimate serum PFOA. Using random effects meta-analysis, we found that the average relative increase in cancer risk per 10 ng/mL increase in serum PFOA for these studies is 16% (95% CI: 3%, 30%) for kidney cancer and 3% (95% CI: 2%, 4%) for testicular cancer. These associations are most likely causal, but results are limited by the small number of studies for testicular cancer, the overlapping study populations for several studies, and the lack of measured or modeled serum PFOA concentrations for several studies.: Our review meta-analysis indicates an average increase in cancer risk per 10 ng/mL increase in serum PFOA for kidney and testicular cancers. These associations are most likely causal, but results are limited by the small number of studies for testicular cancer, the overlapping study populations for several studies, and the lack of measured or modeled serum PFOA concentrations for several studies. The weight of evidence could be even stronger with the addition of future studies conducted in large cohorts.
此前，已有多个不同的监管机构和研究人员对全氟辛酸 (PFOA) 的致癌性进行了审查，得出的结论相互矛盾——尤其是在关于肾癌和睾丸癌的流行病学发现方面。此外，之前的剂量反应评估主要集中在动物研究证据上。本综述总结了经同行评审的有关 PFOA 与肾脏和睾丸癌的流行病学研究，使用改良的希尔标准来评估因果关系的证据。我们根据血清 PFOA 浓度将暴露值转换到一个共同的尺度，并应用荟萃分析来估算有足够信息估算血清 PFOA 的研究报告的癌症风险平均增加量。我们使用随机效应荟萃分析发现，对于这些研究，血清 PFOA 每增加 10ng/mL，癌症风险的平均相对增加率为 16%（95%CI：3%，30%），肾癌风险为 3%（95%CI：2%，4%）睾丸癌。这些关联极有可能是因果关系，但结果受到睾丸癌研究数量较少、几项研究的重叠研究人群以及缺乏对几项研究的血清 PFOA 浓度进行测量或建模的限制。我们的综述荟萃分析表明，血清 PFOA 每增加 10ng/mL，肾脏和睾丸癌的癌症风险平均增加 16%。这些关联极有可能是因果关系，但结果受到睾丸癌研究数量较少、几项研究的重叠研究人群以及缺乏对几项研究的血清 PFOA 浓度进行测量或建模的限制。如果增加在大型队列中进行的未来研究，证据的权重可能会更强。
