Abstract 4980: Association of allostatic load (AL) and neighborhood socioeconomic status (NSES) and breast biopsy outcomes after screening mammography
Authors: Braelyn Wekwerth, Niam Abeysiriwardena, Nathaniel Mercaldo, Sarah Bell, Ruth Carlos
Journal: Cancer Research (2025)

Abstract Purpose: AL represents the physiological consequences of repeated or chronic exposure to exogenous and endogenous stressors, including NSES, which are hypothesized to increase the risk of breast cancer (BC). We showed AL correlation with BC and high-risk benign breast disease after biopsy after a palpable mass or abnormal diagnostic breast imaging. However, the effect of AL and NSES on cancer detection and false positive (FP) biopsy results after a screening mammogram has not been evaluated. Methods: We retrospectively reviewed the Mass General Brigham Biobank to identify women aged ≥40 who underwent screening mammography between 1/1/2021-12/31/2021 and subsequent breast biopsy. We collected age, self-reported race/ethnicity, and zip code and then geocoded to their corresponding census tract. The census tract assigned socioeconomic index scores (SES) 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], 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 occurring within 12 months after the index screen. Multiple imputation accounted for missing data. Multivariable logistic regression assessed age, race, SES, and AL associations with cancer detection and FP rates. We applied Rubin's rules to estimate overall odds ratios, confidence intervals, and p-values for all covariates. Results: Of the 418 eligible women, 59.6% had an FP biopsy, and the remainder had BC, including ductal carcinoma in situ. Women, on average, were 62 years old (SD=13), and 85.6% were White. Each unit increase in AL was associated with a 14% increase in risk of cancer detection (OR 1.14(1.01,1.30),p=0.034) after adjusting for age, race, and NSES. Both age (OR 1.21(1.11,1.321),p&amp;lt;0.001) and marginally NSES (OR 1.19(0.99,1.43),p=0.068), also correlated with cancer detection. We did not detect a significant association between AL and high-risk FP pathology. Conclusion: AL, age, and NSES are associated with cancer detection after screen-indicated biopsy but not high-risk FP pathology. These results underscore the importance of considering biological markers and demographic factors in refining biopsy strategies after a positive screening mammography. Clinical Relevance Statement: AL represents a potential biomarker for precision selection of women after screen-detected mammographic abnormalities to increase cancer yield for biopsy. Citation Format: Braelyn Wekwerth, Niam Abeysiriwardena, Nathaniel Mercaldo, Sarah Bell, Ruth Carlos. Association of allostatic load (AL) and neighborhood socioeconomic status (NSES) and breast biopsy outcomes 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 4980.