What Is The Risk For Triple
The disease can affect anyone, but is more likely to show up in those who are:
- Younger than age 50 .
- Black or Latinx.
- Living with a genetic condition called BRCA mutation that increases the risk for breast cancer and other forms of cancer. Most cancers diagnosed in people with the BRCA1 mutation are triple negative.
Cancer And The Female Breast
Figure: Breast and Adjacent Lymph Nodes
Figure: The female breast along with lymph nodes and vessels. An inset shows a close-up view of the breast with the following parts labeled: lobules, lobe, ducts, nipple, areola, and fat.
Inside a woman’s breast are 15 to 20 sections, or lobes. Each lobe is made of many smaller sections called lobules. Fibrous tissue and fat fill the spaces between the lobules and ducts . Breast cancer occurs when cells in the breast grow out of control and form a growth or tumor. Tumors may be cancerous or not cancerous .
Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L. Annual Report to the Nation on the Status of Cancer, 1975-2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. 2015 Mar 30 107:djv048. doi: 10.1093/jnci/djv048. Print 2015 Jun.
How Is Tnbc Diagnosed
Imaging tests are usually the first tests done:
- Mammography, the most common screening tool for breast cancer, uses X-rays to take images of the breast and can uncover tumors that may be too small to feel.
- MRI uses a magnet, radio waves and a computer to make detailed images of the breast with a much greater resolution than a mammogram offers.
The next step is a biopsy to remove a sample of suspicious cells from the breast to analyze them. Techniques include:
The appropriate type of biopsy for you depends on factors such as the size and location of the tumor. You may also have a biopsy of your underarm lymph nodes at the same time to see if any cancer is there.
Breast cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your breast cancer in a way that fits your individual needs and goals.
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Mammalian Target Of Rapamycin
The mTor pathway is responsible for poor prognosis due to the aggressive nature of the cancer and its good tissue invasion property . Errors in the mTOR pathway are strongly correlated with malignancy . The phosphorylation reactions of this pathway are also associated with proliferation, vascular endothelial growth factor, and angiogenesis, that enhance endothelial cell growth . Moreover, high expression of a protein kinase enzyme has been reported to be involved in tumor invasion and metastasis therefore, inhibiting the mTOR pathway can be an efficient anti-cancer strategy for several human malignancies . In general, inhibitors of the PI3K/AKT/mTOR network can be grouped as: 1) AKT blockers, 2) Pan-PI3K/mTOR blocker, 3) PI3K blocker, 4) Rapalogs , and 5) mTOR blocker . The mTor pathway and checkpoints where it can be blocked are presented in Figure 4.
The mTor pathway illustrating two distinct complexes . The pathway is stimulated by different growth factors. The mTORC2 activated Akt. Multiple cell functions are regulated by both mentioned complexes that are considered vital for cancer development. Also, in the figure different steps of the pathway that can be blocked by inhibitors are shown .
Signaling Pathway Of Cspg4 Protein
The CSPG4 protein is expressed as a cell surface proteoglycan by basal breast carcinoma cells. Therapeutically, CSPG4 inhibition allows for efficient management of breast cancer . Monoclonal antibodies can block the CSPG4 protein, which hinders survival signaling pathways in tumor cells. In addition, controlling the overexpression of CSPG4 by targeting it therapeutically is seen in different TNBC cells .
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What Are Breast Cancer Subtypes
Breast cancer is complex, and not a one-size-fits-all disease. It can be broken down into different types based on an individuals unique diagnosis. Subtype is one factor of a diagnosis that helps explain what may be causing the cancer to grow.
Currently, there are three main breast cancer subtypes:
- Hormone receptor-positive is the most common subtype, accounting for 72 percent of all breast cancers. With this diagnosis, the cancer cells contain receptors for the hormones estrogen and/or progesterone. This means the cancer depends on one or both of these hormones to grow.1
- Human epidermal growth factor receptor 2-positive indicates the cancer cells have an excess of HER2 protein causing the cancer to grow. About 15 percent of breast cancers are HER2-positive.2
- Triple-negative breast cancer is the absence of hormone receptors and excess HER2 protein, and accounts for about 15 percent of breast cancers.1,2
- These are example subtypes. A person could also have a combination of subtypes, and/or other factors contributing to cancer growth.
Want to test what youve just learned? Take our Breast Cancer Quiz.
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 . 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
Effects On Different Races And Ethnicities
In general, young women and Black women have a higher chance of being diagnosed with triple-negative breast cancer than older women and women of other races or ethnicities. The American Cancer Societyâs Breast Cancer Facts & Figures 2019-2020 reports that of all breast cancers diagnosed in Black women, about 21% are triple-negative. In comparison, only 10% of breast cancer diagnosed in non-Hispanic white women and Asian/Pacific Islanders is triple-negative, and only 12% of breast cancer diagnosed in American Indian/Alaska Native women and Hispanic women is triple-negative.
Though Black women have the highest chance of being diagnosed with triple-negative disease compared to women of other races, the rate of triple-negative diagnosis in Black women is still lower than diagnosis of other breast cancers. Like women from all racial and ethnic groups, Black women are most often diagnosed with hormone receptor-positive breast cancer. Of breast cancers diagnosed in Black women, 61% are hormone receptor-positive.
What Questions Should I Ask My Doctor
You will have lots of questions about your cancer, starting with your diagnosis. Here are some basic questions you might ask:
- What is triple negative breast cancer?
- How do you know my cancer is triple negative breast cancer?
- Why did I get this cancer?
- Do I need genetic testing?
- Has my breast cancer spread, and if so, how far has it spread?
- What is the stage of my cancer?
- What is my prognosis or expected outcome?
- What treatments do you recommend?
- Why do you recommend those treatments?
- What are those treatment side effects?
- Will I need surgery? If so, what surgery do you recommend and why?
- Im interested in participating in clinical trials. Are you able to help me find one?
- Do you know if there are any local support groups?
A note from Cleveland Clinic
Triple negative breast cancer is one of the more challenging breast cancers to treat. You might be discouraged by what you have read about triple negative breast cancer. But there are a number of very effective treatments for triple negative breast cancer, including immunotherapy, chemotherapy, surgery and radiation. And every day researchers learn more about this rare cancer. Their knowledge is your power. If youre concerned you arent getting the straight story about your cancer, ask your healthcare provider to walk you through your diagnosis and treatment options.
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What You Need To Know
- Triple-negative breast cancer accounts for about 10% to 20% of all breast cancer cases.
- Every cancer diagnosis is unique, but in general, triple-negative breast cancer is a more aggressive type of tumor with a faster growth rate, higher risk of metastasis and recurrence risk. Therefore, it often requires chemotherapy as part of the treatment.
- Surgery is also an important part of treatment, but if a tumor is small and localized, mastectomy may not be necessary. Chemotherapy can shrink triple-negative breast tumors, and patients can become candidates for less-extensive surgery.
- Triple-negative cancers are more common in patients with hereditary genetic mutations, and genetic counseling and testing should be considered.
Targeting Tumor Microenvironment For Tnbc Therapy
The development of TNBC has strong association with the physiological state of TME. TNBC has been characterized with unique TME and is different from other subtypes . TME has strong association with induction of angiogenesis, proliferation, apoptosis inhibition, suppression of immune system and resistance to drugs . The exosomes function as promising nanovesicles that directs TME orchestration by communicating cells within TME milieu . The different components of TME particularly the soluble factors, transformed extracellular matrix, immune suppressive cells, re-programmed fibroblasts and epigenetic modifications altogether helps in TNBC progression and metastasis . Hence, TME is regarded as a good therapeutic target. The different TME targets for therapeutic intervention is schematically presented in Figure 5.
Different TME targets for therapeutic intervention.
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Screening And Early Detection
Screening and early detection for TNBC are the same as for breast cancer in general. TNBC is only diagnosed after an initial breast cancer diagnosis is made.
Screening tests for breast cancer include:
Once breast cancer is diagnosed, tests will be done to detect different characteristics of the cancer cells, including what receptors they have and whether they make certain proteins.
TNBC is more aggressive and is typically diagnosed at a later stage than other kinds of breast cancer.
Stages Of Breast Cancer
The stage of breast cancer is based on the size and location of the tumor, as well as whether the cancer has spread beyond the part of the breast in which it originated. To determine the stage of breast cancer, healthcare professionals use a scale of stage 0 to stage 4.
Stage 0 breast cancers are isolated in one part of the breast, such as a duct or lobule, and show no sign of spreading into other tissue.
Stage 1 is typically localized, although further local growth or spread may cause the cancer to move into stage 2.
In stage 3, the cancer may be larger and has affected the lymph system. Stage 4 cancer has spread beyond the breast and nearby lymph nodes, and into other organs and tissues of the body.
In addition to stages, breast cancers are given grades based on the size, shape, and activity of the cells in the tumor. A higher-grade cancer means a greater percentage of cells look and act abnormal, or they no longer resemble normal, healthy cells.
On a scale of 1 to 3, with 3 being the most serious, TNBC is often labeled grade 3.
American Cancer Society , the symptoms of TNBC can be the same as those for other types of breast cancer. ACS recommends regular screenings such as mammograms to detect breast cancer before symptoms appear, the time when treatment is most effective.
Other signs of breast cancer include:
Any of these signs can be caused by other conditions. But it is always good to have them checked out by your healthcare professional.
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History Of Radiation Therapy
A history of radiotherapy can lead to the development of secondary tumors. This is mainly dependent on the patients state and age . Patients aged < 30 years are considered at higher risk , and radiotherapy treatments, such as multiple-field IMRT and double partial arc techniques can increase the chances of secondary tumors . Radiotherapy in patients with a family history of breast cancer is considered to be at a higher risk .
Are There Any Particular Symptoms Of Triple Negative I Should Look Out For
Although triple negative is different to other types of breast cancer in many ways, the signs and symptoms are the same. Its important for all women to check their breasts regularly and discuss any unusual changes with their doctor.
For a more detailed look into triple negative breast cancer and links to our support channels, click the button below.
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When Should I Go To The Emergency Room
You might also have unusually strong side effects from your cancer treatment. While your healthcare provider likely gave you medication to help control your side effects, you should go to the emergency room if your side effects continue despite medication.
Many cancer treatments affect your immune system, increasing the chance you will develop infections. Symptoms that might require an emergency room visit during treatment are:
- Fever of 100.5 and above.
- Persistent nausea and vomiting.
What Causes Triple Negative Breast Cancer
While we know many of the factors that affect your chance of developing breast cancer overall, we still dont fully understand why some women develop triple negative rather than other types of breast cancer.
We do know that if you develop breast cancer at a young age, its more likely to be triple negative. Black women are also more likely to develop it.
If you carry a fault in the BRCA1 gene, youre also more likely to develop triple negative breast cancer in fact, most breast cancers caused by BRCA1 faults are triple negative. Because of this, if you dont have a known history of breast cancer in your family but youre diagnosed with triple negative breast cancer under the age of 50, youll be eligible for specialist genetic services to look for BRCA faults. You can read more about BRCA faults in our family history guide.
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What Is Triple
Triple-negative breast cancer is a kind of breast cancer that does not have any of the receptors that are commonly found in breast cancer.
Think of cancer cells as a house. The front door may have three kinds of locks, called receptors
- One is for the female hormone estrogen.external icon
- One is for the female hormone progesterone.external icon
- One is a protein called human epidermal growth factor .
If your cancer has any of these three locks, doctors have a few keys they can use to help destroy the cancer cells.
But if you have triple-negative breast cancer, it means those three locks arent there. So doctors have fewer keys for treatment. Fortunately, chemotherapy is still an effective option.
Think of a cancer cell as a house. To get inside to destroy the cancer, we must bypass three locks on the front door: estrogen, progesterone, and HER2.
If your cancer tests positive for these three locks, which are known as receptors, then doctors have a few keys they can use to get inside the cell to destroy it.
If you have triple-negative breast cancer, those locks aren’t there. So the keys doctors usually use won’t work. But chemotherapy is still an effective option.
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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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.
Survival Rates For Triple
Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as they are familiar with your situation.
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