Androgen Receptor Marker among Iraqi Patients with TripleNegative Breast Cancer Exposed to Depleted Uranium

Abstract

Background. Two recent major wars and a 12-year economic embargo as well as several years of war on terrorism have had a damaging effect on Iraq’s land, air, water, food, and health infrastructure. The presence of depleted uranium (DU) in Iraqi soil, water and the overall food chain is documented by measuring the DU in animal organs and fish as well as the water in the most populated cities in the middle and south of Iraq. Breast cancer is the most common tumor type among Iraqi women living in war zones, and triple-negative breast cancer (TNBC) constitutes the most aggressive molecular subtype among breast tumors. The objective of this pilot study is to determine the prevalence and prognostic target of androgen receptor (AR) positivity in TNBC patients living in war regions polluted with a high level of DU. Methods: This observational, retrospective pilot study included 50 cases of TNBC patients living in the war region. The expression of AR, CK5/6, and CK8/18 biomarkers was evaluated using an immunohistochemistry study on formalin-fixed paraffin-embedded tumor samples from TNBC patients. The serum level of CA-153 and vitamin D was measured. Results: AR was positive (IHC>12%) in 12% of TNBC patients. K5/6 expression was considered if the score was >2. This expression of K5/6 was positive in 80% of cases, and CK8/18 was negative in 80% of cases. Serum vitamin D level was significantly lower in TNBC patients compared to controls. Since the two Gulf wars, there has been a steady increase in the incidence of breast cancer in Iraq. Conclusion: The middle and south of Iraq contain a heavily war-related, DU-polluted environment. Based upon the findings of this study, in regions exposed to high levels of DU, AR overexpression in TNBC patients is similar to studies that have been conducted on populations not exposed to DU.