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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Preparation Of The Fish For Hibernation
All procedures involving animals were approved by the Animal Care and Use Committee of University of Isfahan . Alive adult common carps were purchased from a local fish farm in Isfahan provenance, Iran. They were placed in a 200-L plastic tank with circulating aerated water for one month. After acclimation period, the fish were randomly divided into two groups including non-hibernating and hibernating. Non-hibernating fish were kept in the same containers and conditions . The hibernation protocol was done according to previous studies,,. The fish were induced into a hibernated state by gradient cooling of water at the rate of 12 °C until 3 °C in water tanks located in a temperature-controlled cold room and maintained at this temperature during the winter. Then, we separately put the fish of each groups in a water tank containing eugenol to anesthetize them. Anesthesia of fish is characterized by the complete loss of balance, immobility, and failure to respond to strong external stimuli, such as intense touch and vibration of the tail area. The fish were anesthetized by eugenol and blood was collected from the caudal vasculature. Subsequently, plasma was isolated, separately pooled together for each group, lyophilized and stored at -80° C for further use.
What Tests And Exams Diagnose Triple
The diagnosis of triple-negative breast cancer requires a sampling of tissue from the breast, known as a breast biopsy.
- Medical professionals may perform the biopsy using imaging techniques, such as mammography or others, for guidance.
- If the biopsy shows cancer, they may perform other tests on the biopsy sample to determine the precise type of cancer.
- In particular, they commonly perform tests for expression of the estrogen receptor , progesterone receptor , and HER2 protein as a first step. If these tests are all negative, they classify cancer as triple-negative breast cancer.
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How Soon Does Triple
It is not possible to predict if or when breast cancer will recur. This is even true for triple-negative breast cancer. However, the likelihood of a recurrence is generally higher in comparison to other breast cancers. The highest risk for recurrence is in the first few years after treatment. Some research suggests the three-year period after treatment is the critical time for recurrence. Once women reach year five after treatment, the risk of cancer coming back is the same as other forms of breast cancer.
Triple-negative breast cancer survival rate seems to follow a similar pattern. The 5-year survival rate is lower for women with triple-negative breast cancer compared to other forms. This rate looks at women who had treatment at least five years ago to see how many are still alive. One study found the five-year survival rate is 77% for triple-negative breast cancer and 93% for others. However, another study found the risk of dying decreased after five years post-treatment.
Keep in mind that all of these numbers are estimates. They are general guidelines for triple-negative breast cancer life expectancy. There are many things that contribute to your individual prognosis. The cancer stage and grade are two important ones. But there are others, including your age, your overall health, and the tumors response to chemo. Your doctor is the best resource for information about your outlook. He or she can help you understand how these factors apply to you.
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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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.
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:
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What Makes Triple Negative Breast Cancer Worse Than Other Breast Cancers
Triple negative breast cancer tends to spread earlier and faster than other types of breast cancer. As TNBC is lacking the proteins that are targeted by hormonal and targeted therapies, the treatment options are more limited. Unfortunately, TNBC also has the highest likelihood of recurrence, or coming back, within the first 5 years after diagnosis. While advanced TNBC is still seen as an incurable disease, new treatment options, such as immunotherapy and PARP inhibitors, are starting to change this status quo.
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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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.
Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer consist of breast-conserving surgery and mastectomy .
Types of chemotherapy include the following:
Other therapies for triple-negative breast cancer
Reducing Your Risk Of Triple
Its difficult to reduce your risk of triple-negative breast cancer because you cant control your age or your race. However, women who test positive for the BRCA1 or BRCA2 gene mutations may want to consider preventive . It can reduce the risk of breast cancer in these women by about 97%. But it isnt an easy decision. There are many things to consider before moving forward with surgery. During genetic testing for breast cancer, you will explore the risks and benefits to help you decide if its right for you.
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What Are The Symptoms Of Triple
The symptoms of different breast cancers are the same. In other words, triple-negative breast cancers generally have the same symptoms as other breast cancers.
Breast cancer is often found on a screening mammogram. In these cases, the person often doesnt have any symptoms. In other cases, a person may feel a lump in the breast or in the lymph nodes under the arm.
When breast cancer has spread to other parts of the body, the symptoms depend on where the cancer is located. For example, cancer that has spread to the bones often causes pain.
What Are The Recurrence Rates
Although the response to chemos is appreciable, the chances of relapse of cancer in TNBC are disturbingly high. After initial treatment, some of the rogue cancerous cells escape the wrath of medications or therapies, travel down through the lymphatic system, and then there are chances of recurrence. There exist shreds of evidence that TNBC has a worse clinical outcome and a unique pattern of recurrence than other forms of breast cancers. After diagnosis, TNBC patients experience the highest chance of relapse of cancer within the first five years however, if the patient is cancer-free for that duration, the chances of cancer relapse lower down significantly.
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Basal Cell Breast Cancer
Basal cell breast cancer is a type of breast cancer with a clear pattern of changes in proteins in the cells.
Cancer doctors recognise basal cell breast cancer when they examine the cancer cells under a microscope. It is often linked with triple negative breast cancer.
Basal cell breast cancers are usually triple negative. And most triple negative breast cancers are basal cell cancers. They are similar types of breast cancer, but not exactly the same.
The symptoms of triple negative breast cancer are the same as for other breast cancer types.
Have There Been Any Recent Breakthroughs
In 2018, a clinical trial part-funded by Breast Cancer Now found that for women with secondary triple negative breast cancer and a BRCA gene mutation, carboplatin outperformed standard chemotherapy, giving women extra time before their disease progressed.
Scientists at our Research Unit at Kings College London have also recently identified a target for new antibody-based treatments for triple negative breast cancer. Researchers have shown that triple negative breast cancer cells make high levels of a protein called the folate receptor alpha. They found that antibody-immunotherapies which targeted this protein significantly reduced the growth of triple negative tumours in mice. The team now hope to further develop and refine these novel approaches, with the aim of advancing them into clinical trials.
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How Effective Is Immunotherapy In Treating Triple
In stage 1 to 3 triple-negative breast cancer, immunotherapy is sometimes used to shrink a tumor before surgery.
In stage 4 breast cancer, immunotherapy is often combined with chemotherapy. For some people, adding immunotherapy to chemotherapy improves outcomes. A recent clinical trial studied immunotherapy treatment in women with advanced triple-negative breast cancer. In this trial, half of the group got chemotherapy, and the other half got both chemotherapy and immunotherapy. On average, it took longer for the cancer to progress in the people who got immunotherapy.
Immunotherapys side effects are different from those of other cancer medications. The most common ones are fatigue, rash, and diarrhea.
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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Treatment Of Early Tnbc
TNBC isnt treated with hormone therapy or HER2-targeted therapy because its ER-negative and HER2-negative.
How Keytruda Works
Keytruda is a type of immunotherapy called an immune checkpoint inhibitor. Immune checkpoints are proteins in your body that help your immune system tell the difference between your own cells and foreign invaders, such as harmful bacteria. Cancer cells sometimes find ways to use these immune checkpoint proteins as a shield to avoid being identified and attacked by the immune system.
Immune checkpoint inhibitors target these immune checkpoint proteins and help the immune system recognize and attack cancer cells. PD-1 is a type of checkpoint protein found on T cells, which are immune system cells that roam throughout the body looking for signs of disease or infection. PD-L1 is another checkpoint protein found on many healthy cells in the body. When PD-1 binds to PD-L1, it stops T cells from killing a cell.
Still, some cancer cells have a lot of PD-L1 on their surface, which stops T cells from killing these cancer cells. An immune checkpoint inhibitor medicine that stops PD-1 from binding to PD-L1 allows T cells to attack the cancer cells.
Learn more about immune checkpoint inhibitors and how they work.
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How Common Is Tnbc
About 15-20 percent of all breast cancers are TNBC or basal-like tumors .
TNBC tends to occur more often in :
- Younger women
- People with an BRCA1 inherited gene mutation
- Black, non-Hispanic Black and African American women
TNBC may also be more common among Hispanic women compared to non-Hispanic white women .
What Are The Similarities
The symptoms of TNBC mimic the symptoms of other Breast cancers including, lumps in the breast, pain or redness in that area, nipple discharge, skin discoloration, and others. However, what differs is the treatment approaches used to combat TNBC. Triple-negative breast cancers fall into the category of hard-to-treat cancers. Since there is no relation between receptors/ hormones and TNBC, hormone therapy here is rendered pretty much futile. They, however, can be treated with surgery, radiation therapy, and chemotherapy, or a combination of these. Chemotherapies are the standard of care for Triple-negative breast cancer. These are given as neoadjuvant or adjuvant as both first as well as the second-line of treatment.
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