In contrast, p16INK4A and BMI1 expression was altered depending on the sex and the presence of cancer in DM1 samples (Figure 4N and Supplemental Figure 4B); it was decreased and elevated, respectively, in female patients with increased cancer risk, but the opposite was observed in males, in agreement with a previous study (36). This evidence concerns the gene BMI1 and myotonic dystrophy type 1.