Abstract 4979: Effect of allostatic load (AL) and neighborhood socioeconomic status (NSES) on cancer detection and false positive rate after screening mammography
Authors: Niam Abeysiriwardena, Braelyn Wekwerth, Nathaniel Mercaldo, Sarah Bell, Ruth Carlos
Journal: Cancer Research (2025)

Purpose: AL refers to the cumulative physiological dysregulation on the body's systems due to chronic stress. These cumulative stressors have been hypothesized to increase the risk of breast cancer (BC). AL has been associated with increased risk of high-risk benign breast pathology among women with a false positive (FP) biopsy. Separately, NSES has also been associated with BC outcomes. However, the impact of AL and NSES on cancer detection and FPs rate in a screening mammography population has not been evaluated. Materials and Methods: We retrospectively reviewed the Mass General Brigham Biobank to identify women aged ≥40, who underwent screening mammography from Jan 1, 2021 to Dec 31, 2021. We collected age, self-reported race/ethnicity and zip code, which were geocoded to their corresponding census tract. The census tract-assigned NSES were calculated using U.S. Census Bureau American Community Survey 5-Year Estimates for 2015-2019 and summarized to the ZIP code level. We collected the following biomarkers obtained within two years before the index screen: cardiovascular [heart rate, systolic, and diastolic blood pressure], metabolic [body mass index, alkaline phosphatase, glucose, albumin], immunologic [white blood count], and renal [blood urea nitrogen, creatinine]. AL was assigned one point for each lab value in the worst quartile. The sum of all assigned points represented the composite AL, treated as a continuous variable. We collected diagnostic breast imaging and biopsy encounters that occurred in the 12 months after the index screen. To account for missing data, we performed multiple imputation. Separate multivariable logistic regression models assessed age, race, NSES, and AL associations with cancer detection and with FP rates. Rubin's rules were applied to estimate overall odds ratios, confidence intervals, and p-values for all covariates. Results: Of 13,754 women assessed, 1.2% (n=169) women received a cancer diagnosis. Of the women, 87.6% were White, 2.6% Asian and 5.3% were Black; 1.5% self-identified as Hispanic; the mean age was 64.4±11.3 SD. AL increased risk of cancer detection after screening mammography by 16% (odds ratio OR=1.16, 95% CI:[1.06, 1.26], p=0.001). NSES was marginally associated with cancer detection (OR=1.13[0.99-1.29], p=0.067). After adjusting for AL and NSES, age and race were not significant correlates of cancer detection. We did not detect an association between FPs and either AL or NSES, after adjusting for race and age. Conclusion: In our sample, allostatic load was associated with increased risk of cancer detection after screening mammography after adjusting for age, race, and NSES. A similar association between AL and FPs was not detected. Further work is needed to confirm these observations. Clinical Relevance Statement: AL may represent a potential biomarker for personalized mammographic screening for BC. Citation Format: Niam Abeysiriwardena, Braelyn Wekwerth, Nathaniel Mercaldo, Sarah Bell, Ruth Carlos. Effect of allostatic load (AL) and neighborhood socioeconomic status (NSES) on cancer detection and false positive rate after screening mammography [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4979.