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Detection of endometrial cancer via molecular analysis of DNA collected with vaginal tampons.
Open accessAbstract
Objective We demonstrate the feasibility of detecting EC by combining minimally-invasive specimen collection techniques with sensitive molecular testing.Methods Prior to hysterectomy for EC or benign indications, women collected vaginal pool samples with intravaginal tampons and underwent endometrial brushing. Specimens underwent pyrosequencing for DNA methylation of genes reported to be hypermethylated in gynecologic cancers and recently identified markers discovered by profiling over 200 ECs. Methylation was evaluated individually across CpGs and averaged across genes. Differences between EC and benign endometrium (BE) were assessed using two-sample t-tests and area under the curve (AUC).Results Thirty-eight ECs and 28 BEs were included. We evaluated 97 CpGs within 12 genes, including previously reported markers (RASSF1, HSP2A, HOXA9, CDH13, HAAO, and GTF2A1) and those identified in discovery work (ASCL2, HTR1B, NPY, HS3ST2, MME, ADCYAP1, and additional CDH13 CpG sites). Mean methylation was higher in tampon specimens from EC v. BE for 9 of 12 genes (ADCYAP1, ASCL2, CDH13, HS3ST2, HTR1B, MME, HAAO, HOXA9, and RASSF1) (all p<0.05). Among these genes, relative hypermethylation was observed in EC v. BE across CpGs. Endometrial brush and tampon results were similar. Within tampon specimens, AUC was highest for HTR1B (0.82), RASSF1 (0.75), and HOXA9 (0.74). This is the first report of HOXA9 hypermethylation in EC.Conclusion DNA hypermethylation in EC tissues can also be identified in vaginal pool DNA collected via intravaginal tampon. Identification of additional EC biomarkers and refined collection methods are needed to develop an early detection tool for EC.
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“Interest has increased in the use of biomarkers, such as DNA methylation, to i mprove early detection of endometrial cancer. 31,32,170,171”
From Association of Endometrial Cancer Risk With Postmenopausal Bleeding in Women (2018) · cites this paper as [31]
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Ridgeway, J. L., Albertie, M. L., Williams, S., Pantoja, E., Stephenson, N. A., Pacheco-Spann, L. M., Ball, C. T., Breitkopf, C. R., Bakkum-Gamez, J. N., Chase, L. A., et al. (2021) · Journal of Clinical and Translational Science · doi:10.1017/cts.2021.787 · Cited by 4
Self-citationRepurposing the Vaginal Tampon for Endometrial Cancer Detection
Bakkum-Gamez, J. N. (2015) · Biomarkers in Medicine · doi:10.2217/bmm.15.44 · Cited by 4
Self-citationUnlocking the Potential of Liquid Biopsy: A Paradigm Shift in Endometrial Cancer Care
Gui, N., Cheewakriangkrai, C., Chaiyawat, P., & Udomruk, S. (2025) · Diagnostics · doi:10.3390/diagnostics15151916 · Cited by 3
Lee, J. H. S., Wu, S., Yeung, S. Y., Cheung, C.-W., Fung, W.-K., Kwok, P., Yung, K. K., Wong, T.-K. S., Kanneganti, A., & Lau, T. (2025) · Cancers · doi:10.3390/cancers17183010 · Cited by 3
DNA Methylation of Combined Gene Markers in Cytological Specimens for Endometrial Cancer Screening
Hu, M., Kang, L., Huang, L., Wang, S., Wu, H., Bian, Y., He, L., & Wang, H. (2026) · Diagnostic Cytopathology · doi:10.1002/dc.70081 · Cited by 3
Wang, X., Zheng, L., Zhu, G., Wang, S., Wei, L., Liu, J., Gao, H., Liu, X., Li, G., Li, L., et al. (2026) · Gynecologic Oncology · doi:10.1016/j.ygyno.2026.01.776 · Cited by 3
Lai, J., Rao, B., Tian, Z., Zhai, Q., Wang, Y., Chen, S., Huang, X.-T., Zhu, H., & Cui, H. (2024) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2024.108243 · Cited by 3
Kocherova, I., Kulus, M., Dompé, C., Antosik, P., Bukowska, D., Kempisty, B., & Mozdziak, P. E. (2019) · Medical Journal of Cell Biology · doi:10.2478/acb-2019-0017 · Cited by 3
Are early screening biomarkers for endometrial cancer needed to reduce health disparities?
Walther-Antonio, M. R. S., & Mariani, A. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.12.035 · Cited by 3
Self-citationHarnessing genomics for early cancer detection, risk stratification and prevention
Gu, M., Zhang, W. Z., Fitzgerald, R. C., Frankell, A. M., & Vassiliou, G. S. (2026) · Nature Genetics · doi:10.1038/s41588-026-02505-1 · Cited by 4
Jones, E. R., Narine, N., O’Flynn, H., Njoku, K., Barr, C. E., Carter, S., Cornwall, L., Vinay, S., Fullwood, C., Sergeant, J. C., et al. (2026) · The Lancet Obstetrics Gynaecology & Women s Health · doi:10.1016/s3050-5038(26)00222-0 · Cited by 2
Non-invasive DNA methylation-based testing for the diagnosis of endometrial cancer
Laurent, J. D. S., & Elias, K. M. (2023) · The Lancet Oncology · doi:10.1016/s1470-2045(23)00522-3 · Cited by 2
Holtzman, S., Cox, M., & Blank, S. V. (2024) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000892 · Cited by 2
The Prognosis Prediction Model for Endometrial Cancer Based on DNA Methylation Signature
Ran, R., Wang, M., & Miao, J. (2025) · Cancer Reports · doi:10.1002/cnr2.70218 · Cited by 2
Wright, J., Pankratz, D. G., Liu, G., Wu, E., Payne, D. S., Pattee, P., Wong, M. G., Cao, M., Milton, A. K., Monzon, F. A., et al. (2026) · International Journal of Gynecological Cancer · doi:10.1016/j.ijgc.2026.104546 · Cited by 1
Self-citationMondal, O., Khatun, M., Lawarde, A., Sajitha Lulu, S., Sundararajan, V., Salumets, A., & Modhukur, V. (2026) · Functional & Integrative Genomics · doi:10.1007/s10142-026-01957-2 · Cited by 1
Screening tests for endometrial cancer in the general population
Njoku, K., O’Flynn, H., Jones, E. R., Ramchander, N. C., White, H., Macey, R., & Crosbie, E. J. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013859 · Cited by 1
Detection of Ovarian Cancer Using Samples Sourced from the Vaginal MicroenvironmentPreprint
Galey, M. M., Young, A. N., Petukhova, V. Z., Wang, M., Wang, J., Burdette, J. E., & Sanchez, L. M. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/597740 · Cited by 1
Fambrini, M., Bussani, C., & Sorbi, F. (2015) · Gynecologic Oncology Reports · doi:10.1016/j.gore.2015.04.003
DNA methylation for cervical cancer screening: A validation trial in ChinaPreprint
Kong, L., Wang, L., Wang, Z., Xiao, X., You, Y., Wu, H., Wu, M., Liu, P., & Li, L. (2020) · Research Square · doi:10.21203/rs.3.rs-84125/v1
Qiu, H., Zhang, L., Li, J., cao, T., Feng, Y., Zhang, Y., Qian, Z., & Guo, R. (2021) · Research Square · doi:10.21203/rs.3.rs-644745/v1
Epigenetic biomarker and drug development in gynecological cancers
Su, P., Chen, L., Huang, R., Wen, K., Liew, P., & Lai, H.-C. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-823008-4.00013-5
Epigenetic Alternations in Endometrial Cancer; Future Strategies for Treatment
Nokhostin, F., Sharami, S. R. Y., & Saffarieh, E. (2024) · Indian Journal of Gynecologic Oncology · doi:10.1007/s40944-023-00773-x
Park, Y., Dibbern, M. E., Ring, K. L., & Mills, A. M. (2024) · Journal of the American Society of Cytopathology · doi:10.1016/j.jasc.2024.08.002
Wyatt, J. N. R., Powell, S. G., Arshad, I., Hill, C. J., Maclean, A., Probert, C. S., Ahmed, S., & Hapangama, D. K. (2025) · Journal of Endometriosis and Uterine Disorders · doi:10.1016/j.jeud.2025.100121
Metadata
- Authors
- Bakkum-Gamez, J. N., Wentzensen, N., Maurer, M. J., Hawthorne, K. M., Voss, J. S., Kroneman, T. N., Famuyide, A. O., Clayton, A. C., Halling, K. C., Kerr, S. E., Cliby, W. A., Dowdy, S. C., Kipp, B. R., Mariani, A., Oberg, A. L., Podratz, K. C., Shridhar, V., & Sherman, M. E.
- Affiliations
- Mayo Clinic (US)
- National Cancer Institute (US)
- Corresponding author
- Bakkum-Gamez, Jamie N.
- ORCID
- Venue
- Gynecologic Oncology
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 137
- Issue
- 1
- Pages
- 14-22
- ISSN
- 0090-8258 (ISSN-L)
- PMC
- PMC4380654
- OpenAlex
- W2147798100
- Cited by
- 107
- References
- 57
- Citations by year
- 2026: 12 · 2025: 8 · 2024: 11 · 2023: 11 · 2022: 9 · 2021: 15 · 2020: 11 · 2019: 12 · 2018: 6 · 2017: 3 · 2016: 6 · 2015: 3
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Gynecologic Oncology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NCI Cancer Center Support (P30 CA 15083)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Epigenetics and DNA Methylation
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- endometrial cancer, DNA methylation, hypermethylation, vaginal tampons, tumor markers, early cancer detection, HOXA9, RASSF1, 5-HT1B receptor, CpG sites
- MeSH terms
- Aged, DNA, Neoplasm, Female, Humans, Middle Aged, Neoplasm Staging, Pilot Projects, Biomarkers, Tumor, Vagina, Case-Control Studies, Endometrial Neoplasms, CpG Islands, DNA Methylation, Menstrual Hygiene Products
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