210 Chapter 8 Obtaining prognostic information from patient-friendly samples could provide valuable clinical insights before intervention, guide the necessity for aggressive surgery, and potentially reduce referrals to specialized centers for cancers with favorable outcomes. Furthermore, the current frequent and stringent follow-up regimen in women with a low endometrial cancer recurrence risk could be simplified by remote biomarker testing in home-collected samples. Reducing follow-up visits will decrease the burden of healthcare and associated costs while maintaining responsible and patient-friendly monitoring of patients (5). Although patient-friendly surveillance of recurrent cancer is attractive, more insight into the methylation levels in the urine of women with and without recurrent endometrial cancer is required. Currently, the ‘SOLUTION follow-up’ study has been initiated to analyze methylation levels in home-collected urine and cervicovaginal self-samples of women with and without endometrial cancer recurrence after treatment with curative intent. Urine biomarker testing for ovarian cancer, of which the feasibility is evaluated in Chapter 5, offers a promising approach for early detection and improving pre-surgical diagnosis in women with adnexal masses. Upon continued development, urine biomarker testing could be integrated with current diagnostic modalities, including serum CA-125 biomarker testing and transvaginal ultrasonography. This approach would be particularly valuable for high-risk women, including women presenting with an adnexal mass and BRCA1/2 mutation carriers. Despite the ease of urine collection, it is crucial to acknowledge that blood is already used for ovarian cancer diagnostics and therefore also offers a convenient sample type for diagnostics. The infrastructure for blood-based biomarker testing is already in place for serum CA-125 testing and could be easily extended to the analysis of additional (epi)genetic biomarkers. From a screening perspective, the concept of a single molecular test for the detection of multiple (gynecological) malignancies is appealing. The identification of (methylation) markers specific to each gynecological malignancy would allow for the development of a single test that enables the detection of the most commonly occurring gynecological malignancies, including cervical, endometrial, and ovarian cancer. Given the age differences at which these cancers typically present, one could consider including endometrial cancer screening as part of an exit round during cervical cancer screening when women reach the age of 60. Clinician-taken cervical scrapes and self-collected cervicovaginal samples are readily used for human papillomavirus detection in cervical cancer screening programs, which might ease the implementation of these sample types for the detection of endometrial and ovarian cancer. Urine-based high-risk human papillomavirus and methylation testing has also shown great promise for the
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