Is Triple Negative Breast Cancer An Aggressive Form Of Cancer
Its true that triple negative breast cancers can grow quickly. But your prognosis or expected outcome depends on more factors than your cancer subtype. Healthcare providers will also consider your tumors size and whether it has spread to your lymph nodes and other parts of your breast. Its also helpful to know researchers are focusing on ways to slow the spread of TNBC.
What Is The Chance I Could Die In The Next 5 Years
The average 5-year survival rate for all people with breast cancer is 89%. The 10-year rate is 83%, and the 15-year rate is 78%. If the cancer is located only in the breast , the 5-year survival rate is 99%. More than 70% of breast cancers are diagnosed at an Early Stage.
All survival statistics are primarily based on the stage of breast cancer when diagnosed. Some of the other important factors are also listed below that affect survival.
Stage 0 breast cancer can be also described as a pre-cancer. If you have DCIS you can be quite confident you will do well. DCIS does not spread to other organs. What can be concerning is when an invasive cancer grows back in the area of a prior lumpectomy for DCIS. This type of local recurrence does carry a risk to your life. Luckily, this does not happen frequently. Also, be aware that those who have had DCIS in the past are at a higher risk for developing an entirely new, invasive breast cancer. Take our video lesson on Non-Invasive DCIS to learn more.
Stage I invasive breast cancer has an excellent survival rate. The chance of dying of Stage I breast cancer within five years of diagnosis is 1 to 5% if you pursue recommended treatments.
Stage II breast cancer is also considered an early stage of breast cancer. There is a slightly increased risk to your life versus a Stage I breast cancer. Altogether, the risk of Stage II breast cancer threatening your life in the next 5 years is about 15%.
Definitions And Molecular Features
It is important to clarify the relationship between triple-negative breast cancer and the basal-like phenotype. Triple-negative is a term based on clinical assays for ER, PR, and HER2, whereas basal-like is a molecular phenotype initially defined using cDNA microarrays. Although most triple-negative breast tumors do cluster within the basal-like subgroup, these terms are not synonymous there is up to 30% discordance between the two groups. In this review we will use the term basal-like when microarray or more comprehensive immunohistochemical profiling methodology was used, and triple-negative when the salient studies relied on clinical assays for definition.
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How Is Triple Negative Breast Cancer Diagnosed
The first step might be a mammogram to evaluate a suspicious mass or lump in your breast. Based on what they learn, healthcare providers might perform a biopsy to remove breast tissue. Then they examine the tissues cells to determine the cancer subtype. Identifying the cancer subtype is part of the staging process, which is when providers decide how to treat your cancer.
Sometimes providers use the following tests before treatment to check on your tumors size and whether it has spread, or after treatment to monitor response to treatment:
Survival Rates And Prognosis
The outlook for breast cancer is often described in terms of relative survival rates.
Relative survival rates are an estimate of the percentage of people who will survive their cancer for a given period of time after diagnosis. Survival among people with cancer is compared to survival among people of the same age and race who have not been diagnosed with cancer.
Five-year relative survival rates tend to be lower for triple-negative breast cancer than for other forms of breast cancer.
According to the American Cancer Society, the overall 5-year relative survival rate for TNBC is 77 percent. However, an individuals outlook depends on many factors, including the stage of the cancer and the grade of the tumor.
Your healthcare professional will be able to give you a more precise outlook based on:
- the stage of your TNBC
- your age
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Clinical Trials For Her2
Some women with triple negative and HER2-negative breast cancers choose to partake in clinical trials to test therapies that arent yet available to the public. Additionally, clinical trials help researchers determine whether new treatments are safe and effective.
You may want to consider participating in a research study if your cancer isnt responding to therapy or has spread to other areas of your body.
You can search for a clinical trial in your area at ClinicalTrials.gov.
Causes Of Triple Negative Breast Cancer
The risk factors for triple negative breast cancer are not clear. Some breast cancers depend on hormones to grow. These can be linked with risk factors to do with hormones and having children. But triple negative breast cancer does not seem to share these risk factors.
Most women with triple negative breast cancer have no strong history of breast cancer in their family . But some women with triple negative breast cancer have an altered BRCA1 gene. This will have been inherited from a parent.
An altered BRCA 1 gene can cause breast cancer to run in families. Most breast cancers caused by BRCA1 are triple negative.
If you have triple negative breast cancer, you may be offered genetic testing. This is even if you do not have a family history of breast cancer. Your cancer doctor or breast care nurse can explain more about this to you.
The tests are the same as for any type of breast cancer. You usually have a:
A mammogram is an x-ray of the breast.
- Ultrasound scan
An ultrasound scan uses sound waves to produce a picture of the breast tissue and the lymph nodes in the armpit.
- Breast biopsy
When you have a breast biopsy, your cancer doctor or breast care nurse takes small samples of cells or tissue from your breast. The samples are looked at under a microscope to check for cancer cells. They also do other tests to find out if the cells have receptors for hormones, or for HER2.
The staging and grading is the same as for other types of breast cancer.
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Your Prognosis Depends On Several Factors
Its important to remember that your prognosis and treatment plan will depend on many factors, such as:
- The size of your cancer
- Whether your tumor has spread to other areas of your body
- The type of breast cancer you have
- The hormone receptor and HER2 status of your tumor
- The rate of cell growth
- Your age and menopausal status
- Your general health
Each person is different, and your doctor will likely run several tests before giving you a formal prognosis.
Generally, women with HER2-negative breast cancers have a better outlook than those with HER2-positive breast cancers. HER2-positive cancers are known to grow faster, spread more quickly, and come back more often. Despite this, HER2-positive breast cancer treatment outcomes have improved dramatically with the approval of drugs like Herceptin and Perjeta .
On the other hand, survival rates tend to be lower for those with triple negative breast cancer. One 2007 study that looked at more than 50,000 patients with different stages of breast cancer found 77 percent of women with triple negative cancer survived at least five years, compared with 93 percent of those with other forms of breast cancer.
Another study, of more than 1,600 women, found that those with triple negative breast cancer had a higher risk of death within the first five years of diagnosis, but not after that time.
Oestrogen Progesterone And Her2
These are the three substances behind triple-negative.
Oestrogen & progesterone are hormones. Some of our cells have receptors that these hormones attach to, and fuel them.
- Some breast cancer cells may not have these receptors .
- These tumours are called oestrogen-receptor negative & progesterone-receptor negative, respectively.
- You may also read/hear the terms as ER- & PR-.
- Given their lack of receptors, these tumours would not respond to hormone therapy.
HER2 is a protein in our body.
- Sometimes, a gene may result in excessive production of this protein. This may make cancer cells grow and spread faster. In this situation, called HER2-positive, treatments try to stop this function.
- In the case of HER2-negative breast cancer cells, however, this means that this protein is not produced in large amounts.
- In turn, this means that treatments targeting this function will not affect HER2-negative tumours.
- It is important to note that you do not necessarily inherit this gene mutation from your parents, and you do not pass it on to your children.
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Treatment For Triple Negative Breast Cancer
The main treatments for triple negative breast cancer are surgery, chemotherapy and radiotherapy. The treatment you need depends on:
- where the cancer is
You might have surgery to remove:
- an area of the breast
- the whole breast
When you have your surgery, the surgeon usually takes out some of the lymph nodes under your arm. They test these nodes to see if they contain cancer cells. The surgeon might check the lymph nodes closest to the breast using a procedure called sentinel lymph node biopsy. Testing the lymph nodes helps to find the stage of the cancer and decide on further treatment.
After breast conserving surgery you usually have radiotherapy to the rest of the breast tissue.
Trials For Advanced Triple Negative Breast Cancer
Trials are comparing different types of chemotherapy to see which are better at treating advanced disease. For example, researchers are waiting for the results of the Triple Negative Trial to find out whether it is better to use carboplatin or docetaxel.
Research is looking at using targeted cancer drugs alongside other treatments. For example, a trial is using a drug called atezolizumab in combination with chemotherapy. Some trials are testing a drug called pembrolizumab. Researchers think that these targeted drugs on their own might help to control the growth of the cancer.
National Institute for Health and Care Excellence , July 2018
Biology and management of patients with triple negative breast cancerP SharmaThe Oncologist. 2016, Volume 21, Issue 9
4th ESOESMO International Consensus Guidelines for Advanced Breast CancerF Cardoso and othersAnnals of Oncology,2018, Volume 29, pages 16341657
Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upF Cardoso and others
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Should I Go On A Methionine
Its too early in the research process to prescribe a methionine-free diet for triple negative breast cancer patients with confidence. However, a study was performed on eight patients with metastatic cancer done to test whether a methionine-free diet might be safe. The patients were given a very low protein, low methionine diet for an average of 17 weeks and it was found to be safe .
Can Tnbc Be Prevented
Researchers dont know all the factors that cause triple negative breast cancer. They have identified the BRAC1 gene mutation as one potential cause for triple negative breast cancer. Unfortunately, you cant prevent BRAC1 because you inherit this gene mutation from your parents.
But there are steps that help prevent breast cancers, including TNBC:
- Maintain a healthy weight.
- Exercise on a regular basis.
- Know your family medical history.
- Monitor your breast health. Studies show 95% of women whose breast cancer was treated before it could spread were alive four years after diagnosis.
- Talk to your healthcare provider about genetic testing for the BRCA gene if you have a family history of breast cancer, ovarian cancer, pancreatic or prostate cancer. If you have the BRCA gene, there are steps you can take to prevent breast cancer.
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What Does This Mean For Me
While the human body is far more complex than cells in a petri dish, this experiment gives us a hypothesis, namely that
Since restricting methionine for isolated cancer cells is toxic, restricting methionine from the diet of a cancer patient could help to kill cancer cells, reduce their proliferation and make the drug lexatumumab more effective. The next step to testing this hypothesis is an animal model.
The Emerging Concept Of Triple Negative Breast Cancer
Breast cancers are commonly associated with a high incidence and a high mortality rate in the female population worldwide. However, at a microscopic and molecular level, breast cancer is not a homogeneous disease, thus being the focus of numerous ongoing studies. The molecular heterogeneity of the normal breast tissue has been previously documented and has outlined the different molecular profiles of epithelial and non-epithelial cells responsible for the existence of several molecular types of breast carcinomas, already characterized . Starting from the histopathological classification up to the molecular classification, breast cancer has been constantly redefined in order to ensure a better management of the patient. In 2012 Boyle et al. stated that the minimal characterization of breast cancer was a situation that had lasted for a century, until a quiet revolution has taken place so that in modern times breast cancer is characterized by its molecular and clinical heterogeneity .
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What Is The Prognosis For Triple
A good treatment result depends on several factors. Chemotherapy is what can really make a difference in the outcome. The size of the invasive part of the tumor, and the number of involved lymph nodes can also greatly influence your prognosis, Sun says, but adds that if the cancer has spread , the prognosis is less certain.
There is hope, even with this serious diagnosis, and staying optimistic is essential. It can be stressful and scary to go through chemo, but positive thinking can make a difference. You have to believe that its doing you good, and for most people, it does.
Breast Cancer Treatment at Johns Hopkins
The breast cancer program at Johns Hopkins is made up of a diverse group of nationally-recognized specialists in breast cancer research and treatment.
What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
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Will I Die Of Breast Cancer
This is a difficult question to answer early in your cancer care but it is still worth asking. Many people just diagnosed with cancer have no idea how much of a risk to their life their unique situation poses. Most breast cancers carry a low risk of recurrence, especially early-stage cancers. The answer is usually reassuring.
What Is The Treatment For Triple
Chemotherapy.Chemotherapy is almost always called for, Sun says. Chemo can downstage tumors . While Sun says the chemotherapy for triple-negative breast cancer can be intense, she adds that regimen can be tailored to the individual and adjusted for older or frailer patients.
In those cases where we get complete response, we know we gave you the right medicine and your prognosis is good, Sun says.
Surgery can remove more of the tumor. Surgery for triple-negative breast cancer does not always have to be a mastectomy, Sun says. Effective chemotherapy done first opens up the possibility of less-invasive surgical options that are less of an ordeal for the patient. If the tumor is small enough after chemo, outpatient procedures or a lumpectomy may be possible.
Surgical samples of the cancerous tissues taken from surgery can provide more information on the cancer and how it is behaving so chemotherapy can be tailored accordingly.
Radiation therapy involves the use beams of radiation to destroy cancer cells, using various techniques to prevent damage to healthy surrounding tissue.
Medical treatments are being tested on triple-negative breast tumors in clinical trials.
Immunotherapy and PARP inhibitors are very exciting and theres lots of research going on, including here at Johns Hopkins, Sun says.
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New Medications For Metastatic Breast Cancer
The immunotherapy drugs called checkpoint inhibitors have led to a significant improvement in survival rates for lung cancer and melanoma. In March of 2019 the first immunotherapy drug, Tecentriq was approved for triple-negative breast cancer that is metastatic . As noted above, there are at least a few people who have had excellent responses in clinical trials prior to approval.
PARP inhibitors are also a class of medications that may alter survival rates in the future, particularly among women who have hereditary breast cancer .
For bone metastases, bone-modifying drugs may be effective in treating both metastases, and may reduce the development of further metastases in bone.
Finally, for people who have only a single or a few metastases , treating these metastases locally may be an option. While studies are young, treating oligometastases may improve survival or even lead to long term survival for a minority of people.
In addition, for some people treated with immunotherapy, local radiation may sometimes improve the response of immunotherapy, something known as the abscopal effect. Since immunotherapy is such a recent addition to breast cancer, it’s not known how common this response may be or if it will be seen at all.
What Is Triple Negative Breast Cancer
A diagnosis of triple negative breast cancer means that the three most common types of receptors known to fuel most breast cancer growthestrogen, progesterone, and the HER-2/neu gene are not present in the cancer tumor. This means that the breast cancer cells have tested negative for hormone epidermal growth factor receptor 2 , estrogen receptors , and progesterone receptors .
Since the tumor cells lack the necessary receptors, common treatments like hormone therapy and drugs that target estrogen, progesterone, and HER-2 are ineffective. Using chemotherapy to treat triple negative breast cancer is still an effective option. In fact, triple negative breast cancer may respond even better to chemotherapy in the earlier stages than many other forms of cancer.
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