Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Caroline H. Johnson


Background: Currently, there is information on the detrimental impacts of exposure to pollutants such as per- and polyfluoroalkyl substances (PFAS) but there is still limited information on the impact PFAS has on colorectal cancer.Aim: To review and examine the evidence available in the existing published literature showing an association between exposure to PFAS and colorectal cancer. Methods: In this narrative review using searches of PubMed, SCOPUS and Google Scholar, publications between 2003 and 2023 were identified to ensure the inclusion of all recent development in this area of research. Inclusion criteria included a focus on the association between PFAS/PFOS and colorectal cancer. Both epidemiological and toxicology studies conducted globally were examined as well as reviews. In addition, studies that assessed an association between PFAS/PFOS and GI tract/intestinal inflammation were also reviewed, because they were considered relevant for the colorectal cancer outcome. Results: In the 18 studies included in this review, there is not sufficient evidence to say that PFAS/PFOS causes colorectal cancer. Findings from the animal studies vary, showing negative associations, molecular disruptions and microbiota dynamics, as well as inverse associations between PFAS exposure and reduction of gastrointestinal tumors. Additional studies on colorectal cancer cell lines and metabolic remodeling of cells suggest limited evidence for an association between PFOA exposure and stimulation cell’s invasive ability and metabolism. The epidemiological studies also show complex and distinct findings suggesting the need for further research to establish an association between PFAS/PFOS exposure and colorectal cancer. Conclusion: The current existing body of published literature does not provide sufficient evidence to establish an association between exposure to PFAS/PFOS and colorectal cancer. Additional research is warranted to better understand the mechanisms through which PFAS/PFOS affect colorectal cancer.


This is an Open Access Thesis.

Open Access

This Article is Open Access