PFAS found in blood samples of more than 1,000 people in Cape Fear River Basin

For more than a year, Laura Petersen has waited for the message to arrive.

“I’m so nervous to open that letter,” she said at a meeting this week co-hosted by scientists from the GenX Exposure Study and members of the Haw River Assembly.

Petersen and her family have lived in Pittsboro for 12 years. Every day for those 12 years they drank water from their tap, unaware it contained high levels of toxic PFAS, or per- and polyfluorinated compounds.

Peterson, her husband and their daughter are among 206 Pittsboro residents who consented to have their blood tested for PFAS. Another 800 residents in the Lower Cape Fear River Basin also provided researchers with blood samples.

All the study participants should receive their results within the next week.

Depending on levels of exposure, PFAS have been linked to multiple health problems, including thyroid and liver disorders, reproductive and fetal development problems, high cholesterol, a suppressed immune system, and kidney and testicular cancers.

In addition to drinking water, PFAS are found in microwave popcorn bags, pizza boxes, cosmetics, fast food containers, firefighting foam, stain- and grease-resistant fabrics, and hundreds of other consumer products. There are upward of 12,000 types of PFAS; they’re known as “forever chemicals” because they persist in the environment for hundreds, if not thousands of years.

In 2020-2021, the GenX Exposure Study team collected blood samples from 1,020 people in three communities throughout the Cape Fear River Basin:

• Pittsboro, 206 people on public water (2021)
• New Hanover/Brunswick counties 232 (2020) and 282 (2021), all on public water
• Fayetteville, 300 people (2021), all on private wells.

Scientists tested the blood for 44 types of PFAS. Four of them were found in nearly every person sampled:

• PFOS 99.6%
• PFOA 99%
• PFHxS 99%
• PFNA 96%

For each compound, all three communities in North Carolina had PFAS levels well above the U.S. median. And of the three, Pittsboro residents had the highest median levels of each compound in their blood. For example, the Pittsboro median for PFOS was 8 parts per billion, compared with 7 and 6 for Fayetteville and New Hanover/Brunswick counties, respectively. (A median is a “middle number,” meaning half the numbers are above and half are below.)

“That indicates widespread contamination in the Cape Fear River Basin,” Nadine Kotlarz, a post-doctoral researcher at NC State University said.

About 1 million people live in the Cape Fear River Basin, which extends from Reidsville southeast through Pittsboro, Cary, Fayetteville, Brunswick and New Hanover counties on the coast.

Because PFAS are so widespread in the environment, their sources can be difficult to pinpoint. However, Pittsboro’s can be in part traced upstream, to industry that discharges wastewater to treatment plants in Greensboro, Burlington and Reidsville.

Traditional wastewater treatment methods can’t remove PFAS, so the compounds enter the waterways – the Haw River, the Cape Fear – unimpeded. Sludge, also known as biosolids, from wastewater treatment plants is often applied as fertilizer on agricultural fields. From there, PFAS can seep into the groundwater or run off into rivers and streams, and ultimately the drinking water supply.

In the Lower Cape Fear River Basin, from Fayetteville and points south, Chemours, formerly DuPont, is responsible for much of the PFAS contamination. Two types of PFAS were detected in the blood of lower basin residents that were rarely found in Pittsboro: Nafion Byproduct 2 and  PFO5DoA. Both compounds are either produced or a manufacturing byproduct at the Chemours plant, near the Bladen-Cumberland county line.

There are still inadequate data to determine the toxicity of PFO5DoA in people. But Jamie DeWitt, a toxicologist at East Carolina University who studies PFAS, said that an initial mouse study showed “this chemical is very toxic to mice.”

Researchers had to humanely euthanize mice in the highest-dose group within just a week. Even at lower doses of PFO5DoA, mice became very ill, DeWitt said.

Levels of PFO5DoA and Nafion Byproduct 2 did decrease in blood levels over a year, the study showed.

GenX, also produced at Chemours, was not detected in blood samples, likely because it has a short half-life of just a few days. In comparison, PFOA and PFOS have half-lives of as long as five years. (To illustrate how to calculate a half-life, imagine eating half of a pizza one day, then half of the remaining pizza the next, and half each day until the entire pie is gone.)

For the seven most commonly found PFAS, scientists also calculated the total amount in residents’ blood. This figure is important because people with cumulative levels above 2 parts per billion should discuss the findings with their health care providers. The NC Department of Health and Human Services recently issued guidance for health care providers on additional screening for potential PFAS-linked disorders.

Of the 1,020 people sampled, more than two thirds – 68.5% – had levels between 2 and 20 ppb. The clinical guidance says “sensitive populations” with these levels have “the potential for adverse health effects” These include high cholesterol, breast cancer and high blood pressure during pregnancy.

Nearly a third of study participants, 29%, were in the highest-risk group, those with cumulative PFAS blood levels above 20 ppb. This group is at a higher risk of adverse effects, and should be tested for thyroid function, kidney cancer, testicular cancer and ulcerative colitis, as well as for the potential disorders in people with lower PFAS levels.

The GenX Exposure Study team now plans to study health effects of PFAS, including following participants for as long as 20 years.

“You can use the information to reduce your exposure and to get the care you need.” Jane Hoppin, an NC State environmental epidemiologist, told the crowd in Pittsboro.

Those reductions are already occurring in some communities. In June, Pittsboro installed a granulated activated carbon system at its water treatment plant that is now removing at least 95% of PFAS from drinking water.

The Cape Fear Public Utility Authority also has installed advanced treatment systems that have largely eliminated PFAS from drinking water. In Brunswick County, the northwest plant will also be fitted with a treatment system, but it’s not scheduled to begin operating for more than a year. Many private well owners in Fayetteville qualify for alternative water supplies under a consent order among Chemours, the NC Department of Environmental Quality and Cape Fear River Watch.

The best way for households to reduce PFAS in their drinking water is to install a reverse-osmosis system under the sink, or to use a granulated activated carbon system. (Those on public water should not install a whole-house filter, according to NC State scientist Detlef Knappe, because it would remove disinfectants applied at the treatment plant that prevent residents from getting sick.) (

Story continues below the box

Where to find PFAS blood tests

If you weren’t part of the GenX Exposure Study but are curious about your blood levels, Eurofins offers a home test, empowerDX. Depending on the number of PFAS compounds tested for, the price of the kit ranges from $199 (for the 16 legacy, or most commonly found, PFAS) to $599 (for 40+ types).

Insurance doesn’t cover the cost of the tests.

You can order the kits online. The blood collection method uses a finger prick. After the lab receives your samples, the results should be sent to you online within four to five weeks. If your total PFAS levels are above 2 parts per billion, consult with your health care provider about additional screenings.

“If you opened your letter and the levels were above 20 [parts per billion] would you leave Pittsboro?” Laura Petersen, who is waiting for her results, asked the scientists.

Hoppin herself has elevated levels of PFAS, she said. She lived in Carrboro for nearly 15 years before moving to Raleigh.

“If you love where you are and it gives you joy, don’t do that,” Hoppin advised. “It’s not that everybody with high levels will have anything bad happen. What we measure is your past. You can’t control that, only the future.”