Endometrial Cancer
Conditions
Keywords
Screening, Prevention, Women's Health, Reproductive health, Abnormal Uterine Bleeding
Brief summary
The study goal is to investigate a non-invasive approach to predict endometrial cancer (EC) risk, better understand disease progression and identify opportunities for intervention. This two-part case-cohort prospective study will recruit patients whose abnormal uterine bleeding is being evaluated via endometrial biopsy. Participants will complete an online health questionnaire, and a subset will be invited to self-collect vaginal samples for sequencing. Selected sequenced participants will be invited for longitudinal monitoring (questionnaires, wearable fitness tracker) and an additional vaginal self-collection to identify persistent genetic mutations or microbiome alterations 6-8 months later.
Detailed description
Purpose: To improve the prediction of EC and its precursors by integrating data from questionnaires and biological biomarkers obtained from non-invasive tests (vaginal DNA and microbiome swabs, vaginal pH). We also want to better understand pre-malignant disease progression and identify opportunities for earlier intervention. Hypotheses: 1. Risk factors in combination with ultrasound data, and patterns of abnormal bleeding are associated with endometrial cancer and its precursors. 2. Prediction of pathology is improved by including mutation and microbiome data from noninvasive tests combined with traditional risk factors. 3. Persistence of mutations and microbiome alterations is more common in patients with endometrial hyperplasia than other benign diagnoses and is associated with lifestyle factors. Justification: Non-invasive tests and questionnaires may be used to predict onset of endometrial carcinoma or its precursors and can be used to triage those participants with abnormal bleeding who require an endometrial biopsy. Objectives: To enhance understanding of the progression of EC and propose non-invasive methods for detection in patients who are experiencing abnormal uterine bleeding and have already been referred to a gynecologist for an endometrial biopsy. Research Design: This is a prospective case-cohort study that will recruit n=1000+ participants over the age of 35 years whose abnormal uterine bleeding is being evaluated via endometrial biopsy. Prospective participants will consent to access the information in their medical records, including access to their pathology report. A subset of participants (n=450) will be invited to self-collect vaginal DNA and microbiome samples using swabs and vaginal pH using a litmus kit for sequencing and analysis. A subset of those who retain their uterus (i.e. are not directed to a hysterectomy per standard clinical management) (n=200+), will be invited to take part in longitudinal monitoring using a wearable fitness tracker (Fitbit) and questionnaires, and an additional vaginal self-collection.
Interventions
None listed
Sponsors
University of British Columbia
Canadian Institutes of Health Research (CIHR)
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
40 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Study Part A: * 40 years and older * Experiencing unexplained abnormal uterine bleeding (i.e., not from IUD, etc.) * Have an intact uterus * Referred for an endometrial biopsy Study Part B/Longitudinal monitoring: * Those selected for sequencing (from Part A) and who retained their uterus.
Exclusion criteria
Study Part A: * Endometrial sampling, pelvic radiation, or vaginal infection (vaginosis, yeast) in the past 3 months * Started hormone therapy (HRT, birth control, IUD) in the past year (with the exception of tamoxifen) * Intercourse, vaginal product use, or douching in the past 48 hours Study Part B/Longitudinal monitoring: * Same as Study Part A * EC or EIN, or anyone who is recommended a hysterectomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnostic Performance of cfDNA Mutation Detection for Endometrial Pathology | Through study completion, anticipated 1-2 years | Cell-free DNA (cfDNA) extracted from vaginal swabs will be sequenced to identify endometrial cancer-associated mutations. Diagnostic performance will be evaluated by calculating sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting endometrial pathology, using biopsy-confirmed pathology as the reference standard. |
| Association Between Vaginal Microbiome Profile and Endometrial Pathology | Through study completion, anticipated 1-2 years | Vaginal microbiome DNA extracted from swabs will be sequenced and processed into operational taxonomic units (OTUs) using an in-house bioinformatics pipeline. OTUs will be compared across biopsy-confirmed pathology groups and evaluated against previously published microbiome signatures predictive of endometrial cancer. |
Countries
Canada
Contacts
CONTACTAline Talhouk, PhD
CONTACTJennifer Ellis-White
PRINCIPAL_INVESTIGATORAline Talhouk, PhD
University of British Columbia
PRINCIPAL_INVESTIGATORAnna Tinker, MD
University of British Columbia
Outcome results
None listed