Evaluating Allostatic Load as a Framework for Breast Cancer Risk Assessment Across Sociodemographic Groups: Insights from a Safety-Net Population

Abstract Objective Allostatic load (AL) is an emerging framework quantifying physiological dysregulation from cumulative exposure to stressors over an individual’s life. We evaluated the relationship between AL and malignant breast biopsy results in women across sociodemographic subgroups. Methods Women 18 years and older who underwent at least one image-guided breast biopsy at a safety-net hospital between April 2016 and December 2023 were identified. Consistent with prior studies, AL was defined as a score based on eight values: resting pulse rate, systolic blood pressure, diastolic blood pressure, body-mass index, serum albumin, creatinine, estimated glomerular filtration rate, and white blood cell count. Multivariable logistic regression models were used to assess the association between AL and malignant breast biopsy results among different sociodemographic groups. Effect modification by racial/ethnic category was then examined using stratified models. Results 668 participants had data available for all eight biomarkers. Most participants were Hispanic (n = 376, 54.5%), reported English as their primary language (n = 423, 63.3%), and had Medicaid for insurance (n = 300, 44.9%). In stratified analyses, the association between AL and malignant breast biopsy result was significant in White, non-Hispanic patients. In White, non-Hispanic patients, after adjusting for age, every one-unit increase in AL was associated with a 46% increased likelihood of malignant breast biopsy result (OR 1.46, P = 0.03). Conclusion AL was associated with malignant breast biopsy results in specific sociodemographic subgroups, potentially representing a modifiable risk factor for breast cancer prevention. Further research with large, diverse populations is required to evaluate additional factors impacting breast cancer outcomes across sociodemographic groups.