PFAS cause harm across multiple organ systems, with the strongest evidence in four areas:
Cancer: The WHO's International Agency for Research on Cancer (IARC) classified PFOA as a Group 1 carcinogen (sufficient evidence in humans) in December 2023 — the highest classification. The primary cancers with established links are kidney cancer (RR ~1.9 in the PLCO cohort study) and testicular cancer (RR ~2.0 in the C8 Science Panel study of ~69,000 people exposed near DuPont's West Virginia plant).
Immune suppression: This is the most precisely documented effect in children. A landmark study (Grandjean et al., JAMA 2012) found that each doubling of serum PFOS in children age 5 was associated with a 49% reduction in antibody response to the diphtheria vaccine. The National Toxicology Program concluded PFOA and PFOS are 'presumed immune hazards in humans.'
Thyroid disruption: PFAS structurally mimic thyroid hormones and suppress free T4. A meta-analysis of 22 studies found each doubling of serum PFOS was associated with a 3.2% decrease in free T4. A 2023 study linked PFAS exposure to a 56% increased risk of thyroid cancer.
Pregnancy and development: PFAS cross the placenta. Higher maternal PFAS levels are associated with preeclampsia (OR 2.0), low birth weight, and reduced IQ scores in children. The critical window is early pregnancy when fetal thyroid development depends entirely on maternal T4.
Also established: elevated cholesterol (the most consistently replicated finding across hundreds of studies), reduced fertility in both men and women, and non-alcoholic fatty liver disease.