The sensitivity and specificity of the TR epigenetic test were determined using ROC analysis showed 89.66% and 96.77% respectively and showed that 37.5% above hypermethylation is at risk for TR and breast cancer recurrence. TR groups which have consistency with our methylation alteration results. Online databases expression and survival analysis of DOK7 showed increasing expression in TS groups vs. Significant hypermethylation were found among TR vs. The means of DOK7 CpG hypermethylation were obtained as 85.03%, 29.1% and 57.34% in TR, TS and normal control respectively. DNA was extracted from blood samples of all participants and MSRE-PCR and real-time PCR were used for quantification of CpG methylation alterations. This is the first study to investigate DOK7 CpG hypermethylation in blood leukocytes of 31 TR (ER+) BC compared to 29 tamoxifen sensitive BC to evaluate DOK7 as a potential TR biomarker. The epigenetic alteration that happens by hypermethylation of tumor suppressor genes and hypomethylation of oncogenes has been suggested to be useful in early cancer or drug resistance diagnosis. Hence, TR early detection reduces BC recurrence and fatalities. Tamoxifen drug is the first line therapy for BC however tamoxifen resistance (TR) has shown in 30–50% of cases that may face BC recurrence. Breast cancer (BC) is among the most common cause of cancer 10.4% and one of the leading causes of death among 20–50 years old women in the world.
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