Evaluation of Biomarker and Clinical Indicators in Women with Breast Cancer in Kirkuk Governorate: A Comparative Study
Abstract
Being one of the commonest cancers among women (and rank as leading cause of death in women) makes breast cancer a global problem and Iraqi experience is not different. This study was conducted to assess some biochemical, clinical and prognostic indicators among women diagnosed with breast cancer in Kirkuk Governorate (Iraq) as compared to a control group of apparently healthy women. The clinical parameters included tumor diameter, hormone receptor status (ER/PR), HER2 expression and lymph node metastasis and biochemical indicators such as CA 15-3, CEA, CRP and LDH. Results demonstrate the differences of these biomarkers between these two groups, showing potential for effective diagnosis and prognosis of breast cancer. The study included 90 women: 60 with breast cancer and 30 without it. The data showed that the proportion of patients with larger-size tumor, HER2-positive patient and more positive nodes in the patient group were significantly higher. Additionally, key biomarkers CA 15-3, CEA, CRP and LDH were also increased in breast cancer group suggesting potential for use of these markers for both diagnosis and follow-up of the disease. Tumor characteristics, hormone receptor status, and the prevalence of lymph nodes among breast cancer patients showed significant differences in our study being compared to controls. The levels of CA 15-3, CEA, CRP and LDH are increased in the patient group indicating that these biomarkers may be useful for confirming the presence of breast cancer and monitoring its behavior. This study emphasizes the clinical and biochemical markers have their importance in diagnosis, prognosis as well as monitoring for breast cancer burden to different districts like Kirkuk Governorate. Studies in this area should continue to improve treatments and prevent poor outcomes for patients.
References
G. N. Sharma, R. Dave, J. Sanadya, P. Sharma, and K. Sharma, "Various types and management of breast cancer: an overview," Journal of Advanced Pharmaceutical Technology & Research, vol. 1, no. 2, pp. 109-126, 2010.
M. M. Al-Hashimi, "Trends in breast cancer incidence in Iraq during the period 2000-2019," Asian Pacific Journal of Cancer Prevention: APJCP, vol. 22, no. 12, pp. 3889, 2021.
N. Aljubori, "Breast Cancer in Iraq," International Journal of Medical Sciences, vol. 1, no. 1, pp. 6-12, 2018.
H. T. Hashim, M. A. Ramadhan, K. M. Theban, J. Bchara, A. El-Abed-El-Rassoul, and J. Shah, "Assessment of breast cancer risk among Iraqi women in 2019," BMC Women's Health, vol. 21, pp. 1-9, 2021.
Y.-S. Sun, Z. Zhao, Z.-N. Yang, F. Xu, H.-J. Lu, Z.-Y. Zhu, et al., "Risk factors and preventions of breast cancer," International Journal of Biological Sciences, vol. 13, no. 11, pp. 1387, 2017.
J. J. Kim, T. Kurita, and S. E. Bulun, "Progesterone action in endometrial cancer, endometriosis, uterine fibroids, and breast cancer," Endocrine Reviews, vol. 34, no. 1, pp. 130-162, 2013.
B. Trabert, M. E. Sherman, N. Kannan, and F. Z. Stanczyk, "Progesterone and breast cancer," Endocrine Reviews, vol. 41, no. 2, pp. 320-344, 2020.
C. Chen, X. Gong, X. Yang, X. Shang, Q. Du, Q. Liao, et al., "The roles of estrogen and estrogen receptors in gastrointestinal disease," Oncology Letters, vol. 18, no. 6, pp. 5673-5680, 2019.
H. Sung, J. Ferlay, R. L. Siegel, M. Laversanne, I. Soerjomataram, A. Jemal, and F. Bray, "Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries," CA: A Cancer Journal for Clinicians, vol. 71, no. 3, pp. 209-249, 2021.
N. Harbeck, F. Penault-Llorca, J. Cortes, M. Gnant, N. Houssami, P. Poortmans, et al., "Breast cancer," Nature Reviews Disease Primers, vol. 5, no. 1, p. 66, 2019.
N. L. Henry and D. F. Hayes, "Cancer biomarkers," Molecular Oncology, vol. 6, no. 2, pp. 140-146, 2012.
M. J. Duffy, N. Harbeck, M. Nap, R. Molina, A. Nicolini, E. Senkus, and F. Cardoso, "Clinical use of biomarkers in breast cancer: Updated guidelines from the European Group on Tumor Markers (EGTM)," European Journal of Cancer, vol. 75, pp. 284-298, 2017.
M. Gion, R. Mione, A. E. Leon, and R. Dittadi, "Comparison of the diagnostic accuracy of CA 27.29 and CA 15.3 in primary breast cancer," Clinical Chemistry, vol. 45, no. 5, pp. 630-637, 1999.
K. H. Allin and B. G. Nordestgaard, "Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer," Critical Reviews in Clinical Laboratory Sciences, vol. 48, no. 4, pp. 155-170, 2011.
J. Ferlay, M. Colombet, I. Soerjomataram, D. M. Parkin, M. Piñeros, A. Znaor, and F. Bray, "Cancer statistics for the year 2020: An overview," International Journal of Cancer, vol. 149, no. 4, pp. 778-789, 2021.
M. Arnold, E. Morgan, H. Rumgay, A. Mafra, D. Singh, M. Laversanne, et al., "Current and future burden of breast cancer: Global statistics for 2020 and 2040," The Breast, vol. 66, pp. 15-23, 2022.
A. Nicolini, P. Ferrari, and M. J. Duffy, "Prognostic and predictive biomarkers in breast cancer: Past, present and future," Seminars in Cancer Biology, vol. 52, pp. 56-73, 2018.
E. A. Rakha and I. O. Ellis, "An overview of assessment of prognostic and predictive factors in breast cancer needle core biopsy specimens," Journal of Clinical Pathology, vol. 64, no. 8, pp. 669-677, 2011.
B. Weigelt, J. L. Peterse, and L. J. Van’t Veer, "Breast cancer metastasis: markers and models," Nature Reviews Cancer, vol. 5, no. 8, pp. 591-602, 2005.
R. Yerushalmi, R. Woods, P. M. Ravdin, M. M. Hayes, and K. A. Gelmon, "Ki67 in breast cancer: prognostic and predictive potential," The Lancet Oncology, vol. 11, no. 2, pp. 174-183, 2010.
A. Goldhirsch, E. P. Winer, A. S. Coates, R. D. Gelber, M. Piccart-Gebhart, B. Thürlimann, et al., "Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013," Annals of Oncology, vol. 24, no. 9, pp. 2206-2223, 2013.
M. J. Duffy, "Serum tumor markers in breast cancer: are they of clinical value," Clinical Chemistry, vol. 52, no. 3, pp. 345-351, 2006.
R. Molina, V. Barak, A. van Dalen, M. J. Duffy, R. Einarsson, M. Gion, et al., "Tumor markers in breast cancer–European Group on Tumor Markers recommendations," Tumor Biology, vol. 26, no. 6, pp. 281-293, 2005.
L. M. Coussens and Z. Werb, "Inflammation and cancer," Nature, vol. 420, no. 6917, pp. 860-867, 2002.
K. H. Allin, S. E. Bojesen, and B. G. Nordestgaard, "Baseline C-reactive protein is associated with incident cancer and survival in patients with cancer," Journal of Clinical Oncology, vol. 27, no. 13, pp. 2217-2224, 2009.
L. Faloppi, M. Scartozzi, M. Bianconi, G. Svegliati Baroni, P. Toniutto, R. Giampieri, et al., "The role of LDH serum levels in predicting global outcome in HCC patients treated with sorafenib: implications for clinical management," BMC Cancer, vol. 14, no. 1, p. 110, 2014.
F. Cardoso, S. Kyriakides, S. Ohno, F. Penault-Llorca, P. Poortmans, I. T. Rubio, et al., "Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up," Annals of Oncology, vol. 30, no. 8, pp. 1194-1220, 2019.
D. Slamon, W. Eiermann, N. Robert, T. Pienkowski, M. Martin, M. Press, et al., "Adjuvant trastuzumab in HER2-positive breast cancer," New England Journal of Medicine, vol. 365, no. 14, pp. 1273-1283, 2011.
Copyright (c) 2025 Ahlam Ahmed Mahmood

This work is licensed under a Creative Commons Attribution 4.0 International License.