Abstract
Endometriosis is a painful gynecologic disease affecting one in ten reproductive aged women worldwide. Few studies have correlated this symptomatology with biomarker levels among women with and without endometriosis, and no studies correlating pain with biomarker levels have been performed in young patient populations. The purpose of this study was to examine whether CA125 correlates with different types and severity of pain among adolescents and young women with and without endometriosis and assess its performance as an endometriosis biomarker among those presenting with dysmenorrhea in this young population. Reproductive-aged women with laparoscopically-confirmed endometriosis (n = 282) and controls (n = 293) who participated in The Women’s Health Study: From Adolescence to Adulthood (A2A), a cohort of adolescents and young women enrolled from 2012–2018, were included in this cross-sectional analysis. Plasma CA125 values were measured using WERF EPHect compliant blood samples collected at enrollment. Average CA125 were calculated by self-reported pain type (i.e. dysmenorrhea, non-cyclic/general pelvic pain, dyspareunia), severity, and frequency in endometriosis cases and controls. Median age at blood draw was 24 years in controls and 17 years in cases, with 68% and 89% non-Hispanic white, respectively. Most endometriosis cases (95%) were rASRM stage I/II. Average CA125 values were 12.5 U/mL in controls and 12.1 U/mL in cases adjusted for age. CA125 did not differ by pain type, its severity, or frequency in endometriosis cases or controls. Among participants who reported dysmenorrhea, CA125 did not discriminate endometriosis cases from controls using cutoff of 35 U/mL (AUC = 0.51, 95%CI = 0.50–0.53). Among adolescents and young adult women, CA125 did not correlate with pain type. CA125 did not efficiently discriminate endometriosis cases from controls even when accounting for pain symptomatology. Average CA125 values were low in adolescents and young women in both endometriosis cases and controls, suggesting cautious interpretation may be needed when measuring CA125 in this population.
Highlights
Endometriosis is a painful gynecologic disease affecting one in ten reproductive aged women worldwide [1]
Participants whose age at menarche was greater than 14 had higher Cancer Antigen125 (CA125) values on average compared to those whose menarche started at a younger age
Regardless of whether the participants were diagnosed of endometriosis, those who were on hormonal medication at blood draw had lower CA125 values compared to those who were not
Summary
Endometriosis is a painful gynecologic disease affecting one in ten reproductive aged women worldwide [1]. Though many attempts have been made to identify and validate specific biomarkers, studies have been conducted mostly in adult populations limited by poor methodological quality including small sample sizes, lack of consideration of disease heterogeneity, and inappropriate control groups [6, 7]. CA125 has been reported to be elevated in endometriosis patients and is the most commonly described, extensively studied endometriosis biomarker to date [6, 9,10,11,12,13]. A recent report suggested that CA125 may be predictive of endometriosis in symptomatic women with gynecological pain and/or subfertility [10]. This study was based on only 30 endometriosis cases and 28 surgical controls with heterogeneous endometriosis and control subtypes
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