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
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.
What Is Her2 Negative Breast Cancer
HER2, or human epidermal growth factor receptor 2, is a protein that the human body develops to help regulate reproduction of the cells. Sometimes the gene responsible for developing this protein will over-replicate itself, which can result in overproduction of HER2. In HER2-positive breast cancer, there is an overexpression of the HER2 protein. In HER-negative breast cancer, this is not the case.
About 80 percent of women with advanced breast cancer have HER2-negative breast cancer, according to ASCO. However, while targeted therapies have begun to emerge for HER2-positve breast cancer, development of targeted therapies for HER2-negative breast cancer has lagged.
Image courtesy of Roche.
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Survival Rates For Triple
Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
Should I Consider Participating In A Clinical Trial
Breast cancer treatment has improved tremendously. The reason for this progress is because patients have been willing to take part in tests of newer treatment options.
For any stage of breast cancer, a well done clinical trial could be your best treatment option, Dr. Abraham says. If you qualify for such a trial, your doctor can answer any questions you may have about participating so that you can determine if its a good fit for you.
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What Is Inflammatory Breast Cancer
As its name suggests, inflammatory breast cancer often causes the breast to become red, swollen, and inflamed. Some women with IBC also notice thickened or discolored breast skin with tiny dimples, puckers, or ridges that make it look like an orange peel. While the symptoms may sound like an infection, the real culprit is cancer that is blocking lymphatic vessels in the skin and breast tissue, causing a buildup of fluid and, in some cases, pain, discoloration, and sudden swelling of the breast. Also called inflammatory breast carcinoma or locally advanced breast cancer, IBC can spread quickly, making prompt diagnosis and treatment essential.
Proteins For Targeted Cancer Drugs
Testing cancer cells for particular proteins can help to show whether targeted drug treatments might work for your breast cancer.
Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer.
Some breast cancers have large amounts of a protein called HER2 receptor . They are called HER2 positive breast cancers. About 15 out of every 100 women with early breast cancer have HER2 positive cancer.
Targeted cancer drugs such as trastuzumab can work well for this type of breast cancer. These drugs attach to the HER2 protein and stop the cells growing and dividing.
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What Is The Grade Of My Tumor
Grading is not the same as staging. Both are indicators of a cancers severity and prognosis, but they use different criteria. Staging deals with the tumor size, location and the distribution of cancer cells in your body. But grading is based on how the cancer cells appear under a microscope.
The more abnormal-looking the cells are, the more likely they are to quickly grow and spread. Grades usually run from I to III. A higher grade is a more aggressive cancer. Its possible to have a Stage I tumor thats also a Grade III cancer.
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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How Big Is My Tumor
Tumor size is another factor that will determine your course of treatment. Your doctor uses the size of your tumor to stage, or further categorize your cancer .
The tumors dimensions are estimated by a physical exam, a mammogram, an ultrasound or an MRI of the breast. The precise size wont be known until a pathologist studies the tumor after surgical removal.
What Is My Estrogen Receptor And Progesterone Receptor Status
Your bodys hormones such as estrogen and progesterone may play a role in how your breast cancer progresses.
Normal cells are equipped with receptors that allow them to receive information from circulating hormones, similar to the way your phone picks up satellite signals. Cancer cells may also have hormone receptors, letting them tap into your bodys normal cell growth-regulating system.
Your ER/PR status is determined by testing a sample of breast cancer cells removed during a biopsy. If your breast cancer cells have estrogen and progesterone receptors if theyre ER/PR-positive then theyre capable of detecting estrogens signal and using it to fuel growth. If the cancer cells lack these receptors meaning theyre ER-/PR-negative they cant hear the growth-signaling message.
About 70% of breast cancer patients have positive ER/PR hormone status.
While being ER/PR-positive sounds bad, theres actually a benefit. Doctors can take advantage of the receptors presence. They can use an anti-estrogen drug that blocks the receptors and blocks estrogens growth signal. Or they can use other drugs like aromatase inhibitors that lower your bodys estrogen levels to deprive the cancer cells of fuel.
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Breast Cancer Hormone Receptor Status
Breast cancer cells taken out during a biopsy or surgery will be tested to see if they have certain proteins that are estrogen or progesterone receptors. When the hormones estrogen and progesterone attach to these receptors, they stimulate the cancer to grow. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors . Knowing the hormone receptor status is important in deciding treatment options. Ask your doctor about your hormone receptor status and what it means for you.
What Is The Stage Of My Cancer
Cancer staging is a standardized way of classifying the severity of a patients cancer. There are various systems that use number or letter codes to designate the cancers status and how far it may have spread.
You may have heard of Stages 0 through IV, which reflect a tumors size and the extent of metastasis. A higher stage means a larger tumor and wider distribution of cancer cells.
Your doctor uses staging to plan your treatment, gauge your prognosis and communicate with other cancer specialists. What stage your cancer is in also will help determine whether youre eligible for clinical trials which offer newer treatment options.
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Are There Any Risks To The Test
You may have a little bruising or bleeding at the biopsy site. Sometimes the site gets infected. If that happens, you will be treated with antibiotics. A surgical biopsy may cause some additional pain and discomfort. Your health care provider may recommend or prescribe medicine to help you feel better.
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
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How Worried Should Women Be
Inflammatory breast cancer is a rare disease, so the chances of your getting it are quite small. Awareness of what symptoms to look for and of how to go about having those symptoms evaluated is the most important defense against this and any disease.
Additional information about IBC can be found at:
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How Her2 Status Affects Treatment
For more than 30 years, researchers have been studying HER2-positive breast cancer and ways to treat it.
Targeted therapies have now changed the outlook of stage 1, 2, and 3 breast cancers from poor to good.
While targeted therapies are part of the standard treatment for HER2-positive breast cancer, theyre only used occasionally in HER2-negative breast cancer.
Another difference between HER2-positive treatments and HER2-negative treatments is that HER2-negative treatments are often oral medications. HER2-positive treatments are usually administered intravenously or by injection.
For HER2-positive or HER2-negative breast cancers that are estrogen-positive or progesterone-positive, treatment with hormonal therapy may also be recommended.
Medications that may be used to treat HER2-negative breast cancers that are hormone-negative include:
- sacituzumab govitecan , an IV treatment
- talazoparib
Medications that may be used to treat HER2-negative breast cancers that are hormone-positive include:
- abemaciclib
- palbociclib
- ribociclib
Some of these medications are taken on their own, while others must be administered with other medications. Factors that affect your treatment regimen include whether:
- youve gone through menopause
- youve already received hormone therapy or chemotherapy
- you have certain gene mutations
Trastuzumab is a biologic therapy thats administered intravenously.
Other treatments for HER2-positive breast cancer include:
What Are Estrogen And Progesterone Receptors
Receptors are proteins in or on cells that can attach to certain substances in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone, and need these hormones for the cells to grow.
Breast cancer cells may have one, both, or none of these receptors.
- ER-positive: Breast cancers that have estrogen receptors are called ER-positive cancers.
- PR-positive: Breast cancers with progesterone receptors are called PR-positive cancers.
- Hormone receptor-positive: If the cancer cell has one or both of the receptors above, the term hormone-receptive positive breast cancer may be used.
- Hormone receptor-negative: If the cancer cell does not have the estrogen or the progesterone receptor, it’s called hormone-receptor negative .
Keeping the hormones estrogen and progesterone from attaching to the receptors can help keep the cancer from growing and spreading. There are drugs that can be used to do this.
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Treatments And The Treatment Dilemma
If you have triple negative breast cancer, your doctors will talk with you about chemotherapy. Many patients with triple negative breast cancer are treated with chemotherapy prior to surgery, and patients with stage 2 or 3 triple negative breast cancer may be candidates for immunotherapy combined with chemotherapy prior to surgery.
If you have HER2+ breast cancer but you are negative for hormone receptors, your doctors will talk with you about regimens that combine chemotherapy and HER2-targeted therapy. If your cancer is stage 2 or stage 3, this will likely be given prior to surgery, but if your cancer is stage 1, the HER2-targeted therapy and chemotherapy can be given after surgery.
If your cancer is HER2-negative but hormone receptor positive , you will receive endocrine therapy. Depending on other features of your cancer, your doctor may recommend chemotherapy as well.
What Do The Hormone Receptor Test Results Mean
Test results will give you your hormone receptor status. It will say a tumor ishormone receptor-positive if at least 1% of the cells tested have estrogen and/or progesterone receptors. Otherwise, the test will say the tumor is hormone receptor-negative.
Hormone receptor-positive breast cancer cells have either estrogen or progesterone receptors or both. These breast cancers can be treated with hormone therapy drugs that lower estrogen levels or block estrogen receptors. Hormone receptor-positive cancers tend to grow more slowly than those that are hormone receptor-negative. Women with hormone receptor-positive cancers tend to have a better outlook in the short-term, but these cancers can sometimes come back many years after treatment.
Hormone receptor-negative breast cancers have no estrogen or progesterone receptors. Treatment with hormone therapy drugs is not helpful for these cancers. These cancers tend to grow faster than hormone receptor-positive cancers. If they come back after treatment, its often in the first few years. Hormone receptor-negative cancers are more common in women who have not yet gone through menopause.
Triple-positive cancers are ER-positive, PR-positive, and HER2-positive. These cancers can be treated with hormone drugs as well as drugs that target HER2.
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Management And Treatment Options For Inflammatory Cancer Of The Breast
For some women with IBC, the initial investigations to find a diagnosis may not confirm a benign or a malignant condition.
So, a patient may be given conservative treatments such as anti-inflammatory drugs and antibiotics. Monitoring of the response to antibiotic therapy is very important if symptoms do not improve further investigations will be necessary.
Sometimes, a large excisional breast biopsy is needed to really figure out what is going on.
Inflammatory breast cancer cells tend to grow widely through the tissues of the breast, rather than as a single tumour. For this reason, chemotherapy drugs or radiation therapy are often given before surgery.
What Is Estrogen Receptor
Breast cancer cells sometimes have what are called receptors, which are tiny molecules of protein. Hormones may attach to specific receptors and trigger actions within the cell. Some types of cancerous, or malignant, breast tumors have cell receptors to which the hormoneestrogen attaches, stimulating the cells to grow. In the case of estrogen receptor-negative breast cancer, or ER-negative breast cancer, the cells do not have hormone receptors for estrogen. The presence or absence of estrogen receptors makes a difference to breast cancer treatment, because, with estrogen receptor-positive tumors, hormone therapies can be used which block the receptors, slowing breast cell growth.
A number of different hormone receptors may be found on breast cancer cells. As well as receptors specific to estrogen, other receptors may be present for the hormone progesterone or for a protein known as HER2. When receptors are found, treatments may be given using drugs which target those receptors and act against cancer growth. Some tumors will not show any of the receptors, in which case they are described as triple negative. As estrogen receptor-negative breast cancer does not respond to the body’s progesterone or estrogen levels, it is not usually possible to treat it using hormone therapies.
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What Are The Stages Of Her2 Breast Cancer
All breast cancers are staged by the size of the tumor and extent of spread. Breast cancers are also graded from one to three, based on how abnormal the cancer cells look and how fast they grow. Grade one is low grade cancer and three is high grade which grows and spreads rapidly.
The four stages of breast cancer are:
- Stage I: The tumor is relatively small and localized to the original site with possible spread to the sentinel lymph node, which is the first node the cancer is likely to spread to.
- Stage II: The tumor has grown and spread to a few nearby lymph nodes.
- Stage III: The tumor has grown into many lymph nodes and other breast tissue.
- Stage IV: The cancer has spread to distant parts of the body.
Another classification system is the TMN breast cancer classification, based on Tumor size , lymph Node status and distant Metastasis . It has many detailed classifications for breast cancers.