Relative Rates of Cancers and Deaths in Australian Communities with PFAS Environmental Contamination Associated with Fire-Fighting Foams: A Cohort Study Using Linked Data

Background: Per- and polyfluoroalkyl substances (PFAS) are environmental contaminants that are potentially harmful to health. We examined if rates of selected cancers and causes of deaths were elevated in three Australian communities with local environmental contamination caused by firefighting foams containing PFAS.Methods: All residents identified in the Medicare Enrolment File (1983-2019)—a consumer directory for Australia’s universal healthcare—who ever lived in an exposure area (Katherine, Oakey and Williamtown), and a sample of those who ever lived in selected comparison areas, were linked to the Australian Cancer Database (1982-2017) and National Death Index (1980-2019). We estimated standardised incidence ratios (SIRs) for 23 cancers, four causes of death and three control outcomes, adjusting for sex, age and calendar time of diagnosis.Findings: We observed higher rates of prostate cancer (SIR=1·76, 95% confidence interval (CI) 1·36–2·24) in Katherine; laryngeal cancer (SIR=2·71, 95%CI 1·30–4·98), kidney cancer (SIR=1·82, 95%CI 1·04–2·96) and coronary heart disease (CHD) mortality (SIR=1·81, 95%CI 1·46–2·33) in Oakey; and lung cancer (SIR=1·83, 95%CI 1·39–2·38) and CHD mortality (SIR=1·22, 95%CI 1·01–1·47) in Williamtown. We also saw elevated SIRs for control outcomes. SIRs for all other outcomes and overall cancer were similar across exposure and comparison areas.Interpretation: There was limited evidence to support an association between living in a PFAS exposure area and risks of cancers or cause-specific deaths.Funding Information: This work was supported by the Australian Government Department of Health.Declaration of Interests: MDK worked part-time for the Australian Government Department of Health between 2020-2022 on national COVID-19 response. The other authors declare that they have no competing interests.Ethics Approval Statement: We obtained ethics approval for the study from the nine relevant Australian State and Territory health departments and institutional human research ethics committees: Aboriginal Health and Medical Research Council of NSW Ethics Committee (1545/19), Australian Capital Territory Health Human Research Ethics Committee (2019.STE.00195), Australian Institute of Health and Welfare Ethics Committee (EO2019-3-1048), Australian National University Human Research Ethics Committee (2019/565), NSW Population and Health Services Ethics Committee (2019/ETH12632), NT Department of Health and Menzies School of Health Research Ethics Committee (2019-3472), South Australia Department of Health and Ageing Human Ethics Committee (HREC/19/SAH/62), Tasmanian Health and Medical Human Research Ethics Committee (H0018433) and Western Australian Aboriginal Health Ethics Committee (930).