A Disintegrin And Metalloprotease 23 (
ADAM
23), a member of the
ADAM
family, is involved in neuronal differentiation and cancer.
ADAM
23
is considered a possible tumor suppressor gene and is frequently downregulated in various types of malignancies. Its epigenetic silencing through promoter hypermethylation was observed in breast cancer (
BC
). In the present study, we evaluated the prognostic significance of
ADAM
23
promoter methylation for hematogenous spread and disease‐free survival (
DFS
). Pyrosequencing was used to quantify
ADAM
23
methylation in tumors of 203
BC
patients. Presence of circulating tumor cells (
CTC
) in their peripheral blood was detected by quantitative
RT
‐
PCR
. Expression of epithelial (
KRT
19
) or mesenchymal (
epithelial‐mesenchymal transition [EMT]
‐inducing transcription factors
TWIST
1
,
SNAI
1
,
SLUG
and
ZEB
1
)
mRNA
transcripts was examined in
CD
45‐depleted peripheral blood mononuclear cells.
ADAM
23
methylation was significantly lower in tumors of patients with the mesenchymal
CTC
(
P
=
.006). It positively correlated with Ki‐67 proliferation, especially in mesenchymal
CTC
‐negative patients (
P
=
.001). In low‐risk patients, characterized by low Ki‐67 and mesenchymal
CTC
absence,
ADAM
23
hypermethylation was an independent predictor of
DFS
(
P
=
.006). Our results indicate that
ADAM
23 is likely involved in
BC
progression and dissemination of mesenchymal
CTC
.
ADAM
23
methylation has the potential to function as a novel prognostic marker and therapeutic target.