Populations At Increased Risk For Tnbc
There are certain risk factors that put a woman at greater risk for TNBC. You may be at increased risk if:
- You are under age 50. TNBC is more common among younger women.
- You have an inherited BRCA mutation. Of all breast cancers diagnosed in women with an inherited BRCA1 mutation, about 70 percent are TNBC.
- You are Black or Hispanic. Black and Hispanic women are more likely to develop TNBC and have lower survival rates than white and Asian women.
There are many factors that contribute to these racial disparities that are still unknown. However, Black and Hispanic patients are more likely to have unsatisfying communication with their doctors, experience discrimination in health-care settings and have a harder time getting to and from their appointments.
Triple Negative Breast Cancer Vs Other Types Of Breast Cancer
When compared to other types of breast cancer, triple negative breast cancer generally:
- Grows more quickly
- Is more likely to have spread by the time its diagnosed
- Has fewer treatment options available
- Is more likely to return after treatment
As such, the survival rate for triple negative breast cancer is generally not as good as it is for other types of breast cancer.
Epidermal Growth Factor Receptor
The epidermal growth factor receptor is reported in 89% of TNBC and is considered an attractive therapeutic target, particularly in BL2 subtype tumors . The expression of this gene results in primary tumorigenesis and metastasis. The EGFR inhibitor gefitinib lowers the proliferation of cancer cells and increases carboplatin and docetaxel cytotoxicity . Several EGFR inhibitors, such as lapatinib and erlotinib, are currently being tested against TNBC, in addition to cetuximab and panitumumab . The synergistic therapeutic approach of monoclonal antibodies and chemotherapeutics is considered to be more effective. This can be exemplified by the combined use of carboplatin and cetuximab, and cisplatin and cetuximab proved to be more efficacious in patients with advanced TNBC . Additionally, tri-inhibitor therapy, including carboplatin, gefitinib, and docetaxel, enhances TNBC cytotoxicity. Cannabidiol inhibits breast cancer metastasis by interfering with the epidermal growth factor pathway . The epidermal growth factor receptor signaling pathway is presented along with activator and inhibitor points of action, as shown in Figure 2.
FIGURE 3. Inhibition of poly polymerase in BRCA-1/2-associated and sporadic cancers .
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Medical Moment: New Compound Targets Triple
Triple-negative breast cancer is aggressive, and if it isnt caught early, it has a five-year survival rate of just 12 percent.
But now, a new compound is showing promise in knocking down triple-negative and other breast cancers.
I was first diagnosed with cancer in July of 2018, says Lynnette Dawson. The doctors examined both my breasts and felt a lump on my left.
Lynnettes cancer has responded to chemo and radiation. Shes also had a double mastectomy. Lynnette has a form of cancer called HER2+ that is hormonally driven. But triple-negative breast cancer has no hormone receptors and is very hard to treat.
I think if its a grade two or grade three, 50 percent of them will not survive within five years, says Dr. Ratna Vadlamudi, Professor OB/GYN at UT Health San Antonio.
Vadlamudi and his team tested 30,000 genes to find one to stop triple negative.
So, what we found is ERX-41 binds to a new therapeutic target that is LIPA, Vadlamudi says.
Once ERX-41 binds to the LIPA gene, the cancer then senses defective cells and dies off.
They accumulate in the lumen, and the lumen sends a signal that something is wrongstop everything, Vadlamudi says.
And researchers have found in mice that is the breakthrough.
Its like a missile and it goes and finds its target, Vadlamudi says.
Normal breast cells are not affected by ERX-41, and there is no toxicity to the patient. Its also been effective against Lynettes subtype of cancer.
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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A Potential Drug Target
Recently, we reported on research from the Case Comprehensive Cancer Center at Case Western Reserve University School of Medicine in Cleveland, OH, that suggested that an existing form of antimicrobial therapy may be effective against triple-negative breast cancer.
In that study, in vitro cancer cells treated with interferon- had a significantly reduced likelihood of forming into tumors.
But Reizes and colleagues studied the protein connexin 26 , which was previously believed to fight cancer cells but is now known to contribute to the progression of tumors.
Additional research is needed, says co-author Justin Lathia, Ph.D., but this discovery suggests that inhibiting Cx26 and the related pathway may be a promising new strategy for stopping or preventing triple-negative breast cancer stem cells from self-renewing and spreading.
It may also offer a target for diagnostic testing that helps clinicians predict health outcomes and relapse-free survival for patients with a specific cancer type.
Justin Lathia, Ph.D.
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What Size Tumor Is Considered Large
The study defined tumors less than 3 cm as small tumors, and those that are more than 3 cm as large tumors, in 720 EGC patients. Meanwhile, tumors less than 6 cm in size were set as small tumors, while more than 6 cm as large tumors, in 977 AGC patients. The study has acquired the following results.
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What Is The Recurrence Rate Of Triple
A 2019 study found that roughly 40% of people with stage 1 to stage 3 TNBC will see their cancer return after standard treatment. The remaining 60% will have long-term survival without recurrence.
The outcomes of treatment vary. About 42% of those with this form of cancer will have a rapid relapse after standard treatment. This recurrence typically occurs within the first 23 years following the initial diagnosis.
It is not currently possible to predict who will experience a relapse in their cancer, even if they have had intensive chemotherapy.
On average,
Triple-negative breast cancer can recur in various areas of the body and at local, regional, and distant levels:
- Local means that the cancer remains in the breast and has not spread.
- Regional is when the cancer spreads from the breast to lymph nodes and other structures located nearby.
- Distant refers to cancer that has spread far from the breast to other organs, such as the liver or lungs.
A 2017 study examined the patterns of recurrence among 1,930 people with TNBC. The researchers divided the patients into two age groups: 15% were younger than 40 years at the time of their diagnosis, and 85% were 40 years or older.
The researchers found only a small difference between the two groups in terms of recurrence of the cancer on the local level: 6% of those under 40 versus 5% of those aged 40 or above.
The same study found that the rate of regional recurrence was 2% for both groups.
Patient And Treatment Characteristics
One hundred ten of the 992 patients were triple negative. The median age was 50 and 50 in the TNBC and non-TNBC groups, respectively. The median follow-up was 73.57 months . Also, 47.4% of our patients were postmenopausal. The characteristics of the patients and the treatments are summarized in Table1 and Table 2. The most common histology in the TNBC group was invasive ductal carcinoma . The medullary carcinoma subtype was observed more frequently than non-TNBC group. The TNBC group had more grade 2-3 tumors , a higher ki-67 value , more metastasis presence and more exitus than the non-TNBC group. Also, local recurrence was higher in the TNBC group, although it was not statistically significant. When the patients with metastases were evaluated, visceral and bone metastases were not different between the groups, while brain metastases were observed to be more common in the TNBC group .
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What Is Triple Negative Breast Cancer
Triple negative breast cancer is a rare cancer that affects about 13 in 100,000 women each year. It represents about 15 % of all invasive breast cancers. Triple negative breast cancer is one of three types of breast cancer. It is called as triple negative because it doesnt have three markers associated with other types of breast cancer, which is important for prognosis and treatment. Its one of the more challenging breast cancers to treat. But researchers are making steady progress toward more effective treatments. Overall, 77% of women who have triple negative breast cancer are alive five years after diagnosis.
How Common Is Triple
About 10 to 20% of breast cancers are found to be triple-negative. However, triple-negative cancer cells are found more often in people under the age of 50. This is about 10 years younger than the average age of 60 or older for other types of breast cancer diagnoses. Triple-negative breast cancer is also found in higher percentages of Black and Hispanic patients and less often in Asian and non-Hispanic patients.
Another population that is more likely to be diagnosed with this type of breast cancer has an inherited mutation of the BRCA gene. About 70% of those with triple-negative breast cancer also test positive for having the BRCA mutation. You may qualify for genetic testing based on your family history. Learn more about genetic testing for breast cancer.
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Is Her2 A Cancer
HER2 breast cancers are likely to benefit from chemotherapy and treatment targeted to HER2. Group 4 . This type, which is also called triple-negative breast cancer, includes tumors that are ER negative, PR negative and HER2 negative. Basal-like breast cancers are likely to benefit from chemotherapy.
Prognosis For Metastatic Breast Cancer
Metastatic breast cancer isnt the same for everyone who has it. According to the National Breast Cancer Foundation, your symptoms at stage 4 will depend on the degree to which the cancer has spread in your body.
Although metastatic breast cancer has no current cure, it can be treated. Getting the right treatment can increase both your quality of life and longevity.
Life expectancy for breast cancer is based on studies of many people with the condition. These statistics cant predict your personal outcome each persons outlook is different.
The following factors can affect your life expectancy with metastatic breast cancer:
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Risk Factors For Triple Negative Early Breast Cancer
Anyone can get triple negative breast cancer, however there are some things that increase a persons risk.
Having an inherited BRCA mutation
Everyone has BRCA1 and BRCA2 genes. These genes normally prevent cancers from developing. However if there is a fault, called a mutation, in one of these genes, it can increase a persons risk of developing breast cancer and other cancers including ovarian cancer and prostate cancer in men. These gene mutations can be passed down through families.
About 5-10% of all people diagnosed with breast cancer have an inherited BRCA1 or BRCA2 gene mutation.
A BRCA1 mutation is associated with a higher risk for triple negative breast cancer. Not all breast cancers caused by BRCA mutations are triple negative, however, and not all triple negative breast cancers are caused by inherited BRCA mutations.
BRCA2 mutations are more likely to be present in oestrogen receptor positive breast cancer.
If you have a strong family history of breast and/or ovarian cancer , it is possible that you and your relatives could carry a BRCA mutation. For more information on breast cancer and family history, visit thebreast cancer in the family section of this website.
Being premenopausal
Premenopausal women have a higher rate of triple negative breast cancer than postmenopausal women. Scientists do not yet understand why this is the case, however research is currently underway in this area.
Symptoms Of Triple Negative Breast Cancer
The symptoms of triple negative breast cancer are similar to other breast cancer types.
Symptoms can include:
- a new lump or thickening in your breast or armpit
- a change in size, shape or feel of your breast
- skin changes in the breast such as puckering, dimpling, a rash or redness of the skin
- fluid leaking from the nipple in a woman who isnt pregnant or breast feeding
- changes in the position of nipple
Make an appointment to see your GP if you notice anything different or unusual about the look and feel of your breasts.
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Triple Negative Breast Cancer Survival Rate
The triple negative breast cancer survival rate is a general point of reference that is sometimes used by physicians when discussing patient outcomes. Like all other cancer survival rates, it must be viewed in context and cannot be used to predict the outlook for any specific patient.
It is understandable, however, that a patient might be interested in learning as much as possible about triple negative breast cancer, including the survival rate, which can sometimes provide a general, but helpful, perspective. The most accurate source of information is a personal consultation with a physician, who can provide individualized information based on the:
- Patients overall health
- Patients response to treatment
Its important to remember that no one, not even a physician, can forecast exactly how a certain triple negative breast cancer case will progress or respond to treatment. Survival rates, while sometimes useful as benchmarks, are based on broad national statistics. These statistics are derived from information relating to patients who were diagnosed and treated several years ago, and likely before many current breast cancer treatment options were available. The bottom line is that every breast cancer patient has a unique experience that cannot be accurately predicted.
Treatment Of Early Tnbc
Early TNBC is aggressive, but it can be treated effectively. Its usually treated with some combination of surgery, radiation therapy, chemotherapy and immunotherapy.
TNBC isnt treated with hormone therapy or HER2-targeted therapy because its ER-negative and HER2-negative.
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Afraid Of Your Triple
If you have recently received a TNBC diagnosis, you likely feel a great deal of fear. Common fears that TNBC patients have include:
- Lack of targeted drug treatments
- Treatment not working
- Cancer recurrence
While a TNBC diagnosis can be terribly scary, remember that it is not a death sentence. There are effective treatments for this cancer and many women go on to beat TNBC and live full lives, cancer-free. The earlier the cancer is caught, the easier it is to treat. This is why mammograms and early detection are so important.
Triple Negative Breast Cancer Clinical Trial
Ongoing clinical trial tried to investigate effectiveness and safety of different possible treatment for future use and also has several clinical trials in the pipeline. The patient can also enroll their name in these trials to get novel therapies and also assist in research by providing the data to the research team. The different research aim is different, some are investigating new therapies to treat the patient, whereas some drugs may use in preventive therapy. Name registration for a clinical trial is the first step to enrolling name to the research3,4.
References
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Tnbc Treatment Options At Siteman
As a TNBC patient, making treatment decisions can be stressful. At Siteman, our exceptional providers offer a variety of triple-negative breast cancer treatment options:
- Surgery: oftentimes, patients first need to have either the lump removed or the entire breast removed . Then, they will receive chemotherapy to target any remaining cancer cells.
- Chemotherapy: because hormone therapy and HER2 drugs arent effective treatment options for women with TNBC, chemotherapy is the main systemic treatment option. Patients may receive chemo prior to surgery , either by itself or with pembrolizumab to shrink a large tumor. Patients may also receive chemo after surgery to reduce the chances of recurrence.
- Targeted drugs: for women with TNBC who have a BRCA mutation and whose cancer no longer responds to more common breast cancer chemo drugs, their treatment teams may turn to other chemo drugs or targeted drugs .
- Radiation therapy: radiation usually comes after lumpectomies or mastectomies. High-energy radiation targets the breast to kill any remaining cancer cells. The process takes about 20 minutes. Most women receive radiation four to five days a week for about six weeks.