Polyfluorinated compounds in the workplace: assessing occupational exposure and cancer risk mechanisms
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Abstract
Introduction: Occupational exposure to per- and polyfluorinated substances (PFAS) poses health risks, particularly for firefighters. Mitigation includes stricter personal protective equipment (PPE) use, PF-free foam alternatives, and ongoing exposure monitoring. Objective: To summarize the evidence on the health impacts of occupational exposure to PFAS. Methods: A systematic review was conducted in the PubMed and Web of Science databases, considering all studies available at the time of the search, following the PRISMA 2020 guidelines. The MeSH terms utilized included "occupational exposure and PFAS", “occupational exposures and polyfluorinated compounds,” and "occupational exposures and Per- and polyfluoroalkyl substances (PFAS)". These articles were assessed by three independent reviewers. The selection followed the PECO model. Results: A total of 12 studies published between 2010 and 2023 were included. Sample sizes ranged from 11 to 225 participants, with studies conducted mainly in the USA, Europe, China, and Australia. Overall, the evidence indicates that firefighters consistently present higher body burdens of PFAS compared to the general population. Additionally, significant PF contamination was reported in occupational environments beyond emergency services, such as offices and classrooms, with elevated levels of PFNA, PFTeDA, FTOHs, PFOA, and PFHxS. These findings suggest that exposure is not limited to high-risk professions but may also occur in seemingly low-exposure settings. Conclusion: The reviewed studies point to firefighters having greater occupational exposure to PFAS, and an alternative to minimize this exposure would be more rigorous application of PPE protocols, replacement of firefighting foams containing PFAS with safer alternatives, and constant monitoring.
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