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What Is Double Negative Breast Cancer

Types Of Invasive Breast Cancer

What is Triple-Negative Breast Cancer, and How is it Treated?

Most breast cancers are invasive, meaning the cancer has spread from the original site to other areas, like nearby breast tissue, lymph nodes or elsewhere in the body. Invasive breast cancer cells break through normal breast tissue barriers and spread to other parts of the body through the bloodstream and lymph nodes. The two most common types of invasive breast cancer are invasive ductal carcinoma and invasive lobular carcinoma.

Invasive ductal carcinoma

The most common type of breast canceraccounting for roughly 70 to 80 percent of all casesis called invasive ductal carcinoma . IDC is a cancer that starts in a milk duct and grows into other parts of the breast. With time, it may spread further, or metastasize, to other parts of the body.

Invasive lobular carcinoma

Invasive lobular carcinoma is the second most common type, accounting for roughly 5 to 10 percent of all breast cancers. ILC starts in lobules and then spreads into nearby breast tissue. Like IDC, it may metastasize. However, this cancer is harder to detect on mammograms and other exams than IDC. One in five women with ILC have both breasts affected.

Inflammatory breast cancer

Pagets disease of the breast

Angiosarcoma of the breast

Phyllodes tumors

Other, even more rare, types of invasive breast cancer include adenoid cystic carcinoma, low-grade adenosquamous carcinoma, medullary carcinoma, mucinous carcinoma, papillary carcinoma and tubular carcinoma.

What Should A Person With Stage 3 Breast Cancer Expect From Treatment

Stage 3 treatment options vary widely and may consist of mastectomy and radiation for local treatment and hormone therapy or chemotherapy for systemic treatment. Nearly every person with a Stage 3 diagnosis will do best with a combination of two or more treatments.

Chemotherapy is always given first with the goal to shrink the breast cancer to be smaller within the breast and within the lymph nodes that are affected. This is known as neoadjuvant chemotherapy.

Other possible treatments include biologic targeted therapy and immunotherapy. There may be various clinical trial options for interested patients with Stage 3 breast cancer.

How Quickly Do Breast Cancer Tumors Grow From Stage To Stage

Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.

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The Emerging Concept Of Triple Negative Breast Cancer

Breast cancers are commonly associated with a high incidence and a high mortality rate in the female population worldwide. However, at a microscopic and molecular level, breast cancer is not a homogeneous disease, thus being the focus of numerous ongoing studies. The molecular heterogeneity of the normal breast tissue has been previously documented and has outlined the different molecular profiles of epithelial and non-epithelial cells responsible for the existence of several molecular types of breast carcinomas, already characterized . Starting from the histopathological classification up to the molecular classification, breast cancer has been constantly redefined in order to ensure a better management of the patient. In 2012 Boyle et al. stated that the minimal characterization of breast cancer was a situation that had lasted for a century, until a quiet revolution has taken place so that in modern times breast cancer is characterized by its molecular and clinical heterogeneity .

Targeted Therapy In Tnbcs

Double whammy for triple negative breast cancer

Different potential therapeutic options in TNBCs are summarized in Figure . Unlike the luminal types and the HER2 overexpressing type of breast carcinomas, TNBC lacks a specific targeted therapy. However, considering TNBCs heterogeneity, it is possible that BRCA1/2 mutations, along with AR may represent potential molecular targets in TNBCs treatment . Also, Pim-2, a serin/threonine kinase strongly involved in breast cancer metastasis, may become a therapeutic target in TNBCs . HJ-PI01, a Pim-2 inhibitor, seems to induce autophagic cell death and apoptosis thus decreasing malignant proliferation in TNBC cell lines . Shindikar et al. highlighted the anticancer properties of curcumin and resveratrol in TNBCs treatment, however, difficulties regarding their in vivo availability, distribution and kinetics along with a poor solubility, limits their routine use in patients . Chemotherapeutic agents such as nab-paclitaxel seems to be beneficial in the treatment of aggressive forms of breast cancer, such as TNBCs and HER2+, as well as in elderly and taxane-pretreated women .

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Statistics Dont Account For Late Recurrences

When comparing triple-negative breast cancer to positive tumors, its important to keep in mind late recurrences. Most statistics are presented as five-year survival rate, and in this setting, triple-negative breast cancer can look more ominous. But looking at longer periods of time, say 20 years following diagnosis, this may be different.

What Is The Prognosis For Triple Negative Breast Cancer

Triple negative breast cancer can be more aggressive and difficult to treat. Also, the cancer is more likely to spread and recur. The stage of breast cancer and the grade of the tumor will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.

Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.

Material on this page courtesy of Johns Hopkins Medicine

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What Are The Chances Of Breast Cancer Recurrence After Treatment For Stage 2 Breast Cancer

In women who have breast-conserving treatment, the chance of recurrence is about 3-15% in 10 years, depending on tumor characteristics and margins. Distant recurrence in those who had mastectomy is most influenced by axillary lymph node involvement. When axillary lymph nodes are not cancerous, the recurrence rate is 6% in 5 years. When axillary lymph nodes are cancerous, the recurrence rate is 23% in 5 years with mastectomy but no radiation.

What Is Invasive Breast Cancer Versus Noninvasive Breast Cancer

What Causes Cancer? Triple Negative Breast Cancer

Noninvasive cancer means the abnormal cells are contained in the milk ducts of the breast and lack the ability to spread to surrounding tissue or elsewhere in the body. Invasive breast cancer means the cancer has grown beyond its original location into surrounding normal breast tissue and has the potential to spread to other parts of the body.

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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.

Breast Cancer And Test Results: Is A Positive Really A Negative

I recently received the following text: “Hi! My friend just came back with a double negative on her breast cancer . What does that mean?”

When a patient is faced with the shock and worry associated with breast cancer, there are many issues to face and decisions to be made. The last thing she needs is to be confused by the results of diagnostic tests. Sometimes a “positive” or “negative” test result can be confusing because it’s not always clear if it is good or bad news. Your doctor might, for example, tell you that a test result is positive, which gives you the false impression that it’s a good outcome. Similarly, when a result is negative, it sounds bad when it could in fact be good news. It’s important that you fully understand the implications of any test results, but particularly ones in which the results can be ambiguous.

There are basically two types of medical test results:

“Relative” results: These provide information about how the levels of certain substances compare to those that are considered within a healthy range by the medical community. A blood test would fall in this category.

Let’s decode some results of tests associated with breast cancer:

Positive Biopsy: Not good. This means that the biopsy of the suspicious area on a mammogram or ultrasound is a pre-cancer or cancer.

When it comes to medical test results, don’t be afraid to ask questions. Be sure you understand exactly what your test results are telling you so that you can make informed decisions.

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Clinicopathologic Characteristics Of Single Hormone Receptor

The median follow-up duration for the 6,980 patients included in this analysis was 45 months . In this study, 4,651 cases were double HR+ tumors, 1,758 were double HR- tumors, and 571 cases were single hormone-receptor positive tumors, of which 90 cases were ER-PR+ tumors and 481 were ER + PR- tumors. The clinicopathological characteristics of the four subtypes are summarized in Table . Overall, ER+/PR- tumors were found more frequently in postmenopausal women than other subtypes . Compared with ER + PR+ tumor, ER + PR- tumors were not significantly different in staging , but ER+PR- tumors exhibited higher nuclear grade , higher Ki-67 level , and higher EGFR and HER2 expression . However, compared with ER-PR- tumors, ER + PR- tumors showed lower stage , lower NG , lower Ki-67 level , lower p53 expression and lower EGFR expression , but there was no difference in HER2 overexpression .

Table 1 Clinicopathologic characteristics of patients with ER + PR+, ER + PR-, ER-PR+ and ER-PR- tumors

ER-PR+ tumors had higher NG , higher Ki-67 level , and higher expression of p53 and EGFR than ER + PR+ tumors. However, compared with ER-PR- tumors, there was no difference in stage or NG . Also, there was no difference in expression of Ki-67 , p53 , EGFR or HER2 .

How Is Triple Negative Breast Cancer Diagnosed

Double whammy for triple negative breast cancer

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:

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Survival Rates For Her2

Cancer survival statistics are typically reported using a 5-year survival rate. This is the percentage of individuals that are still living 5 years after their diagnosis.

Survival rates can vary based off of the subtype of breast cancer that you have. A publication from the reports 5-year survival rates for HER2-negative breast cancers as:

  • 92 percent for HER2-negative, HR-positive breast cancer
  • 77 percent for triple-negative breast cancer

Keep in mind that HER2 and HR status arent the only factors that can influence outlook. Other important factors at diagnosis include:

  • the stage of the cancer
  • the specific type of breast cancer
  • your age and overall health

What Is A Breast Papilloma And Is It Cancer

Also called intraductal papilloma, a breast papilloma is a small, wartlike growth in the breasts milk ducts. This benign condition may cause a clear or bloody discharge from the nipple, or you may feel a small lump behind or next to the nipple. Having one papilloma does not raise your breast cancer risk, though having several of these growths has been linked to higher risk.

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Risk Of Recurrence: Early And Late

Research has shown the HER2-positive early breast cancers are two to five times more likely to recur than HER2-negative tumors. Even very small HER2-positive tumors with negative lymph nodes have a much higher risk of recurrence relative to tumors that are HER2-negative. Treatment with Herceptin can cut this risk by half.

The pattern of breast cancer recurrence may also differ. Small tumors are also more likely to have a metastatic recurrence if they are HER2-positive.

Despite the fact that HER2-positive and estrogen receptor-negative tuors are more likely to recur early on than estrogen receptor-positive and HER2-negative cancers, late recurrences are much less common.

With estrogen receptor positive breast cancers, the cancer is more likely to recur after five years than in the first five years, and the risk of recurrence remains steady each year for at least 20 years following the diagnosis. In contrast, those who have HER2 positive tumors and reach their five-year mark are much more likely to be “in the clear” and remain recurrence free.

Can Tnbc Be Prevented

What is triple negative breast cancer?

Researchers dont know all the factors that cause triple negative breast cancer. They have identified the BRAC1 gene mutation as one potential cause for triple negative breast cancer. Unfortunately, you cant prevent BRAC1 because you inherit this gene mutation from your parents.

But there are steps that help prevent breast cancers, including TNBC:

  • Maintain a healthy weight.
  • Exercise on a regular basis.
  • Know your family medical history.
  • Monitor your breast health. Studies show 95% of women whose breast cancer was treated before it could spread were alive four years after diagnosis.
  • Talk to your healthcare provider about genetic testing for the BRCA gene if you have a family history of breast cancer, ovarian cancer, pancreatic or prostate cancer. If you have the BRCA gene, there are steps you can take to prevent breast cancer.

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Where Do These Numbers Come From

The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results Program database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:

  • Localized: There is no sign that the cancer has spread outside of the breast.
  • Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
  • Distant: The cancer has spread to distant parts of the body such as the lungs, liver, or bones.

Clinical Characteristics Epidemiology And Risk Factors

Triple-negative breast tumors have been characterized by several aggressive clinicopathologic features including onset at a younger age, higher mean tumor size, higher-grade tumors, and, in some cases, a higher rate of node positivity. A histologic study of basal-like tumors, of which all were ER/HER2negative, illustrated marked increases in mitotic count, geographic necrosis, pushing borders of invasion, and stromal lymphocytic response. The majority of triple-negative breast carcinomas are ductal in origin however, several other aggressive phenotypes appear to be overrepresented, including meta-plastic, atypical or typical medullary, and adenoid cystic.

In parallel with our understanding of the molecular basis of triple-negative breast cancer, our awareness of the epidemiology and risk factors associated with this disease process has matured, specifically related to age and race. Among approximately 500 women evaluated in the Carolina Breast Cancer Study, those with basal-like tumors were more likely to be African-American and premenopausal . These investigators observed a particularly high prevalence of basal-like tumors among premenopausal, African-American women compared to postmenopausal African-American women and nonAfrican-American women of any age . These findings are consistent with several large-scale, population-based studies indicating that triple-negative breast cancers are more likely to occur among premenopausal women of African-American descent.

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Many Women With Early

It turns out that many women with early stage breast cancer dont need chemotherapy. The recent study called the TAILORx trial found that thousands of women with a certain type of early-stage hormone-positive, HER-2 negative breast cancer did just as well with hormone therapy alone. These results will be practice-changing, said Kristen D. Whitaker, MD, a clinical cancer geneticist specializing in breast cancer at Fox Chase Cancer Center.

About 1 in 8 women in the US get invasive breast cancer. Half of these cancers are due to estrogen-sensitive tumors that test negative for the HER2 protein, a protein that promotes the growth of cancer cells.

Breast cancers that test positive for HER2 tend to be more aggressive than other types of breast cancer and are less responsive to hormone therapy alone, which is why patients with this disease are usually treated with a combination of chemotherapy and hormone therapy.

But, patients with cancers that test negative for HER2, have a lower risk of cancer recurrence, and have estrogen-positive cancer in an early stage that hasnt spread to the lymph nodes, may be able to skip chemotherapy and just take hormone therapy alone.

The TAILORx trial found that chemotherapy can be avoided in about 70 percent of women with estrogen sensitive, HER2-negative, lymph node-negative breast cancer, Whitaker said. This is exciting because we now have data to better tailor treatments.

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Definitions And Molecular Features

Breast Cancer: Signs, Symptoms, and Complications

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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