Considerations for Measurements of Aggregate PFAS Exposure in Precision Environmental Health

Per- and polyfluoroalkyl substances (PFAS) have become a major focus of research due to their widespread environmental presence and adverse health effects associated with human exposure. PFAS include legacy and emerging structures and are characterized by a range of functional groups and carbon-fluorine chains that vary in length (from fewer than 3 carbons to more than 7 carbons). Research has linked PFAS exposure to an array of health concerns, ranging from developmental and reproductive disorders to immune system impairments and an increased risk of certain cancers. In this new era of personalized health, measuring markers of PFAS exposure in human biospecimens is an important part of environmental public health surveillance. PFAS are typically measured in human blood and tissues using targeted approaches, which quantify individual PFAS structures using specific instrumentation. The diversity and complexity of PFAS, the limitations of the targeted approaches due to the sheer number of structures, and the absence of publicly available analytical standards pose significant challenges for measurement methodologies. This perspective aims to describe aggregate PFAS exposure measurements and their potential for use in precision medicine applications including a discussion of the limitations and potential benefits of these aggregate measurements. As public health organizations, healthcare professionals, and the public look for guidance regarding the safe use of and exposure to PFAS, in a pragmatic cost-effective manner, the dynamic field of measurement science is poised to respond with innovative technological solutions to an important public health need.