Six months after taking a “next step” to address the risks of per- and polyfluoroalkyl substances (PFAS) with a draft document, the government of Canada has published its final “State of Per- and Polyfluoroalkyl Substances (PFAS) Report.” The report concluded that the whole class of PFAS, except for fluoropolymers, is harmful to human health and the environment. Fluoropolymers have been excluded because current evidence suggests they may have different exposure and hazard profiles compared with other PFAS.

“The report is a strong and much-needed step in recognizing the harms associated with PFAS exposure,” Johan Foster, PhD, associate professor of chemical and biological engineering at the University of British Columbia in Vancouver, told Medscape Medical News . “Acknowledging the entire class of PFAS — excluding fluoropolymers, like Teflon — as harmful is a progressive approach, especially given how often one harmful PFAS has been replaced by another unregulated but equally concerning compound.”

Asim Cheema, MD, senior interventional cardiologist at St. Michael’s Hospital in Toronto and co-founder of Your Doctors Online, agreed. “Saying the whole class, minus fluoropolymers, is a danger to human health under the Canadian Environmental Protection Act (CEPA) is a big step toward eliminating them,” he told Medscape Medical News . “Pushing for a class-based approach makes a lot of sense, as there are far too many of these chemicals to tackle one by one.”

“Simpler terms mean faster action can be taken. We see clear multisystemic effects and harms in both animal and human studies, with impacts on the liver, immune system, kidneys, reproduction, development, thyroid, and metabolism, even at low levels for some well-studied PFAS like perfluorooctanoic acid and perfluorooctanesulfonic acid.”

Future Actions

PFAS are a class of thousands of “extremely persistent” human-made substances used in a wide range of products for their waterproofing, oil resistance, or nonstick properties, the new report affirmed. “In the environment, PFAS are harmful to wildlife and can build up in living organisms. These substances do not break down easily and remain in the environment for long periods of time,” according to a Canadian government statement.

To address the health and environmental risks, the Canadian government proposed the addition of the class of PFAS, excluding fluoropolymers, to Part 2 of Schedule 1 of the CEPA. Additional actions will proceed on a step-by-step basis, according to the report.

The first phase, starting this year, will address PFAS in firefighting foams. The second phase (no start date given) will focus on limiting exposure to PFAS in products that are not needed for the protection of human health, safety, or the environment (ie, cosmetics, food packaging materials, and textiles). The government is also requiring manufacturing and other facilities to report the use of PFAS to Canada’s National Pollutant Release Inventory .

“While the report outlines a phased approach to regulation, there remains a need for clearer, more immediate timelines and commitments to phase out nonessential uses, particularly in consumer products,” Foster said. “The report does not lay out concrete support mechanisms for industries and municipalities seeking to transition away from PFAS, including funding for alternatives or remediation technologies. What happens to materials that are used to absorb PFAS from water, like home-based water filters? After they are used, they are just thrown out and put PFAS back into the garbage or environment.”

Transparency around contamination data and product labeling could also be improved, thus empowering consumers and clinicians to make safer choices, he added.

While noting that the government is “showing a clearer commitment to real action,” Cheema commented that “the pace feels a little slow when you consider the health risks, and more could absolutely be done.”

“The actions section [of the report] feels a bit thin compared with the size of the problem we’re facing here,” he said. “They acknowledge the huge risk, but the plan seems to be more research, monitoring, and thinking about guidelines rather than immediate, broad action across the class. Where are the timelines for banning nonessential uses or even defining what’s essential? That practical road map seems missing, which makes it difficult to create real accountability around this issue.”

Furthermore, he added, “We’re exposed to mixtures of these chemicals, and the combined effects are unknown. That’s a huge worry. But it doesn’t seem to offer a clear way forward for assessing or regulating based on that cumulative risk.”

Clinical Implications

What do PFAS mean for clinicians? For one thing, there needs to be increased awareness, according to Foster. “Clinicians and consumers alike should understand that PFAS exposure is not just an industrial issue,” he said. “These chemicals are present in everyday items like cosmetics, food packaging, textiles, and drinking water. The health risks are real and wide-ranging, affecting everything from the immune system to reproductive health.”

“We must keep PFAS in the back of our minds when patients present with certain issues, like thyroid problems, high cholesterol, immune issues, and more,” Cheema emphasized. Clinicians need to be asking more patients about potential exposures, he said, “but it’s tough because testing isn’t standard, and there’s no specific PFAS removal treatment. Basically, we manage the resulting health problems and advise on reducing future exposure, which feels inadequate.”

Many patients worry about PFAS, and hearing about widespread “forever chemicals” linked to health issues is stressful, he added, especially because individuals can’t easily find out their personal levels.

“Those chemicals can directly harm patient health, and those worries and stresses could even cause secondary issues,” Cheema said. Advice to patients should focus on minimizing known sources, filtering water if needed, and being cautious with certain food packaging or nonstick items.

“It’s hard to give definitive guidance, especially when the government isn’t outlawing the use of these PFAS altogether,” he acknowledged. “We need public health messaging that’s clear about real risks and a government that’s making the moves to protect its people.”

Water Contamination

Scott Bartell, PhD, professor of environmental and occupational health at the University of California, Irvine, Joe C. Wen School of Population and Public Health, has been studying human exposures and health effects of PFAS in US water sources for more than 25 years.

“People who know they have PFAS in their water can take steps to reduce their exposure right now, like installing home water filters that are approved for PFAS removal or switching to bottled water,” he told Medscape Medical News. “Clinicians who know that their patients have a history of PFAS exposure should consider targeted medical screening, as discussed in the recent National Academies report on this topic.”

The United States has recently taken “a big step in the right direction” by regulating PFAS contamination in drinking water for the first time at the national level, he said, although water suppliers will have a few more years before they have to meet the new regulations. “This is an important step because this is often the primary route of exposure for communities with PFAS in their water supplies.”

Regarding the new Canadian report, he said, “It was well done and consistent with my understanding of the scientific literature. One thing that surprised me was how little testing for PFAS has been done in Canadian water supplies. This is low-hanging fruit because most public water systems already do routine testing for a list of common contaminants and would have the capability to do PFAS testing. Even requiring a nationwide spot check for PFAS in Canada, as we’ve done in the United States via Unregulated Contaminant Monitoring Rule 3 and Rule 5 , would go a long way toward helping identify opportunities to intervene and reduce Canadians’ exposure to these toxic chemicals.”

Potential Solutions

“While government regulation is essential, it will take time to implement,” Foster said. “In the meantime, individuals should stay informed, ask questions about product safety, and advocate for transparency in labeling.”

Emerging technologies such as ReAct, the University of British Columbia’s cleantech start-up that neutralizes PFAS , “offer hope,” said Foster, who heads the start-up. “This [technology] provides a path forward for both remediation and prevention, and we’re working to bring that technology to the communities and industries that need it most.”

Foster, Cheema, and Bartell reported having no relevant financial relationships.