Why Is It Called Triple
Triple-negative breast cancer is when the pathology test shows negative for estrogen receptors , progesterone receptors , and HER2 . These negative results mean that the growth of the cancer is not affected by the hormones estrogen and progesterone, or by the existence of too many HER2 receptors. This means that triple-negative breast cancer does not respond to hormonal therapy such as tamoxifen, or therapies that target HER2 receptors, such as Herceptin.
Triple-negative breast cancer can still be treated with other methods such as surgery, radiotherapy and chemotherapy, and there is a lot of research being carried out to find new medications that can treat this type of cancer.
Can You Advise About The Use Of Topical Oestrogens In Women With Breast Cancer
The long-term risks of using topical oestrogen creams after breast cancer are still fairly unknown. Some studies have shown that the use of topical creams after the diagnosis of breast cancer should only be initiated in cases where the patient experiences a high degree of distress, and if it needs to be prescribed then an ultralow dosed formula should be used whenever possible in the first few weeks. Patients also need to be provided with the knowledge of increased risk of recurrence is possible.
There are non-hormonal alternatives that can be prescribed . Replens MD is a cream applied 23 times a week which binds to the vaginal wall and helps rehydrate cells as well as increasing blood flow in the vagina. There is also Hyalofemme that can be applied daily.
What Are Breast Cancer Subtypes And Why Do They Matter
Your breast cancer subtype is one factor healthcare providers take into account when theyre deciding how to treat your cancer. Thats because not all cancer treatments are successful with all breast cancer subtypes.
Providers look at your cancer cells to identify subtypes. Specifically, they look for molecules on your cells surfaces. These molecules, called receptors, are built to order so only certain substances can climb on and start affecting what your cells do.
Breast cancer cells receptors are open to estrogen and progesterone. Understanding if your breast cancer cells have receptors and if theyre housing hormones helps providers determine how your breast cancer might spread and what treatment might be most effective.
The other type of breast cancer that has another receptor is called her-2 neu. This receptor makes the cells more active, but allows healthcare providers to treat the cancer with specific medicines that target her-2 proteins. If your breast cancer doesnt have her-2 neu and hormone receptors, its called triple negative.
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What Is Her2 And What Does It Mean
HER2 is a protein that helps breast cancer cells grow quickly. Breast cancer cells with higher than normal levels of HER2 are called HER2-positive. These cancers tend to grow and spread faster than breast cancers that are HER2-negative, but are much more likely to respond to treatment with drugs that target the HER2 protein.
All invasive breast cancers should be tested for HER2 either on the biopsy sample or when the tumor is removed with surgery.
Is Triple Negative Breast Cancer An Aggressive Form Of Cancer
Its true that triple negative breast cancers can grow quickly. But your prognosis or expected outcome depends on more factors than your cancer subtype. Healthcare providers will also consider your tumors size and whether it has spread to your lymph nodes and other parts of your breast. Its also helpful to know researchers are focusing on ways to slow the spread of TNBC.
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Implication For Patient Care
While being recognized as an aggressive disease, an early and accurate recognition of TN breast cancer will be beneficial for preoperative planning and outcome improvement.
Knowledge of the sonographic appearances of breast cancers and their possible variations determined by the tumor biology is important for the ultrasound radiologist to minimize misdiagnosis.
Benign-like breast masses with an oval shape and without angular or spiculated margin in young patients require additional attention during ultrasound examinations, particularly by less experienced doctors.
Tnbc Chemotherapy Drugs And Efficacy Evaluation
Compared to other types of breast cancer, TNBC has limited treatment options, is prone to recurrence and metastasis, and has a poor prognosis. The main reason is that the expression of ER, PR, and HER2 are all negative, making specific endocrine therapies and targeted therapies ineffective. Therefore, chemotherapy has become the main approach for the treatment of TNBC. In recent years, a large body of literature has shown that the use of neoadjuvant chemotherapy regimens in the treatment of TNBC has a significantly higher pathological remission rate than for hormone receptor-positive breast cancer and can significantly improve the prognosis of TNBC patients. The national comprehensive cancer network guidelines recommend using combination regimens based on taxane, anthracycline, cyclophosphamide, cisplatin, and fluorouracil. At present, taxel/docetaxel + adriamycin + cyclophosphamide , docetaxel + cyclophosphamide , adriamycin + cyclophosphamide , cyclophosphamide + methotrexate + fluorouracil , cyclophosphamide + adriamycin + fluorouracil , and cyclophosphamide + epirubicin + fluorouracil + paclitaxel/docetaxel are the preferred adjuvant regimens for TNBC. Therefore, the selection of appropriate chemotherapy drugs and the optimization of chemotherapy regimens are important for ensuring good treatment outcome and prognosis of TNBC patients.
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Asco: Pembrolizumab Plus Chemotherapy For Advanced Triple
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The Immune Milieu As A Prognostic And Predictive Factor For Tnbc
Gene expression profiling has allowed significant progress in our ability to assess prognosis and predict response to therapy in breast cancer. First-generation prognostic signatures, which rely markedly on proliferation-related genes, allow reliable stratification of ER-positive breast cancer, however these have a limited utility in TNBC, mainly due to the high proliferative nature of most ER-negative cancers, and, therefore, the lack of discriminatory power of first-generation prognostic signatures in triple-negative disease. Activation of immune response genes was shown, however, to be a good prognostic factor in ER-negative cancers., Second-generation signatures based on immune response-related genes have been developed , although these signatures allow for the stratification of TNBC patients according to overall and relapse-free survival, their clinical utility remains negligible owing to the high number of events in this population, even in patients with favorable signatures.
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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.
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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What Do The Test Results Mean
The results of HER2 testing will guide you and your cancer care team in making the best treatment decisions.
It is not clear if one test is more accurate than the other, but FISH is more expensive and takes longer to get the results. Often the IHC test is done first.
- If the IHC result is 0 or 1+, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
- If the IHC result is 2+, the HER2 status of the tumor is not clear and is called “equivocal.” This means that the HER2 status needs to be tested with FISH to clarify the result.
Triple-negative breast tumors dont have too much HER2 and also dont have estrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers. See Triple-negative Breast Cancer to learn more.
Triple-positive breast tumorsare HER2-, ER-, and PR-positive. These cancers are treated with hormone drugs as well as drugs that target HER2.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Last Revised: November 8, 2021
How Life Expectancy And Relapse Differ From Positive Tumors
Questions about the survival rate and recurrence rate are very common when someone is diagnosed with triple-negative breast cancer . While prognosis is, on average, poorer than with hormone receptor or human epidermal growth factor receptor 2 positive tumors, triple-negative breast cancer is a very heterogeneous disease. On a positive note, and unlike hormone-positive tumors that commonly recur late , late recurrence is less common with triple-negative tumors. The recent approval of immunotherapy only for triple-negative disease is also optimistic.
We will look at factors that may affect survival or recurrence as well as the statistical rates of both. We will also look at life expectancy with stage 4 triple-negative breast cancers and recent case reports of a few long-time survivors.
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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.
Special Histologic Subtypes Of Tnbc
Metaplastic breast carcinoma is a rare entity, comprising less than 1% of all breast carcinomas. It is most often triple negative on immunophenotyping, and genomic profiling places them with the basal-like breast carcinomas. This type of tumor is histologically heterogeneous and can be entirely epithelial in nature or mixed epithelial and mesenchymal. These tumors can be purely metaplastic in composition or can be admixed with other types of invasive carcinoma. Components seen in these tumors that are not typically seen in other breast carcinomas include squamous differentiation, a spindle cell component, and chondroid , osseous, and rhabdomyoid elements. These carcinomas often express EGFR and have a poor prognosis. In patients with lymph node metastasis who underwent adjuvant chemotherapy, the 3-year disease-free survival rate was 44.4% in metaplastic breast carcinomas and 72.5% in triple-negative invasive ductal carcinomas.
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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.
The Survival Outcomes Of T1an0m0 Triple
- 1Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
- 2Department of Burn and Plastic Surgery, Affiliated Longyan First Hospital, Fujian Medical University, Longyan, China
- 3Department of Gynecology and Obstetrics, Fujian Provincial Maternity and Children Health Hospital, Fuzhou, China
Purpose: Triple-negative breast cancer is a subtype with distinct heterogeneity, high invasiveness, and poorer prognosis. There is a controversy about adjuvant chemotherapy at the T1aN0M0 stage. This study was carried out to assess the survival benefit of ACT for these patients.
Methods: We identified 1,099 patients with T1aN0M0 TNBC who were diagnosed between 2010 and 2016 from the Surveillance, Epidemiology, and End Results database. Univariate and multivariable analyses were conducted to determine factors related to survival. One-to-one propensity score matching was applied to construct a matched sample consisting of pairs of ACT and non-ACT subjects. Breast cancerspecific survival and overall survival of the two groups were evaluated by KaplanMeier plots and Cox proportional hazard regression models. Stratified analysis according to different variables was also performed.
The study results indicate that there is no strong association between ACT and better survival in T1aN0M0 TNBC. It implies that the chemotherapy decision should be made cautiously and further research into therapeutic strategies are needed in T1aN0M0 TNBC patients.
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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 .
Tnbcs: The Importance Of Histologic Subtyping
The large majority of TNBCs are high-grade invasive carcinomas of no special type displaying pushing invasive borders, central necrosis, brisk lymphocytic infiltrates, marked nuclear pleomorphism, and numerous mitoses., Nevertheless, there is a multitude of rare histologic special types of breast cancer that are consistently of TN phenotype .
Some high-grade special histologic types of breast cancer, including carcinomas with apocrine features, carcinomas with medullary features, and metaplastic breast carcinomas almost invariably display a TN phenotype. Notably, among TNBCs, carcinomas with apocrine features are the ones most likely to express androgen receptor and display a molecular apocrine or LAR gene expression profile. Thus, their identification may suggest potential sensitivity to anti-androgen receptor agents and may trigger androgen receptor testing, but does not carry definite prognostic information as their outcome is uncertain and has been reported to be comparable to that of conventional invasive carcinomas of no special type. Likewise, contradictory data have been published regarding the prognostic impact of androgen receptor expression in TNBCs.,
Figure 4
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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.
Ethics Approval And Consent To Participate
This study was approved by the research ethics committee of the Radiology department of the Faculty of medicine Cairo University on 3/9/2014, Reference number of approval: 780-2014.
All patients included in this study gave a written informed consent to participate in the research. If the patient was less than 16 years old, or unconscious at the time of study, written informed consent was given by their parent or legal guardian.
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Understanding The Triple Negative Breast Cancer Patient: Tips And Tools For Health Care Professionals
A cancer diagnosis often brings about feelings of fear and anxiety. But when the diagnosis is triple negative breast cancer , the patient often experiences even more anxiety when she learns about the high recurrence rates and lack of targeted drug treatments available for this particular subtype of breast cancer. Helping patients understand the disease, how it is treated, and dispelling myths related to it are important factors to improve their ability to cope with their diagnosis.
Triple negative breast cancer accounts for 15% to 20% of breast cancer cases.1 TNBC is a subtype of breast cancer that lacks typical receptors: estrogen, progesterone, and HER2. Treatments such as tamoxifen and trastuzumab act as receptor blockers, which slow or stop cancer growth and prevent recurrences. However, because TNBC lacks receptors, these targeted therapies are ineffective treatments for TNBC.
Throughout the treatment process, doctors and nurses should explain the diagnosis and treatment plan to patients in simple, understandable terms. Providing written information is also helpful as many patients are overwhelmed and in shock during their initial appointments. Living Beyond Breast Cancer offers the Guide to Understanding Triple Negative Breast Cancer, which provides useful information about the disease, treatment options, and posttreatment recommendations.