Quantifying Social Determinants of Health in Early-Onset Cancer Risk Prediction

In an on-site interview at the 2026 ASCO Annual Meeting, Ravi B. Parikh, MD, MPP, genitourinary medical oncologist at Winship Cancer Institute of Emory University and associate professor at Emory University School of Medicine, discusses how allostatic load may provide a biologic framework for understanding the impact of social determinants of health on early-onset cancer risk.

While social determinants such as income disparities, environmental exposures, and neighborhood conditions, are increasingly recognized as contributors to cancer outcomes, incorporating these factors into risk prediction models remains challenging. Data are often inconsistently collected, variably reported, and difficult to standardize across populations. To address this challenge, the study team used an exposome-based framework to evaluate a broad range of environmental, lifestyle, and socioeconomic exposures and their relationship to allostatic load, a measure of the cumulative physiologic burden of chronic stress.

Parikh explains how allostatic load may function as an objective biologic marker that captures the downstream effects of social and environmental risk factors. Notably, the analysis found that a substantial proportion of the association between social determinants and early-onset cancer incidence could be explained through allostatic load, suggesting that physiologic stress pathways may represent a key mechanism linking these exposures to cancer development.

Parikh poses how biologic measures such as allostatic load could ultimately improve risk stratification efforts and help identify patients who may benefit from earlier intervention and prevention strategies.