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:
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.
A Lump In The Breast And Nipple Discharge Are Some Of The Warning Signs
Triple-negative breast cancer is a type of breast cancer that does not have any of the three receptors that contribute to some types of breast cancer growth. Approximately 10-20% of breast cancers are diagnosed as triple-negative breast cancer, and its more likely to occur in younger people, African Americans or Hispanics, and those with a BRCA1 gene mutation.
While treatment of triple-negative breast cancer is different than the treatments used for other types of breast cancer, the symptoms are similar.
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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
Expert Review And References
- Alluri P, Newman, L. Basal-like and triple negative breast cancers: searching for positives among many negatives. Surgical Clinics of North American. 2014.
- Badve S, Dabbs DJ, Schnitt SJ, Baehner TD, Decker T, Eusebi V, et al. Medscape Reference: Basal-like and Triple-negative Breast Cancers. 2011: .
- Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 79: 1117-1156.
- National Cancer Institute. Breast Cancer Treatment for Health Professionals . 2015.
- O’Reilly EA, et al. The fate of chemoresistance in triple negative breast cancer . BBA Clinical. 2015.
- Tomao F, Papa A, Zaccarelli E, et al. Triple-negative breast cancer: new perspectives for targeted therapies. OncoTargets and Therapy. 2015.
- Wahba HA, El-Hadaad HA. Current approaches in treatment of triple-negative breast cancer. Cancer Biology and Medicine. 2015.
- Merck Canada . Product Monograph: Keytruda. .
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What Is Triple Negative Early Breast Cancer
Triple negative breast cancer is a type of breast cancer that does not have any of the three receptors commonly found on breast cancer cells the oestrogen, progesterone and HER2 receptors. Around 15% of early breast cancers are triple negative.
Triple negative breast cancer generally responds well to chemotherapy. Five years after diagnosis, people with triple negative breast cancer are no more likely to experience a recurrence of their breast cancer than people with other types of breast cancer. In the longer term , a recurrence is less likely with triple negative breast cancer.
Oestrogen And Progesterone Receptors
Some breast cancers are stimulated by the hormone oestrogen. This means that oestrogen in the body helps the cancer to grow. This type of breast cancer is called oestrogen receptor positive .
Invasive breast cancers are tested to see if they are ER+ using tissue from a biopsy or after surgery. Tests will also be done to see if your breast cancer is progesterone receptor positive . Progesterone is another hormone.
If breast cancer doesnt have oestrogen receptors, its called oestrogen receptor negative . If it doesnt have progesterone receptors, its called progesterone receptor negative .
Find out more about hormone receptors and breast cancer.
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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.
Learn about emerging areas in drug therapies for early breast cancer.
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
- the size of the cancer and whether it has spread
- how abnormal the cells look under the microscope
- your general health
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.
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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.
What Are Symptoms Of Triple Negative Breast Cancer
TNBC symptoms are the same as other common breast cancers. And many breast cancer symptoms are similar to other less serious conditions. That means having certain symptom doesnt mean you have breast cancer. Possible breast cancer symptoms include:
- A new lump or mass.
- Swelling in all or part of a breast.
- Dimpled skin.
- Nipple retraction, when your nipple turns inward.
- Nipple or breast skin thats dry, flaking, thickened or red.
- Nipple discharge that is not breast milk.
- Swollen lymph nodes. This symptom happens when breast cancer spreads to the lymph nodes under your arm or near your collarbone.
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Chemotherapy For Early Tnbc
Early TNBC is treated with chemotherapy. People with TNBC tend to get more treatment benefit from chemotherapy than people with hormone receptor-positive breast cancers do .
Some people get chemotherapy before breast surgery. This is called neoadjuvant chemotherapy.
For people with TNBC who have cancer remaining in their breast after neoadjuvant chemotherapy, treatment with the chemotherapy drug capecitabine may lower the risk of recurrence and improve survival .
Learn more about chemotherapy.
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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Treatment Of Triple Negative Breast Cancer
Standard treatment of early stage triple negative breast cancer typically consists of surgery, chemotherapy and usually a course of radiotherapy. Often chemotherapy treatment is given prior to breast surgery as can effectively reduce the size of the breast cancer while providing useful information about the effectiveness of the treatment being given.
How Is Triple
Once a breast cancer diagnosis has been made using imaging tests and a biopsy, the cancer cells will be checked for certain proteins. If the cells do not have estrogen or progesterone receptors , and also do not make any or too much of the HER2 protein, the cancer is considered to be triple-negative breast cancer.
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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.
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.
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How Common Is Triple Negative Breast Cancer
15% of all breast cancers over 8,000 cases a year in the UK are triple negative.
Triple negative breast cancer is more common in:
- women who have inherited an altered BRCA gene
- black women
- women who have not yet reached the menopause
- women under 40
Some types of breast cancer are more likely to be triple negative than others. These include medullary and metaplastic breast cancer. However, most people with triple negative breast cancer have invasive ductal breast cancer as this is the most common type of breast cancer in general.
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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New Medications For Metastatic Breast Cancer
Immunotherapy drugs called checkpoint inhibitors have led to a significant improvement in survival rates for lung cancer and melanoma.
In 2019, Tecentriq became the first immunotherapy drug to be approved for triple-negative breast cancer that is metastatic or locally advanced but unresectable . However, in August 2021, Tecentriq’s manufacturer voluntarily withdrew that indication in the United States.
However, also in 2021, the Food and Drug Administration approved Keytruda for high-risk, early-stage, triple-negative breast cancer. It is used in combination with chemotherapy as a neoadjuvant treatment , and then continued as a single agent as adjuvant treatment .
PARP inhibitors are another class of medication 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 both treating metastases and possibly reducing 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.
What Is The Staging Of Triple
Staging is the process of determining the extent of cancer and its spread in the body. Together with the type of cancer, staging helps determine the appropriate therapy and predict the chances for survival.
To determine if cancer has spread, medical professionals may use several different imaging techniques, including X-ray, CT scans, bone scans, and PET scans. Staging depends upon the size of a tumor and the extent to which it spread to lymph nodes or distant sites and organs in the body. Examination of lymph nodes removed at surgery and the results of ER, PR, and HER2 tests performed on the tumor tissue also help determine the stage of a tumor.
- The American Cancer Society defines 4 stages of breast cancer.
- Stage I is the lowest stage, while stage IV is the highest stage and refers to tumors that have metastasized, or spread to areas distant from the breast.
Most doctors specifically adjust breast cancer treatments to the type of cancer and the staging group.
Surgery
Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer consist of breast-conserving surgery and mastectomy .
Radiation therapy
Radiation therapy destroys cancer cells with high-energy rays. Doctors commonly administer radiation therapy to patients after breast cancer surgery, most commonly after lumpectomy.
Chemotherapy
Types of chemotherapy include the following:
Other therapies for triple-negative breast cancer
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What Are The Symptoms Of Triple Negative Breast Cancer
The symptoms of triple negative breast cancer are the same as any other type of breast cancer.
Symptoms can include:· A new lump in the breast, armpit area or around the collarbone.· A change in breast size or shape.· Changes to the nipple, such as sores or crusting, an ulcer or inverted nipple.· Clear or bloody nipple discharge.· Changes to the skin including redness, puckering or dimpling .· Breast tenderness or pain
You can learn more about the symptoms of breast cancer here.
Triple Negative Breast Cancer
Triple-negative breast cancer is subtype of breast cancer that comprises about 15% of breast cancer cases. Unlike more common forms of breast cancer, TNBC is not fueled by the hormones estrogen or progesterone, nor is its growth supported by the human epidermal growth factor receptor 2 protein. Thus, the triple-negative in the name refers to tumor cells that lack and test negative for these three molecular substances.
While triple-negative breast cancer is similar to basal-like breast cancerand the terms are often used interchangeablythey are not exactly the same. Most but not all of triple-negative breast cancers are basal-like breast cancers and vice versa.
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Prevention Of Triple Negative Breast Cancer
For those who have the BRCA1 or BRCA2 gene mutation, there are important considerations for the prevention of breast cancer. Women who carry BRCA1 or BRCA2 gene mutations have an approximate 70% risk of developing breast cancer and up to 40% risk of developing ovarian cancer over their lifetimes.
There are preventative strategies for those with this genetic mutations which include protective surgery via the removal of both healthy breasts and hormonal therapy medicines such as tamoxifen or an aromatase inhibitor. Removal of the ovaries and fallopian tubes helps reduce the risk of both ovarian and breast cancer. The breast cancer benefit is due to a reduction in the levels of oestrogen in the body.
There is no definitive way to prevent breast cancer, however there are a number of risk factors that you can manage to reduce the likelihood of future breast cancer. This includes maintaining a healthy body weight, not smoking and engaging in regular exercise. You can read about breast cancer prevention and how to reduce your risk here.