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What Is Triple Negative Breast Cancer

How Effective Is Immunotherapy In Treating Triple

How Is Triple-Negative Breast Cancer Treated?

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.

What Are Causes And Risk Factors For Triple

Although there are known risk factors for the development of any kind of breast cancer, doctors do not understand the exact cause of breast cancer.

  • Normal cells become cancer cells due to changes or mutations in the DNA.
  • While people inherit some DNA changes, others acquire these DNA changes during a person’s life.

The following are causes and risk factors for any type of breast cancer, including triple-negative breast cancer:

  • Increasing age

What Is Triple Negative Early Breast Cancer

Triple negative breast cancer is a type of breast cancer that does not have any of the three receptors commonly found on breast cancer cells the oestrogen, progesterone and HER2 receptors. Around 15% of early breast cancers are triple negative.

Triple negative breast cancer generally responds well to chemotherapy. Five years after diagnosis, people with triple negative breast cancer are no more likely to experience a recurrence of their breast cancer than people with other types of breast cancer. In the longer term , a recurrence is less likely with triple negative breast cancer.

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Moffitt Cancer Centers Approach To Triple Negative Breast Cancer

At Moffitt Cancer Center, we believe in a multispecialty approach to breast cancer diagnosis and treatment. Our Don & Erika Wallace Comprehensive Breast Program comprises highly specialized medical oncologists, radiologists, fellowship-trained surgeons, radiation oncologists and other health care professionals who work together to provide our patients with well-rounded care. Our patients also have access to our supportive care services, which include counseling, integrative medicine, nutritional help and much more.

We continue to make strides in developing our understanding of triple negative breast cancer. Treatments are being evaluated regularly by medical researchers and clinicians as more is being learned about triple negative cancers. Our extensive research efforts and innovative clinical trials help our patients lead healthy and productive lives.

If you are interested in learning more about triple negative breast cancer treatment at Moffitt, call or complete a new patient registration form online.

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Sociodemographic And Clinical Characteristics Of Tnbc Patients

Understanding Breast Cancer

We enrolled 152 patients aged 26-85, median age 58 years , just over two-thirds of them menopausal. In routine medical records, family history data were lacking in a high percentage of cases, i.e. 42 for any cancer and 43 for BC. We kept these data in descriptive , but did not interpret them. In patients for whom we had properly collected data, 18/109 had a positive family history of BC. Patients with a positive family history of BC were younger, median age 43 years compared to patients without family BC, median age 57 years. The vast majority of patients had ductal invasive carcinoma with a median tumor size of 2.2 cm, 62 with positive lymph nodes, 124 with grade III tumor, and median Ki67 proliferation index 57 . Just over one-third of patients underwent radical surgery , and almost all of them underwent axillary dissection. Adjuvant chemotherapy was used in 130/148 patients, in 114/128 cases with anthracyclines or a combination of anthracyclines and taxanes. A total of 103/140 patients were treated with adjuvant radiotherapy. None of the patients was treated with the neoadjuvant approach.

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Risk Factors For Triple

Doctors aren’t sure what makes you more likely to get triple-negative breast cancer. Not many women do — it only affects up to 20% of those who have breast cancer. You’re most at risk for triple-negative breast cancer if you:

  • Are African-American or Latina
  • Are under 40
  • Have what your doctor will call a BRCA mutation , especially the gene BRCA1

The Prognosis For Patients With Triple

Prognosis refers to the likely outcome of treatment for patients with triple-negative breast cancer. Unlike other types of breast cancer that have a well-proven set of treatments, triple-negative breast cancer is still in the process of being researched for a more standardized treatment plan. Because of this, several treatments may be needed to find one that is effective. Studies have shown that triple-negative breast cancer is more likely to have metastasized , have a higher grade, and are more likely to recur after treatment.

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What Is Clear About The Still Fuzzy Tnbc Subtyping

Perhaps, the several strategies employed to construct systems that identify clinically useful TNBC subtypes reflect the lack of proper definition of this disease. From the quantitative variables such as gene and protein expression or metabolic and epigenomic profiling to the qualitative traits such as gene mutation, basic and translational researchers have explored a problem that still appears to remain unsolved. We see a common factor, independently of the approach, that clear overlaps exist between the different classification systems . This is encouraging as it points towards the existence of stable entities identified in diverse patient populations. However, the fact that there is still a large variability, added to several subtle similitudes between some of the current subtyping systems , suggests that there is still a long way to go.

How Is Triple Negative Breast Cancer Diagnosed

Video: What is 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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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.

In Pursuit Of The Consensus Tnbc Subtypes

In the upcoming years, integrating different data sources will be key in identifying definitive TNBC subtypes that will help guide clinicians toward specific treatment recommendations for their patients. Integrative analyses comparing TNBC and non-TNBC patients from the TCGA cohort have been performed combining gene expression, DNAm, and somatic mutations, revealing differential signatures between these two types of BC . Thus, a similar approach combining even more layers of information may identify consensus TNBC subtypes. There is already one attempt to stratify TNBC patients using multiple data types, specifically using transcriptome , micro-RNA expression , and CNV . However, this study did not use metabolomics, proteomics, imaging, or histomolecular features, which have independently proven to be informative for subtyping TNBC.

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Triple Negative Breast Cancer Stages

Triple negative breast cancer stages are assigned based on the extent of the cancer at the time of diagnosis, including the size of the tumor and whether it has spread to other areas of the body. Approximately 15 percent of all breast cancer cases are classified as triple negative, or hormone receptor negative, which means that the cancer cells lack receptors for estrogen, progesterone and HER-2/neu hormones. While triple negative breast cancers are sometimes treated differently than hormone-receptor-positive cancers, the staging process is the same for all types of cancer.

Breast cancers are typically staged using a numerical scale that ranges from zero to four, with higher numbers indicating progressively larger and more invasive cancers. Triple negative and other types of breast cancer stages include:

  • Stage 0 Abnormal cells are confined to the milk ducts or lobes
  • Stage 1 Small, localized cancers that have not spread beyond a single, nearby lymph node
  • Stage 2 Moderate, regional cancers that have not spread beyond the lymph nodes in the underarm area
  • Stage 3 Regionally advanced cancers that have spread beyond the breast but have not metastasized to distant organs
  • Stage 4 Metastatic malignancies that have spread to distant organs

For more information about triple negative breast cancer stages, call or request to schedule an appointment online. No referrals are necessary to meet with Moffitts oncologists who specialize in breast cancer.

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Risk Factors For Triple Negative Breast Cancer

The Association Between Obesity And Triple Negative Breast Cancer

A risk factor is a characteristic that increases an individuals chance of getting a certain condition. For example, cigarette smoking is a risk factor for lung cancer. While anyone can receive a diagnosis of triple negative breast cancer, it is more likely to affect the following individuals:

  • Those who are younger than age 40
  • Those who have the BRCA1 mutation
  • Those of African-American or Hispanic descent

Having one or more of these risk factors does not mean developing triple negative breast cancer is for certain, just as not having any of these risk factors doesnt prevent an individual from being diagnosed with this condition.

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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:

5-Year Survival Rate by Stage

Stage
IV 22%

How Triple Negative Breast Cancer Is Diagnosed

Breast cancer is often diagnosed using imaging tests and a biopsy. Some of the most common diagnostic tools for breast cancer include:

  • Mammograms Digital mammography and full-breast tomosynthesis may be used to take X-rays of the breast from several angles.
  • Breast ultrasounds During a breast ultrasound, penetrating sound waves make computerized pictures of the inside of the breast. Ultrasounds provide a much clearer image of breast tissue than mammograms and can define whether a mass is solid or filled with fluid.
  • Magnetic resonance imaging An MRI is not always necessary to diagnose breast cancer, especially if the breast ultrasound was conclusive. But it can be a helpful screening tool for those with a higher-than-average risk for breast cancer.
  • Biopsies Fine-needle aspirations, core-needle biopsies, stereotactic biopsies and surgical biopsies can be used to confirm a breast cancer diagnosis. During this procedure, tissue or fluid is removed from the breast and then analyzed under a microscope.

If breast cancer is the confirmed diagnosis after imaging tests and a biopsy have been done, the breast cancer cells will be sent to a lab to be analyzed. If the cells do not have progesterone and estrogen hormone receptors or an excess amount of the HER2 protein, the resulting diagnosis is triple negative breast cancer.

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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.

Treating Triple Negative Breast Cancer

Risk factors for developing triple-negative breast cancer

Triple negative breast cancer can be treated with a combination of

Research has shown chemotherapy generally has a larger benefit for triple negative breast cancer compared to oestrogen receptor positive breast cancer. Chemotherapy for triple negative breast cancer is often given before surgery. The drugs used are likely to include carboplatin or cisplatin.

Some breast cancer treatments, such as hormone therapy and HER2 targeted therapies are of no benefit to people with triple negative breast cancer.

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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.

What Do You Attribute To The Hesitancy Black Women Have To Partake In Clinical Trials

RF: The traumatic history of exploitation and racism in the scientific and medical industries has understandably posed huge barriers of trust for women of color. Nearly a third of Black women believe scientists cannot be trusted, compared to only 4% of white women. As a result, the average participation by Black women in breast cancer clinical trials overall is less than 3%. This is where a platform like Ciitizen dedicated to democratizing health data and empowering patients to take charge of their treatment journey is critical. By giving Black patients tools to safely store and access their medical data, Ciitizen fosters trust between Black patients and researchers.

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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.

What Are Symptoms Of Triple Negative Breast Cancer

CDC

TNBC symptoms are the same as other common breast cancers. And many breast cancer symptoms are similar to other less serious conditions. That means having certain symptom doesnt mean you have breast cancer. Possible breast cancer symptoms include:

  • A new lump or mass.
  • Swelling in all or part of a breast.
  • Dimpled skin.
  • Nipple retraction, when your nipple turns inward.
  • Nipple or breast skin thats dry, flaking, thickened or red.
  • Nipple discharge that is not breast milk.
  • Swollen lymph nodes. This symptom happens when breast cancer spreads to the lymph nodes under your arm or near your collarbone.

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Stage 3 Breast Cancer Treatment Options

Treatment for stage 3 breast cancers typically involves a combination of surgery along with chemotherapy to shrink the tumor before surgery and radiation after surgery to treat the chest wall and/or lymph nodes. Lymph nodes will also likely be removed during surgery.

Targeted therapies, including hormone therapy, can also be used depending on your cancers specific characteristics.

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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.

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Phase Iii Keynote 355 Trial

The much anticipated KEYNOTE-355 trial was presented at the inaugural virtual ASCO annual meeting in June 2020. This trial investigated pembrolizumab/chemo vs chemo in patients with treatment-naïve, metastatic TNBC. Patients were excluded if they had active brain metastases or recurrence of disease < 6 mo prior to primary treatment. PD-L1 was assessed with the IHC 22C3 pharmDx CPS assay in a central laboratory. The primary outcome measure was pre-defined as OS and PFS in the PD-L1 positive population and the ITT population. In this trial, a hierarchial statistical testing method involved statistical testing of OS and PFS in the CPS > 10 group initially, followed by CPS > 1 and then the ITT population. The trial included 566 patients in the chemotherapy/IO arm vs 281 in the chemotherapy arm. In patients with a CPS score of 10 or greater, the median PFS favoured pembrolizumab with a PFS of 9.6 mo vs 5.6 mo . In patients with a CPS score of 1 or greater, the median PFS favoured the pembrolizumab arm with a PFS of 7.6 mo vs 5.6 mo . This was not statistically significant. This was similar to the ITT population where the PFS was 7.5 mo in the pembrolizumab arm and 5.6 mo in the placebo arm . OS data is awaited. This progression free survival improvement led to accelerated FDA approval for pembrolizumab in combination with chemotherapy in the first-line setting in November of 2020.

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