Diagnosing Triple Negative Breast Cancer
In many women the cancer is found during breast screening. But symptoms such as a breast lump can be a sign of breast cancer. So it is important to get any symptoms checked by your doctor.
If you have symptoms and see your GP they refer you to a specialist breast clinic. At the breast clinic the doctor or breast care nurse takes your medical history and examines your breasts. They also feel for any swollen lymph nodes under your arms and at the base of your neck.
You have some of the following tests:
- a mammogram
- an ultrasound
- a biopsy your doctor or nurse take a small sample of cells or tissue from your breast to look at under a microscope
Depending on your age and whether other family members have had breast cancer, your doctor might refer you for gene testing. This is to find out if there is a fault in the BRCA cancer gene.
Finding The New Normal As A Triple
Two years ago, Brianna Hinojosa-Flores was a 41-year-old mother of two who had just been diagnosed with a cancer thats tough to beat triple-negative breast cancer. Today shes back at work as an attorney, serves on her local City Council, enjoys time with her family, and shares her experience with other women who have been diagnosed with triple-negative breast cancer at an early age.Triple-negative breast cancer is an aggressive type of cancer that does not respond to targeted drug therapies such as Tamoxifen, raloxifene , or Herceptin. It is associated with the BRCA gene and can affect women of any ethnicity, though it is more common in African-Americans. Women diagnosed with triple-negative breast cancer have a poorer short-term prognosis than those diagnosed with other breast cancer types.
Ethics Approval And Patients
This was an observational, retrospective study. Our procedures respected ethical standards in accordance with the Declaration of Helsinki and were reviewed and approved by a Human Research Ethics Committee at our institution . Patients were treated between 1997 and September 2017 at the Cancer Center Nuestra Señora de La Esperanza in the Pontificia Universidad Catolica de Chile and the Red de Salud UC CHRISTUS. Only patients with advanced metastatic ER-positive disease were included in the study. They were further categorized as either: being diagnosed with metastatic disease at diagnosis or being diagnosed with early disease but whom later developed a systemic or unresectable disease . Clinical data analyzed included: Age, clinical presentation, recurrence status, calendar year at diagnosis and overall survival , defined as the time period between the diagnosis of ABC and the time of patient death by any cause.
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Regional Recurrence Within Three Years Carries A Less Favorable Prognosis But Overall Survival Statistics Are Still Good
Generally speaking, if the breast cancer returns regionally lymph nodes) within the first five years following original treatment, the overall likelihood of survival is thought to be somewhat poorer.
Five-year overall survival after an isolated chest wall recurrence is 68% and after intra-breast recurrence it is 81%.
In one 2010 medical research study, the ten year overall survival rate was estimated at 84% for women without recurrence. However, this figure goes down to 49% for women with a locoregional recurrence and 72% for women with a second primary tumour.
A large 2015 study examined the impact of the time of the disease free interval on survival rates. For women with a locoregional recurrence that happened in the first 18 months, the ten year overall survival rate is around 30%. The overall 10 year survival rate for those whose recurrence happened within 3 years goes up to 50%. Furthermore, for those who suffered a recurrence after 3 years the ten year overall survival rate increases to 70%.
This recent study clearly demonstrates that the longer the time span since the primary prognosis and treatment to the recurrence, the better the long-term prognosis.
| 33 | 30 |
The rate of distance breast cancer metastasis and overall survival is most favorable for women in which the recurrence occurred locally and after five years.
However, women with a same-breast recurrence within five years have a distant metastasis rate of about 61%, which are slightly poorer odds.
What Does Triple Negative Mean In Terms Of Breast Cancer
Normal breast cells have receptors that respond to hormones such as estrogen and progesterone, which allows them to grow and regress in response to the hormone level. Hormone receptors may or may not be present in breast cancer. About two-thirds of breast cancers are positive and contain these receptors like normal breast cells do. These are less aggressive cancers that are less likely to need chemo and are often treated with hormone therapy and surgery. Radiation may or may not be needed.
HER2/neu , is a protein molecule that has a role in cell proliferation in normal cells. In some breast cancers, this protein is overly produced or positive. For HER2-positive tumors, there a specific medication that targets this protein.
Triple-negative breast cancers are not positive for estrogen receptors, progesterone receptors or HER2 protein. Since these targets are absent in triple-negative breast cancer, chemotherapy is needed, Sun says. Triple-negative breast cancer is often very sensitive to chemotherapy, which, despite the side effects, is an effective treatment that can save lives. Because this is an aggressive cancer, treatment is aggressive also. But there are several ways we can address it.
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Prognosis And Survival Rates
Treatment may make triple-negative breast cancer go away. It depends on the size of your tumor, how quickly your cancer grows, and whether the cancer has spread to the lymph nodes or other parts of your body. The treatments may cause side effects like nausea, vomiting, pain, fatigue, or mental fuzziness .
Itâs hard to say exactly what the odds are because cancer affects everyone differently. Plus, how well you do depends on how early you catch the cancer and how well you responded to treatment.
In general, about 91% of all women with triple-negative breast cancer are still alive 5 years after diagnosis. If the cancer has spread to the lymph nodes near the breast the 5 year relative survival rate is about 65%. If the cancer has spread to distant places, the 5 year relative survival rate is 12%.
Variable And Outcome Definitions
The database was used to gather information regarding patient demographics , cancer stage , tumour characteristics , type of therapy , dosing and administration details of chemotherapy, and pathologic and clinical outcomes. Clinical outcomes included local recurrence, distant recurrence, breast cancer-related death, non-breast cancer-related death, and death from unspecified cause. These clinical end points were translated to the outcomes of interest on the basis of the STEEP criteria. Recurrence-free interval was measured from the date of diagnosis of primary cancer to the date of first invasive ipsilateral breast tumour recurrence, local or regional invasive recurrence, distant recurrence, or death documented because of breast cancer. Recurrence-free survival was measured from the date of diagnosis of primary cancer to the date of the first invasive ipsilateral breast tumour recurrence, local or regional invasive recurrence, distant recurrence, or death from any cause. Distant relapse-free survival was measured from the date of diagnosis of primary cancer to the date of first distant recurrence or death from any cause . Patients were censored at the date of their last follow-up for those who did not have an event.
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The Same But Different
The story of progress in beating breast cancer is a testament to decades of painstaking work by researchers around the world. Nearly eight in 10 women diagnosed today will still be going strong ten years later, compared to around half that number back in the 1970s.
But this broadly positive picture of breast cancer hides a complex biological tapestry: not all breast cancers are equal.
For starters, around three quarters of all breast tumours are whats called ER positive, meaning they carry oestrogen receptors and so respond to the female sex hormone oestrogen. About two thirds of these are also PR positive, bearing receptors for another female hormone called progesterone. These types of cancers usually respond well to hormone-blocking treatments, such as tamoxifen, and there is a very good chance of surviving for a decade or more.
Then there are the HER2 positive bunch around one in five breast cancers. These carry multiple copies of a molecule called HER2, and tend to grow more aggressively. But they can be targeted by the drug Herceptin , which has helped to boost survival.
By a process of elimination, triple negative cancers are those that are left ER negative, PR negative and HER2 negative, and these make up roughly 15 per cent of all breast cancers somewhere in the region of 7,500 cases every year in the UK. Younger women under 40 are more likely to have this type, as are black women, and the cancers tend to grow and spread aggressively.
T1a Tnbc Had Worse Prognosis Than T1a And T1b Her2+/hor Cancer
Both univariate and multivariate analyses proved worse BCSS and OS of T1a TNBC tumors than T1a HER2+/HoR tumors , whereas T1b TNBC patients revealed no survival difference compared with T1b HER2+/HoR tumors in terms of BCSS or OS . For T1c tumor, T1c TNBC had poorer survival than T1c HER2+/HoR .
Figure 2Table 3
Since T1a TNBC had worse prognosis than T1a HER2+/HoR and showed a trend with poorer survival than T1b TNBC, it raised the concern that whether T1a TNBC had the worst prognosis among small tumors of TNBC and HER2-rich subtypes. To prove this hypothesis, further comparison was performed between T1a TNBC and T1b HER2+/HoR. BCSS of T1a TNBC was significantly worse than that of T1b HER2+/HoR in both univariate and multivariate analyses. Multivariate analyses for OS also drew the similar conclusion that T1a TNBC associated with increasing mortality . Both BCSS and OS data supported the notion that T1a TNBC without chemotherapy has the worst prognosis among all the small tumor of TNBC and HER2-rich subtypes.
Figure 3Table 4vs.
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Treatment For Triple Negative Early Breast Cancer
Treatment for triple negative early breast cancer may involve:
- Immunotherapy provided through a clinical trial.
As triple negative breast cancer is usually very responsive to chemotherapy, your medical oncologist will most likely develop a chemotherapy treatment plan for you. This will take into account your own individual needs and preferences.
Chemotherapy for triple negative breast cancer is often given before surgery. This is called neoadjuvant chemotherapy. There are a number of benefits in having chemotherapy before surgery.
- You can see if the chemotherapy is working .
- You may be able to have breast conserving surgery instead of mastectomy if the tumour shrinks enough.
- It gives you time to have genetic testing done to determine if you have an inherited gene mutation if the test comes back positive it may affect your decision around what type of surgery to have.
Treatment for triple negative breast cancer may also include radiotherapy after surgery, especially if you have breast conserving surgery.
You may be offered immunotherapy treatment through a clinical trial, although there are strict eligibility criteria. You can talk to your medical oncologist about any clinical trials that may be suitable for you.
Frequency And Characterisation Of Late Events
Figure 2 illustrates the cumulative probabilities of remaining free from event for RFI, RFS, and DRFS. The 10-year RFI was 97%, RFS 91%, and DRFS 92%. The 15-year RFI was 95%, RFS 83%, and DRFS 84%. Of the 873 patients, 22 had late recurrences. Sixteen of the recurrences were distant. Sites of distant metastases included the lungs/pleura , distant lymph nodes , bones , liver , central nervous system , pancreas , and distant skin . Six patients initially presented with local recurrence only, with 5 presenting with ipsilateral breast masses and the other with regional lymph node recurrence. Of the 22 patients who had recurrences, 16 died, with a median time to death after recurrence of 1.2 years . There were 57 deaths: 28.1% were attributed to breast cancer, 63.2% to other, and 8.8% to unknown causes in the absence of documented recurrence. Supplementary Tables 13 show comparison of patient, tumour, and treatment characteristics between patients who had an event and those who did not for each of the three end points in this study.
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T1a Tnbc Had Comparable Survival With T1b Tnbc And T1a/t1b Tnbc Had Better Survival Than T1c Tnbc
There was no survival difference between T1a and T1b TNBC in terms of BCSS and OS . However, Kaplan-Meier curves showed a trend of worse prognosis of T1a TNBC than T1b TNBC, which was contradictory to the common sense that large tumor usually had poor prognosis .
Figure 1Table 2
T1c tumors was strongly associated with poor BCSS and OS , compared with T1b tumors .
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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Intake Of Processed Food/diet
According to the WHO, processed foods, such as meat, are confirmed group-1 carcinogen for gastrointestinal cancer and breast malignancy . The excessive use of saturated fats is also considered a carcinogen. The obesity-causing ultra-processed diet plans that are enriched in elements such as sugar, sodium, and fats are thought to be carcinogenic and increase the risk by 11% . Diets that are rich in green vegetables, fresh fruits, protein-enriched grains, and legumes are anti-carcinogenic and therefore reduce the risk of breast cancer . Similarly, diets rich in phyto-estrogen, folate elements, saturated fibers, n-3 PUFA, and vitamin D are regarded as anti-cancer agents . Hence, a low dose consumption of saturated fat and n-6 PUFA has been proposed . The antioxidants found in green tea have also shown anti-carcinogenic properties . Curcuminoids and sulforaphane derived from turmeric are thought to be anti-carcinogens .
What Is The Survival Rate By Stage For Triple Negative Breast Cancer
Survival rates are a way to discuss the prognosis and outlook of a cancer diagnosis. The number most frequently mentioned is 5-year survival. Many patients live much longer, and some die earlier from causes other than breast cancer. With constant change and improvement in therapies, these numbers also change. Current 5-year survival statistics are based on patients who were diagnosed at least 5 years ago and may have received different therapies than are available today.
Below are the statistics from the National Cancer Institute’s SEER database for the survival of all patients with breast cancer, by tumor stage:
| Stage | |
|---|---|
| IV | 22% |
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Signs And Symptoms To Know
The signs and symptoms of triple-negative breast cancer are the same as with all breast cancers. It may present as a lump, which is more commonly hard, painless and irregular, but can also be soft, round and painful. Other signs include:
- Breast swelling
- A nipple that turns inward
- Skin changes on the breast or nipple, including redness, dryness, thickening or flaking
Triple Negative Breast Cancer Survival Statistics
Triple Negative Breast Cancer or TNBC is a diagnosis of a type of breast cancer that does not have one of the three most common identifiers. It means that it is negative for the three most common receptors that are typically identified during the testing process to determine which type of treatment is best to fight the cancer. A diagnosis of TNBC means that HER 2 gene is not present, estrogen and progesterone receptors are also not present in the tumor. While it sounds quite awful because of the triple negative factor and it can be a little different to treat it can actually be more responsive in the early stages to chemotherapy than other types of cancers.
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The Stages Of Breast Cancer And Your Treatment Options
Compared to most other cancers, staging breast cancer is more complex. And when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.
At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.
Below we dive into the treatment options your care team might recommend at various breast cancer stages.
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