Solving A Breast Cancer Mystery Why Do Double
- 5 minute read
Dr Jason Carroll working in his lab
When a doctor suspects a woman might have breast cancer, one of the first things they do is take a small sample of cells from her breast, , for tests.
The cells in this tiny tissue sample carry answers to crucial questions about what happens next. First and foremost is it cancer or not? If it is cancer, has it started spreading? And how aggressive it is likely to be?
The levels of different molecules within these cells also yield information about cancers nature and in breast cancer, one of the most crucial for helping guide treatment is the oestrogen receptor .
Women with high levels of this molecule in their cancer cells benefit from hormone therapy drugs that either lower their oestrogen levels, or prevent cancer cells responding to the hormone. About 7 out of ten women have ER-positive breast cancer.
But theres a second molecule the progesterone receptor levels of which inside breast cancer cells also seem to be important. Doctors have known for a long time that women with high levels of both the oestrogen and progesterone receptors have the best chance of surviving they respond better to treatment, and their cancer is less likely to spread.
But these double-positive women are given the same hormone therapy as those who have no progesterone receptor in their breast cancer, so doctors dont always routinely test for this second molecule any more.
Is Inoperable Breast Cancer Still Treatable
Although stage 3C breast cancer is defined as either operable or inoperable, an inoperable diagnosis doesnt necessarily mean that it cant be treated.
The term inoperable may mean that all the cancer in the breast and surrounding tissue cant be removed through simple surgery. When breast cancer is removed, a rim of healthy tissue around the tumor, called a margin, is also removed.
For breast cancer to be successfully removed, there needs to be healthy tissue in all margins of the breast, from your clavicle down to a few inches below the breast mound.
It is possible for inoperable breast cancer to become operable following a treatment to shrink the cancer.
The Tnm System For Staging Breast Cancer
The AJCCs addition of the letters T, N, and M for anatomic breast cancer staging adds more information to a breast cancer diagnosis. Heres what they mean:
- T : The tumor grade shows a higher number for a larger size or density.
- N : Nodes refers to lymph nodes and uses the numerals 0 to 3 to give information about how many lymph nodes are involved in the cancer.
- M : This refers to how the cancer has spread beyond the breast and lymph nodes.
The AJCC also added clarifications in staging for ER, PR, and HER2 expression and also genetic information.
Ultimately, this means someone diagnosed with stage 3 breast cancer can receive more information from their breast cancer staging than ever before.
No matter the stage, the best source of information about your individual outlook is your own oncology team.
Getting the right treatment and the support you need can help you navigate the challenges of being diagnosed with stage 3 breast cancer.
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Changing The Way Breast Cancer Is Treated
Dr Carrolls research is a big step forward in understanding the role of progesterone receptor in breast cancer. Until now, its presence was simply considered an indication of how good a womans chances of surviving were.
But Dr Carrolls study findings reveal that the receptor itself is the direct reason why these women have a better outlook.
Understanding the progesterone receptors role as a molecular handbrake on oestrogen-fuelled growth could also explain the observation that breast cancers frequently evolve to get rid of their progesterone receptors this is an advantage to cancer, helping it grow quicker.
This new research offers a unique opportunity to exploit the braking action of the receptor with hormone therapy to improve breast cancer outcomes. According to Dr Carroll, this is precisely what needs to be done, and the next steps are obvious.
The results are pretty clear and potentially have direct benefits for many women with breast cancer, he told us.
Were already discussing a clinical trial to test whether giving women with ER/PR double-positive breast cancer progesterone, alongside oestrogen-blocking drugs, helps more women survive this disease.
If proven successful, they suggest that it could benefit up to half of women diagnosed with the disease.
The pioneering technology we used in this study could be used as a simple way to see if adding progesterone to oestrogen blocking drugs further slows tumour growth, Tilley predicts.
Understanding Her2+ Status And Survival
Doctors use three markers to help define breast cancers and guide treatment. One of those is the HER2 protein. The other two are hormone receptors . When a cancer has none of these, doctors call it triple negative. Until recently, there wasnt much information about how these markers changed survival rates for breast cancer.
A recent study looked at the National Cancer Institute data to see if there were differences in survival for women based on these markers. The study shows there are. Overall, women who have HR+ and HER2- breast cancer do best. But in the later stages, those who have the HER2+ type have better survival rates than those with HER2-. Breast cancers that are triple negative have the lowest survival rates. The 4-year survival rates are as follows:
- HR+/HER2-: 92.5%
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Faith In The El Camino Health Cancer Care Team
Through it all, Carol drew strength from knowing she had an entire team in her corner fighting her cancer. In fact, she says she can’t begin to describe how much she has grown to love everyone at the El Camino Health Cancer Center.
“The whole team is amazing,” she says. “Dr. Dormady and nurse practitioner Katie are the best! They put up with my questions and quirks with the best humor and love. They understood my desire to be treated but not overtreated.”
“The nurses are like family. I have to give a shoutout to my nurse Hannah. We shared our lives together every week for a whole year. That was the biggest blessing ever. I still drop by with treats when Im in the area as an excuse to say hi.”
How Long Does It Take For Stage 1 Breast Cancer To Develop Into Stage 2
It is not possible to determine exactly how long it will take for newly diagnosed breast cancer to progress from stage 1 to stage 2. It can happen within months if it is an aggressive high-grade tumor, or it can take longer. It’s important to know that stage 1 breast cancer could have already been present for a while before being detected, so it may progress quickly.
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How Do The Er And Pr Receptors Work
Only certain types of cells that respond to hormones make these receptors for example breast, ovary and womb cells.
Both receptors are directly involved in switching genes on and off theyre called transcription factors.
When oestrogen and progesterone are present, these hormones physically stick to their respective receptor, causing them to move into the nucleus of the cell, where DNA is housed. They can then attach to specific regions of our DNA and turn genes on or off, changing the cells behaviour.
When breast cancer develops, the tumour cells become overly sensitive to oestrogen. When oestrogen activates the oestrogen receptor, it turns on a panel of genes that tell the cells to keep dividing, driving tumour growth:
But what happens when breast cancer cells have a working progesterone receptor too? Dr Carroll and his team set out to find out.
Her2 Breast Cancer Treatment
Targeted therapy is the hallmark of treatment for HER2-positive cancer. The drug used most often is trastuzumab . Trastuzumab interferes with HER2 production and slows or prevents the cancer cells from growing. It is often administered with the chemotherapy agent emtansine in a combined drug called T-DM1.
Another medication, pertuzumab , is sometimes prescribed with trastuzumab when the cancer has spread to other parts of the body or metastasized. Oncologists also may prescribe an aromatase inhibitor, such as lapatinib or neratinib to lower estrogen levels.
If the cancer is also HR-positive, oncologists often prescribe endocrine therapy after the completion of targeted therapy. Endocrine or hormone therapy helps prevent cancer from returning by suppressing estrogen production. Tamoxifen is a common form of endocrine therapy used primarily in premenopausal women. It belongs to a class of drugs called selective estrogen receptor modulators .
Postmenopausal women have the option instead of taking an aromatase inhibitor , such as anastrozole , exemestane , or letrozole to block estrogen production. Postmenopausal women who have completed a tamoxifen regimen may be encouraged to follow up with an AI for added benefit.
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What Is Triple Negative Breast Cancer
It might sound surprising, but in a sense, breast cancer isnt really one disease, Erica Mayer, M.D., M.P.H., senior physician at the Susan F. Smith Breast Oncology Center at Dana Farber Cancer Institute in Boston, tells SELF. Subtypes of the condition, like triple negative breast cancer, have characteristics that differentiate them from other forms of the disease.
To fully understand triple negative breast cancerand what makes it different from other breast cancersyou need to know a bit about breast cancer receptors.
Receptors are proteins that are located on the outside of a cancer cell, and they receive signals from the body that may influence the growth pattern of the cancer cell, Dr. Mayer says. The receptors that help to determine a breast cancer diagnosis are estrogen receptors , progesterone receptors , and HER2 protein receptors. Doctors separate breast cancer into a few main categories based on the presence or absence of these receptors.
Doctors test tumors for all three of these receptors when people undergo breast biopsies, according to the Mayo Clinic. When tests for all three receptors come back negative, doctors diagnose triple negative breast cancer, which makes up around 12 percent of all breast cancers, according to the ACS.
What Is The Life Expectancy For Stage 3 Breast Cancer
The life expectancy for people with breast cancer is improving, according to the American Cancer Society. It points out that current survival rates are based on people who were diagnosed and treated at least 5 years ago and treatments have advanced over that time.
Your life expectancy with stage 3 breast cancer depends on several factors, such as:
- your age
- the size of the tumors
You should talk with your doctor about how these factors may apply to you.
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Study: New Genes Linked With Triple Negative Breast Cancer
A research study identified new genes that may be associated with a higher risk for triple negative breast cancer.
This image is an example of the kind of gel pictures researchers use to understand the order, or sequence, of genes or to look for mutations in genes.
This image is an example of the kind of gel pictures researchers use to understand the order, or sequence, of genes or to look for mutations in genes.
Out of 100 people with breast cancer about 15 will have triple-negative breast cancer . Its one of the most challenging types of breast cancer to treat due to several things:
- TNBC tends to be more aggressive than other common types of breast cancer.
- Women usually dont learn they have it until the cancer has already spread to other parts of the body .
- Treatment options remain limited.Hormone therapies and targeted therapies that help treat people with some types of breast cancer, typically dont work for a woman with TNBC. Doctors use chemotherapy to treat these patients, but it isnt very effective and may have side effects.
If doctors had a way to identify women at risk for TNBC, they might be able to find cancer earlier and before it spreads when it might be easier to treat. And, if doctors had a way to personalize treatment for women with TNBC, they might be able to improve a womans outlook . One approach researchers are using to identify women at risk for TNBC and possible treatment options for TNBC is by studying inherited changes in cancer genes.
How Does Staging Relate To Types Of Breast Cancer
In addition to cancer stage, doctors will determine the tumor grade and subtype.
Tumors are graded on a scale of 1 to 3, based on how abnormal the cells appear compared to normal cells. The higher the grade, the more aggressive the cancer, meaning that it tends to be growing quickly.
The subtype is important because treatment and outlook will vary depending on which subtype of breast cancer that you have. Subtypes include:
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Determining Next Steps After Testing Positive
People who test positive for an inherited BRCA mutation may decide to take steps to reduce the chance that theyll develop another breast cancer, often by undergoing a bilateral mastectomy. Some women may choose to have additional screening rather than a mastectomy. Although screening does not prevent the development of cancer, it aims to detect it earlier. Women with BRCA mutations are also at increased risk of ovarian cancer and are recommended to undergo the removal of the ovaries and fallopian tubes once they are done having children or by age 35-40.
Treating Aggressive Breast Cancers
Women diagnosed with breast cancer undergo testing to determine the form of the disease and whats driving its growth. This information is key to developing an individualized treatment strategy. Choice of treatment also depends on how extensive the cancer is within the breast, whether it has metastasized, and whether the patient is menopausal.
When either HER2-positive or triple-negative breast cancer is diagnosed early, surgery is often performed to remove the tumor and its surrounding tissue or the entire breast . Nearby lymph nodes sometimes are removed as well.
Neoadjuvant therapy, a treatment given as a first step before the primary treatment, is standard for both HER2-positive and triple-negative breast cancers if the tumor can be surgically removed. Chemotherapy is often used as a neoadjuvant therapy before surgery to shrink the tumor. The goal is to reduce the area that needs to be removed so the surgery can be less extensive, possibly avoiding a mastectomy. For HER2-positive cancer, chemotherapy may be combined with targeted therapy, medication that acts on the specific cause of the cancer.
After neoadjuvant therapy and surgery, the treatment strategies for HER2 and triple-negative breast cancers differ.
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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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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.