How Is Triple Negative Breast Cancer Different From Other Diagnoses
No one could blame you for having a mountain of questions after receiving a breast cancer diagnosis. That list might be even longer if you receive a diagnosis of triple negative breast cancer: What exactly does that mean? How is triple negative breast cancer different from other diagnoses? And how can you make life easier on yourself if you have this illness? Here, breast cancer experts answer these and other questions.
Who Needs More Frequent Or Aggressive Screening
Perhaps women with dense breast are getting cancers missed, but they may be more slow growing and have a better prognosis. Whereas younger women are more likely to have more aggressive cancers, McCarthy says. If were going to move the dial on breast cancer mortality we have to focus on what can we do about the cancers that are more likely to kill women. Its important to dial in on poor prognosis cancers and what can we do about that.
Currently, the U.S. Preventive Services Task Force recommends most women begin regular breast cancer screening at age 50 unless an individual has a family history of the disease or has tested positive for genetic markers that increase risk, such as the BRCA genes. In the future, research may suggest guidelines for specific groups of women, such as those most at risk for cancer with a poor prognosis.
There are several types of breast cancer, McCarthy notes, and they differ in treatment options and prognosis. For example, a type called triple negative breast cancer has fewer treatments and is linked to worse outcomes.
Very few women are going to get diagnosed with breast cancer before 50, but for those who do, the cancer tends to be of poorer prognosis, McCarthy says. Its this trade-off of the risks and benefits of screening. I think the recommendations of the USPSTF are good. They are evidence-based and make sense. But I think that we need to be able to identify women who are at higher risk who need screening in a different way.
Determining Risk Of Recurrence In Triple
A personalized prognosis for patients diagnosed with triple-negative breast cancer was the goal of a new study by Katherine Varley, PhD, researcher at Huntsman Cancer Institute and assistant professor of oncological sciences at the University of Utah.
Twenty percent of women diagnosed with breast cancer in the United States will learn they have triple-negative breast cancer. That diagnosis means the three most common proteins known to fuel breast cancer growthestrogen receptor, progesterone receptor, and HER2are not present in the tumor. Those patients will not respond to any of the targeted therapies developed to treat breast cancer with those characteristics. After surgery, their only treatment option is chemotherapy. Targeted therapy allows healthy cells to survive, but chemotherapy can kill normal cells when eliminating the cancer cells.
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Time To Treatment With Metastatic Breast Cancer
There is little research looking at the optimal time until treatment for metastatic breast cancer, though it appears that waiting more than 12 weeks has been linked with lower survival. In general, however, the goal of treatment with MBC is different than early stage disease. For most people, treatment for early-stage disease is aggressive, with the goal to reduce the risk of recurrence. With MBC, the goal is often to use the least amount of treatment necessary to control the disease.
Where Do These Numbers Come From
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the breast.
- Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs, liver or bones.
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Survival And Time To Surgery
A 2016 study published in JAMA Oncology looked at data from over 115,000 people via the National Cancer Database . This study included people age 18 and older who were cared for at Commission on Cancer-accredited cancer centers across the United States.
All of the people had early stage breast cancer with surgery as their first treatment. They then looked at wait times to surgery and survival rates at five different intervals: a wait of less than 30 days, a wait time of 31 to 60 days, a wait time of 61 to 90 days, a wait time of 91 to 120 days, and a wait time of 121 to 180 days.
They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better.
How Stages Are Determined
Stages of breast cancer are defined by a system called TNM:
- T stands for tumor. It describes the size and location of the main tumor.
- N stands forlymph nodes. It describes whether cancer has spread to the nodes. It also tells how many nodes have cancer cells.
- M stands formetastasis. It tells whether the cancer has spread to parts of the body away from the breast.
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Symptoms And Diagnosis Of Metastatic Breast Cancer
The most common parts of the body where breast cancer tends to spread are the bones, lungs, brain, and liver. But metastatic breast cancer can affect other parts of the body, as well.
Metastatic breast cancer symptoms can be very different depending on the cancers location, but may include:
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back, bone, or joint pain that does not go away
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difficulty urinating , which can be a sign that the cancer is pinching nerves in your back
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numbness or weakness anywhere in your body
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shortness of breath or difficulty breathing
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abdominal bloating, pain, or tenderness
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constant nausea, vomiting, or weight loss
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jaundice
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vision problems
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biopsy of any suspicious area
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a tap, removal of fluid from the area with symptoms to check for cancer cells a pleural tap removes fluid between the lung and chest wall a spinal tap removes fluid from around the spinal cord and a tap of fluid in the abdomen removes fluid in the abdominal cavity
These tests may also be used if you have no history of breast cancer and your doctor is having trouble determining the cause of your symptoms.
A biopsy may be done to determine these factors that can influence your treatment, which will be listed in your pathology report. Learn more about Understanding Your Pathology Report.
Do I Need Genetic Counseling And Testing
Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.
If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.
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What Other Factors Go Into Staging Breast Tumors
Here are some other breast cancer characteristics that go into staging.
Tumor grade: Grade refers to how abnormal the cancer cells are. A pathologist looks at the cancer cells under a microscope. The more the cancer cells resemble healthy cells, the lower the grade. Very abnormal cancer cells may be faster growing or more likely to spread.
Hormone receptor status: Cancer cells can have hormone receptors that make them more likely to respond to hormone therapy.
Tran explains, Your pathology report will determine if your cancer is estrogen receptor positive or negative, or progesterone receptor positive or negative. Positive hormone receptive cancers are more likely to respond to anti-estrogen therapies, like tamoxifen or an aromatase inhibitor. Hormone negative cancers may respond to other types of treatments.
HER2 status: A breast cancer cells DNA can reveal more about how aggressively the cancer can grow or spread. HER2 is a cancer gene that creates extra HER2 protein receptors in some breast cancers, which are known as HER2+, or HER2 positive, disease.
While HER2+ cancer can be aggressive, biologic targeted therapies such as trastuzumab can treat it successfully, Tran says.
Studying the cells of a breast tumor can reveal how and how quickly they are growing and spreading. Certain genetic characteristics signal cancer cells that are more likely than others to come back, Tran says.
Living With Breast Cancer
Being diagnosed with breast cancer can affect daily life in many ways, depending on what stage it’s at and the treatment you will have.
How people cope with the diagnosis and treatment varies from person to person. There are several forms of support available, if you need it.
Forms of support may include:
- family and friends, who can be a powerful support system
- communicating with other people in the same situation
- finding out as much as possible about your condition
- not trying to do too much or overexerting yourself
- making time for yourself
Find out more about living with breast cancer.
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How Long Does It Take Breast Cancer To Grow
Every type of breast cancer varies based on individual factors and subtypes, says Dr. Roesch.
Different types of breast cancer tend to behave differently, and because every cancer is different and every person is too its hard to say exactly how quickly breast cancer can grow and spread. Still, experts understand that some types of breast cancer tend to be more aggressive and fast moving, while other types typically move slower.
Speed of breast cancer growth can be influenced by these factors:
Your cancer team will determine how likely or fast your breast cancer may spread based on your breast cancer subtype, stage and individual factors. Although breast cancer experts can hypothesis and estimate the speed of cancer growth, every breast cancer is different and distinctive to that person.
What Are The Different Grades Of Breast Cancer
There are three grades of invasive breast cancer:
- Grade 1 looks most like normal breast cells and is usually slow growing
- Grade 2 looks less like normal cells and is growing faster
- Grade 3 looks different to normal breast cells and is usually fast growing
Sometimes the grade given to a cancer after a biopsy can change after surgery. This is because after surgery theres more tissue for the pathologist to look at, which can give them more detailed information about the cancer.
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Survival For Inflammatory Breast Cancer
Many factors can influence life expectancy for women with inflammatory breast cancer. These include:
- the exact position of the cancer
- how big the cancer is and whether it has spread only to the lymph nodes or to other organs
- how abnormal the cancer cells look under the microscope
- your age
- whether the cancer cells have receptors for hormone therapies
- how well the cancer responds to treatment
Inflammatory breast cancer can develop quickly and may spread to other parts of the body. So, in general, the outlook with this type is not as good as for women diagnosed with other types of breast cancer. But doctors think that the outlook is improving as breast cancer treatment improves.
Can You Do Anything To Prevent Or Slow The Spread Of Breast Cancer
Like any type of cancer, there are factors that can put you at higher risk. For breast cancer, these include things like smoking, unhealthy diet, lack of exercise and not performing monthly self-breast exams. Its also important to make sure and get your annual mammogram for breast cancer screening.
Other risk factors can include using hormone-based prescriptions, how many children youve had in the past, getting older and at what age you got your period and went through menopause.
In some instances, you cant necessarily prevent breast cancer, but you can sometimes slow it down, stop it from spreading or reduce the size of the tumor, says Dr. Roesch. You can do this by taking your medications as directed, following through with treatments, going to your appointments and being involved in your cancer care.
Youre in control of taking your medication correctly, eating a healthy diet, participating in an exercise program and managing stress. All of these things can contribute to a stronger physical body and better mental attitude both of which can have a positive impact on your breast cancer diagnosis.
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Hormones Make Some Breast Tumors Grow Faster
The hormones öestrogen and progesterone can boost the growth of breast cancer cells. It is therefore crucial to find out whether a tumor is growing in a hormone-dependent manner or not, says Professor Dr. Wolfgang Janni, Director of the Womens Clinic at the University Hospital in Ulm. So you examine whether the tumor is hormone receptor positive. If this is the case, an anti-hormonal therapy is initiated. This means that a tumor that grows due to hormones can be slowed or stopped in its growth by withdrawing hormones. Appropriate drugs are available for this purpose this is also referred to as endocrine therapy. Sometimes chemotherapy can be dispensed with in this way.
What You Need To Know
- There are several kinds of breast cancer staging:
- Clinical staging is based on preliminary information such as imaging findings, clinical exam and pathology information.
- Anatomical staging is based on tumor size and the location of lymph node involvement.
- Pathology staging is based on the tumors size, pathological characteristics and lymph node involvement after surgery.
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Factors That Affect The Growth Rate Of Breast Cancer In 202:
Some studies have found that these factors are also related to breast cancer growth rates: hormone levels, family history, and age.
1. The type of cancer:
Inflammatory breast cancer is fast-growing, while other types of breast cancer tend to be slow-growing.
2. Age at diagnosis:
Breast cancer is very common in women as they age, but we usually find that young women have faster-growing breast cancers. These cancers also tend to be more aggressive with higher tumor grades.
3. Receptor status:
Triple-negative cancers grow more quickly than estrogen receptor-positive tumors. Triple-positive tumor also grow faster.
4. Menopausal state:
There is an increase in breast tumor growth during and after menopause. It is likely caused by the decrease in estrogen during this time.
5. Estrogen treatment:
Women who used hormone replacement therapy after menopause had, in general, a more rapid growth rate of breast tumors.
6. Tumor grade:
A higher grade of the tumor indicates a faster doubling time, as determined by two sets of measurements.
7. Ki-67 index:
The tumor marker index, also known as the Ki-67 index, or the doubling time, measures how quickly the tumor is increasing in a person. Please note that these are two different technologies and should be used together.
Take Advantage Of Patient Navigators
Though intuition would tell us that people who are insured would experience shorter delays before surgery, that doesn’t appear to be true. A large 2019 study in PLoS One looked at over 1.3 million people to see how time to initial treatment affected survival. In this study, they found that with early stage breast cancer, waiting more than 35 days between diagnosis and surgery reduced survival rates. Surprisingly, uninsured people had faster times to initiation of treatment.
While the reasons weren’t certain, it was thought that perhaps those who were insured lost precious time going through prior authorization procedures for diagnostic tests and treatment. Difficulty navigating the maze of large treatment centers may also be at play, and the authors made mention of recent clinical trials showing patient navigation could have a beneficial effect on assuring timely cancer care.
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Management And Treatment Options For Inflammatory Cancer Of The Breast
For some women with IBC, the initial investigations to find a diagnosis may not confirm a benign or a malignant condition.
So, a patient may be given conservative treatments such as anti-inflammatory drugs and antibiotics. Monitoring of the response to antibiotic therapy is very important if symptoms do not improve further investigations will be necessary.
Sometimes, a large excisional breast biopsy is needed to really figure out what is going on.
Inflammatory breast cancer cells tend to grow widely through the tissues of the breast, rather than as a single tumour. For this reason, chemotherapy drugs or radiation therapy are often given before surgery.