Inverse association of colorectal cancer prevalence to serum levels of perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) in a large Appalachian population.
BACKGROUND
Perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) are persistent environmental contaminants that affect metabolic regulation, inflammation, and other factors implicated in the development and progression of colorectal cancer (CRC). However, the link between these compounds and CRC remains unknown. In this cross-sectional study, we investigated the association of CRC diagnosis to PFOA and PFOS blood levels in a large Appalachian population.


METHODS
Participants were 47,359 adults ≥ 21 years of age and residing in six PFOA-contaminated water districts in the mid-Ohio Valley (N = 47,151 cancer-free adults, 208 cases of primary CRC). All participants completed a comprehensive health survey between 2005 and 2006; serum levels of PFOA, PFOS, and a range of other blood markers were also measured. Medical history was assessed via self report and cancer diagnosis confirmed via chart review.


RESULTS
CRC showed a strong inverse, dose-response association with PFOS serum levels (odds ratio (OR) adjusted for potential confounders = 0.2, 95% confidence interval (CI) 0.2,0.3) for highest vs. lowest quartile of PFOS, P-trend < 0.00001) and a significant, but more modest inverse association with PFOA (adjusted OR = 0.6 (CI 0.4, 0.9) for highest vs. lowest quartile, P-trend = 0.001). These inverse associations were stronger in those diagnosed within the previous 6 years and resident in the same water district for a minimum of 10-15 years preceding assessment. The relationship between PFOA and CRC was also more pronounced in men and leaner adults, and showed a stronger linear trend at lower exposure levels.


CONCLUSIONS
In this large cross-sectional study, we found a strong, inverse association between PFOS and likelihood of CRC diagnosis and a significant, although more modest inverse association between PFOA and CRC. If confirmed in prospective investigations, these findings may aid in identifying new strategies for CRC prevention and treatment and inform future studies regarding mechanisms underlying CRC pathogenesis.
Department of Epidemiology, West Virginia University School of Public Health, PO Box 9190, Morgantown, WV 26506-9190, USA. kinnes@hsc.wvu.edu.
Kim E
KE
Innes
Jeffrey H
JH
Wimsatt
Stephanie
S
Frisbee
Alan M
AM
Ducatman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017738:Alkanesulfonic Acids / Q000009:adverse effects / Q000097:blood*; D001061:Appalachian Region / Q000453:epidemiology; D002210:Caprylates / Q000009:adverse effects / Q000097:blood*; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects / Q000097:blood*; D019538:Health Care Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D014874:Water Pollutants, Chemical / Q000009:adverse effects / Q000097:blood*; D055815:Young Adult
D017738:Alkanesulfonic Acids; D002210:Caprylates; D005466:Fluorocarbons; D014874:Water Pollutants, Chemical; C023036:perfluorooctanoic acid; C076994:perfluorooctane sulfonic acid