Comparative Assessment of Serum Asprosin, FGF21, GDF-15, and FABP4 Levels in Iraqi Women With and Without Breast Cancer

Circulating metabolic and cellular-stress proteins are increasingly being studied as potential biomarkers for the development of minimally invasive methods to determine who is most likely to develop breast cancer (BC). However, there is very little information available regarding asprosin, FGF21, GDF-15, and FABP4 in Iraqi women. Therefore, the purpose of this study was to compare serum levels of these four biomarkers in women with BC to those from healthy control subjects and assess whether the biomarkers could distinguish between women with BC and healthy control subjects. A total of 60 female participants (30 newly diagnosed with BC and 30 control females) were recruited from Al-Eluia Hospital for Women Care and the Oncology Teaching Hospital during the period March-August 2026. Serum levels of asprosin, FGF21, GDF-15, and FABP4 were measured using ELISA. Welch's t-test or Mann-Whitney U test, as appropriate, was used to determine differences between the groups. Multiple comparisons were corrected for by applying the Holm correction. In addition, Spearman rank correlation and ROC analysis with the Youden index were applied. Body mass index and menopausal status information were not obtained in the current study. Following the use of Holm's correction, each of the four biomarkers continued to be considerably higher than normal in BC patients (all adjusted P < 0.001). There were no significant associations among any of the biomarkers. Of the four biomarkers studied, FGF21 had the best ability to differentiate between BC patients and controls (AUC = 0.928), followed by FABP4 (AUC = 0.927), asprosin (AUC = 0.881), and GDF-15 (AUC = 0.779). Serum asprosin, FGF-21, GDF-15, and FABP4 were increased in Iraqi women with breast cancer, while FGF-21 and FABP4 demonstrated the greatest within-cohort discriminating ability. The results of this study are preliminary and warrant additional validation in larger cohorts that are characterized by greater clinical and metabolic diversity prior to being used in clinical settings