The effects of endocrine disruptors (EDs) on human health are complex. Scientific evidence suggests that they can disrupt numerous functions of the hormonal system, known as the endocrine system. They can affect reproductive health, as well as many other organs and bodily functions (immune system disruption, thyroid disorders, hormone-dependent cancers, etc.). Neurodevelopmental disorders such as autism, decreased IQ, or metabolic disorders such as diabetes or obesity are also suspected of being associated with exposure to endocrine disruptors.

As part of its environmental health program and the National Strategy on Endocrine Disruptors (SNPE), Santé publique France has been conducting specific surveillance related to endocrine disruptors, with a focus on reproductive health, since 2015. To incorporate new scientific knowledge, the PEPS’PE project, launched in 2021, aims to prioritize health effects linked to endocrine disruptors and thereby identify health outcomes to be included in the agency’s current surveillance. Based on a broad consultation with experts, this study is a preliminary step toward defining a new strategy for monitoring the effects of endocrine disruptors.

Nearly 60 health effects were assessed and prioritized in the PEPS’PE study

59 health effects suspected of being linked to exposure to endocrine disruptors were proposed in our study based on two criteria: the strength of the evidence and the epidemiological and societal relevance of the health effect.

21 health effects are assessed as priorities for monitoring

Among these, 6 reproductive health effects are already being monitored as part of the surveillance program: cryptorchidism, hypospadias, precocious puberty, testicular cancer, impaired sperm quality, and endometriosis. Added to these are infertility and reduced fertility (currently not monitored for their link to endocrine disruptors).

Metabolic effects are also being considered (overweight and obesity, cardiovascular diseases, type 2 diabetes, and metabolic syndrome), neurodevelopmental disorders in children (behavioral disorders, intellectual disability, and attention-deficit/hyperactivity disorder), cancers (breast cancer, prostate cancer, lymphomas, and leukemias in children), and asthma.

Furthermore, 22 health effects were assessed as low priority or non-priority when, for example, they presented weak or moderate evidence with varying levels of interest in establishing surveillance. Finally, 16 health effects could not be prioritized due to a lack of scientific experts on these topics, as no consensus was reached (e.g., bone disorders, adrenal disorders, and skin and eye disorders).

These results therefore indicate the need to expand the scope of the Agency’s surveillance beyond reproductive health, incorporating new conditions when surveillance data become available.

Based on the initial findings from this study, Santé publique France will analyze the feasibility of establishing surveillance for the effects classified as priorities.

How will the surveillance strategy for endocrine disruptors evolve?

Santé publique France is developing a new, so-called integrated surveillance strategy. This surveillance will rely on the development of robust indicators derived from multiple data sources (National Health Data System, cohorts, etc.), as well as on the integration of various methodologies and tools, in addition to spatiotemporal analysis, to measure, analyze, and interpret the impact of endocrine disruptors on human health.

The new strategy will help address the concept of the exposome, which refers to the totality of environmental exposures to which an individual is subjected throughout their life. Initially, it will be applied to historical health effects related to reproductive health (testicular cancer, hypospadias, cryptorchidism, sperm quality, endometriosis, precocious puberty) and cancers of the breast, prostate, ovary, and endometrium.

In the longer term, this integrated monitoring aimed at characterizing the health impacts associated with endocrine disruptors offers promising prospects for ultimately identifying effective management and prevention strategies and actions.