Epidemiology: Occupational and Environmental

GenX is a member of a large group of man-made chemical compounds known as per- and polyfluoroalkyl substances (PFAS). PFAS are man-made chemicals that do not occur naturally in the environment. These chemicals have broad uses in commercial products such as food packaging, nonstick coatings, and firefighting foam.

GenX is a trade name for one unregulated PFAS used in manufacturing nonstick coatings and for other purposes. It is also produced as a byproduct of certain manufacturing processes.

In June 2017, the North Carolina Department of Health and Human Services (NCDHHS) was notified of a chemical, called GenX, found in drinking water sourced from the lower Cape Fear River. GenX and other emerging PFAS were found in the river and drinking water in a study led by researchers at North Carolina State University. The Chemours facility in Fayetteville was identified as the source of the GenX chemical. Further investigation by the NC Department of Environmental Quality (NCDEQ) found GenX in private drinking water wells near the Chemours facility.

GenX and other PFAS were measured in air emissions from the Chemours facility and have been found in rainwater and other bodies of water close to the facility. Under a consent order between NCDEQ, Chemours, and the Cape Fear River Watch, Chemours is responsible for characterizing GenX in the environment and reducing or eliminating their emissions through wastewater and air.

For more information about environmental monitoring for GenX and other PFAS, visit DEQ's GenX Investigation webpage.

In April 2024, the U.S. Environmental Protection Agency (EPA) implemented new drinking water regulations known as maximum contaminant levels (MCLs) for six PFAS chemicals including GenX (Table 1). The MCLs are part of the National Primary Drinking Water Regulations, which are legally enforceable primary standards and treatment techniques that apply to public water systems. The MCLs reflect levels that protect human health and that water systems can achieve using the best available treatment technologies.

Water from a Private Well

• If you live in the Fayetteville area or lower Cape Fear region, you may be eligible for free Visit the North Carolina Department of Environmental Quality (NCDEQ) website or contact the Chemours Fayetteville Works Plant to request well testing:
  • Bladen, Cumberland, Robeson, and Sampson counties: (910) 678-1101
  • New Hanover, Brunswick, Pender, or Columbus counties: (910) 678-1100
  • Those with GenX levels exceeding the EPA MCL or other PFAS contamination may be eligible for replacement drinking water supplies or filtration systems at no cost.
• Other private well owners should regularly test their wells for various contaminants that may be impacting their well water. Information on PFAS testing and filtration is available on the PFAS testing and filtration factsheet and routine well testing information can be found on this FAQ about testing.
• EPA provides training and technical assistance to private drinking water well owners. This includes test kits for emerging contaminants, including PFAS and assistance when test results indicate there is contamination.

Water from a Public Water Supply

• Reach out to your water utility provider with questions regarding concentrations of PFAS in your public water Based on the National Primary Drinking Water Regulations implemented in April 2024, water systems must take action to reduce the levels of these PFAS in drinking water if the levels exceed MCLs. Public water systems have 5 years to meet this new requirement.
• Several utilities in the lower Cape Fear region are already implementing treatment systems to limit levels of GenX and other PFAS in municipal drinking water supplies.

• In October 2021, EPA released a human health toxicity assessment of GenX chemicals, which is a written summary of available information about the potential health effects associated with this chemical.
• Laboratory studies of animals show effects on the liver at GenX exposure levels lower than levels where other effects are seen, indicating that the liver may be sensitive to GenX. Other negative effects seen in animal studies at higher levels include effects on the kidney and immune system, and developmental effects as well as liver, pancreatic, and testicular cancer.
• Scientists are actively studying the health effects of PFAS to learn more. NCDHHS continues to work with various federal and state partners to review all new health and toxicity information about these compounds and shares new information with communities, as it becomes available. This includes the ongoing Agency for Toxic Substances and Disease Registry (ATSDR) Exposure Assessments and Multi-Site Health Studiesand North Carolina State University's GenX Exposure Study 

NCDHHS is working to address PFAS issues throughout the state. Our work includes:

• PFAS Community Survey: In early 2019 NCDHHS conducted a survey of residents near the Chemours Plan to document concerns about GenX and other PFAS chemicals. These survey results have been used to tailor health education activities to better meet community needs. Results from that survey are summarized in this report (PDF) and appendix (PDF).
• Reviewing new data: We regularly review new environmental data about PFAS exposures to better understand potential public health implications and recommend actions to reduce exposure and protect public health.
• Engaging with researchers: We continue to engage with researchers at the forefront of PFAS research to evaluate and integrate new health and toxicity information as it becomes available.
  • Coordinate with PFAS Testing Network researchers to better understand the extent of exposure from drinking water across our state and to reach out to local health departments to interpret water testing results.
  • Serve on advisory boards for ongoing research projects: the GenX Exposure Study  at North Carolina State University and the PFAS UNITEDD   multi-university project headed by the Colorado School of Mines.
  • Communicate with researchers and subject matter experts from federal agencies such as the US Environmental Protection Agency, National Institute of Environmental Health Sciences, and the ATSDR.
  • Attend local and national seminars, symposiums, and conferences with a focus on PFAS.
• Health education: We provide affected communities with health information through factsheets and assist other agencies with health education and outreach. We participate in public meetings, field phone calls from concerned residents, and act as a resource for local health departments.
• Guidance for Physicians NCDHHS has developed new guidance for clinicians working with patients exposed to PFAS chemicals in our NCDHHS PFAS Clinician Memo. This is based on recent recommendations from the National Academies of Science and Medicine Guidance on PFAS Testing and Health Outcomes .
• Public Health Assessments and Health Consultations: The Health Assessment, Consultation & Education (HACE) program works with other state, local, and federal partners to evaluate public health impacts from exposure to toxic substances in the environment throughout North Carolina and provide recommendations to protect human health. Public health assessments and health consultations gather information about hazardous substances at a site and evaluate whether exposure to those substances might cause harm to people. These public health assessments or health consultations are completed through a cooperative agreement with ATSDR.

Specific activities and reports associated with GenX response include the following:

Cancer and birth defects investigations

NCDHHS has completed investigations into the prevalence of certain types of cancer and birth defects in the Lower Cape Fear Region. Overall, most cancer and birth defects rates were similar to state rates. Only a comprehensive research study can provide information about whether a specific exposure might be associated with an elevated prevalence of a specific birth defect or type of cancer.

Biomonitoring

NCDHHS worked with the Cumberland and Bladen County Health Departments, the CDC, and the ATSDR to conduct biomonitoringby testing for GenX and other PFAS in blood and urine samples from approximately 30 residents living close to the Chemours facility. This summary report details the results of this investigation. The results were also documented in an article  in the CDC's scientific series Morbidity and Mortality Weekly Report (MMWR).

PFAS Community Survey

In early 2019 NCDHHS conducted a survey of residents near the Chemours Plan to document concerns about GenX and other PFAS chemicals. These survey results will be used to tailor health education activities to better meet community needs. Results from that survey are summarized in this report (PDF) and appendix (PDF).

Assisting Researchers

NCDHHS staff are advising researchers performing ongoing studies. These include:

• North Carolina State University GenX Exposure Study
• PFAS U.S. National Investigation of Transport and Exposure from Drinking Water and Diet (PFAS UNITEDD)

Public health assessments and health consultations gather information about hazardous substances at a site and evaluate whether exposure to those substances might cause harm to people. These public health assessments or health consultations are completed through a cooperative agreement with ATSDR and include the following regions:

1. Camp Dixie (completed)
   DEQ sampled the lake at Camp Dixie for GenX and other PFAS in October 2017, since the lake is located close to the Chemours facility. The HACE program evaluated these sampling results and issued a letter to the director of the camp. HACE concluded that exposure to GenX at levels measured in October 2017 while recreating in the lake is not expected to harm people's health.

FAQs and Fact Sheets

• Updated! NCDHHS PFAS Fact Sheet English, Spanish (PDF)
• Updated! NCDHHS GenX Fact Sheet English, Spanish (PDF)
• NCDHHS: PFAS Clinician Memo (PDF)
• PFAS Water Testing and Filtration Resources (PDF)

GenX Historical Information

• EPA's Final Human Health Assessment for Toxicity of GenX Chemicals
• DHHS to Survey Citizens on GenX and PFAS Concerns - Jan. 17, 2019
• DHHS Receives Results from Blood and Urine Testing of 30 Residents Near Fayetteville Works Site - Oct. 16, 2018
• Limited Number of Residents Near Fayetteville Works Site to be Invited to Participate in Blood and Urine Testing - July 17, 2018
• DHHS Releases Summary of Selected Cancer Rates for Counties in Cape Fear Region - June 29, 2018
• Members Named to State Science Advisory Board to Advise on Emerging Chemicals - Oct. 19, 2017
• State Releases First Water Quality Data, Updated Health Information for GenX in Cape Fear River - July 14, 2017
• NCDHHS Questions and Answers Regarding the 2017 GenX Provisional Health Goal (PDF)
• NCDHHS: EPA’s Human Health Toxicity Assessment for GenX Chemicals (PDF)
• DEQ, DHHS investigating reports of unregulated chemical in Cape Fear River - June 14, 2017

• DEQ's GenX Investigation Webpage