Risk Factors For 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.
What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
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 .
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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.
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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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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Who Is Affected By Tnbc
- An estimated 268,670 new cases of breast cancer are expected to be diagnosed in the U.S. in 2018.3
- TNBC accounts for about 40,300 of these cases.4
- TNBC tends to be more common in younger women and in women who are African-American or Hispanic/Latina.1
- In the U.S., TNBC is twice as likely to occur in African American women compared to Caucasian women, and is twice as deadly.5
- Women diagnosed with breast cancer before age 40 are 53 percent more likely to have TNBC compared to women in their sixties.5
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Study Selection And Patient Characteristics
A total of 527 publications were identified from the three databases, 219 from PubMed, 303 from Embase, and five from Cochrane Library. The titles and abstracts of all remaining publications were reviewed after removing the duplicate publications and 307 more publications were excluded as irrelevant to the topic. Next, 26 publications were further excluded for insufficient data , feline mammary focus , and non-original research after carefully examining the full texts of the remaining 42 publications. Finally, 16 eligible publications were included in the study of meta-analysis . The screening method and results of the relevant studies are shown in Figure Figure11 and the main characteristics of participated patients are summarized in Table Table11.
Flow chart for study selection.
Are There Any Drugs That Block The Pi3k / Akt Pathway
There are promising data indicating that rapalogs or inhibitors of PI3K/Akt are active in breast cancers. Everolimus is a rapamycin analog and inhibitor of mTOR, which is currently the only compound approved for the treatment of hormone receptor -positive, HER2-negative metastatic or locally advanced breast cancer. The PI3K/Akt/mTOR pathway
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I Have Triple Negative Breast Cancer What Can I Do To Help Myself
You already took the first step when you decided to help yourself. Many times cancer makes people feel as if theyve lost control of their lives. Committing to self-care is one way to overcome that feeling. Here are some things you can do during and after your treatment:
- Triple negative breast cancer is a rare and often misunderstood illness. Many people dont realize this cancer cant be treated the same as other breast cancers. As a result, you might feel isolated and alone with your cancer. If that happens, your healthcare provider can direct you to TNBC support groups and programs where you can talk to people who understand your experience.
- Youll probably need or want help while youre going through treatment. Your friends and family likely are anxious to do what they can. Let them know how they can help you.
- If you will need cancer surgery, ask your healthcare provider what to expect immediately after surgery and any follow-up treatment. Knowing what to expect will help you focus on what you can control rather than what you cant control.
- Cancer is stressful. You might find activities such as meditation, relaxation exercises or deep breathing exercises help to ease your stress.
- Chemotherapy treatments might affect your appetite. Try to eat a healthy diet, and talk to a nutritionist if you’re having trouble eating.
- Radiation treatment can leave you feeling exhausted. Plan to rest as much as possible during your treatment.
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.
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Association With Brca1 Mutation Status
It has been observed that a high percentage of BRCA1- associated hereditary and sporadic breast cancers are triple negative and express a high proportion of basal like cytokeratins , as well as P-Cadherin and HER1/EGFR . Gene expression studies support this association among patients with BRCA1 mutations that breast tumours tend to cluster within the basal like category .
Survival Rates And Prognosis
The outlook for breast cancer is often described in terms of relative survival rates.
Relative survival rates are an estimate of the percentage of people who will survive their cancer for a given period of time after diagnosis. Survival among people with cancer is compared to survival among people of the same age and race who have not been diagnosed with cancer.
Five-year relative survival rates tend to be lower for triple-negative breast cancer than for other forms of breast cancer.
According to the American Cancer Society, the overall 5-year relative survival rate for TNBC is . However, an individuals outlook depends on many factors, including the stage of the cancer and the grade of the tumor.
Your healthcare professional will be able to give you a more precise outlook based on:
- the stage of your TNBC
- your age
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Metastatic Triple Negative Breast Carcinoma
Evaluation of triple negative breast carcinoma metastatic to the ovary has distinctive clinical, pathologic, and molecular implications. Triple negative breast carcinomas are more likely to occur in patients with a BRCA mutation,63 and the presence of a BRCA mutation also confers an increased but small risk for a separate primary pelvic serous carcinoma. Risk of occult tubo-ovarian metastatic breast cancer versus early serous carcinoma was evaluated in one retrospective analysis of 108 patients undergoing prophylactic bilateral salpingo-oophorectomies for a BRCA mutation, 69% of whom had a personal history of breast cancer, and only identified one case of unexpected metastatic breast cancer and two cases of early serous carcinoma.64
Nevertheless, metastatic triple negative breast carcinoma and serous carcinomas can have significant morphologic overlap, and immunohistochemical stains are key adjunctive studies. PAX8 is reliably expressed in serous carcinomas and negative in breast carcinomas.65 Triple negative breast carcinomas are frequently negative for specific breast markers with only 21% of cases expressing GATA3, so the absence or presence of PAX8 is most helpful.66 Although not entirely specific, antibodies to keratin 5/6 have been identified in triple negative basal-like tumors,67 and SOX10 has been shown to be expressed in up to 66% of triple negative breast carcinomas .68,69 SOX10 is not expressed by serous carcinomas.
Recurrence Rate For Triple
Breast cancer isnt a single disease. Its made up of several subtypes.
One of these subtypes is known as triple-negative breast cancer . TNBC doesnt have receptors for the hormones estrogen or progesterone, and doesnt overexpress the protein HER2/neu.
Therefore, TNBC doesnt respond to the therapies that target these receptors, such as hormonal therapies or the targeted therapy Herceptin.
According to Johns Hopkins Breast Center, about 10 to 20 percent of those who receive a breast cancer diagnosis have the triple-negative subtype. TNBC grows rapidly. It also has a higher grade and tends to metastasize .
Because the cancer grows quickly, it may be discovered between mammograms. However, the fast growth rate means that standard chemotherapy can be effective at treating the cancer.
Recurrence is the return of breast cancer. Its also sometimes called relapse. Breast cancer can return locally in breast or scar tissue, or distantly in other parts of the body, including bones or organs.
Cancer that reoccurs distantly is considered metastatic cancer. It may be treatable, but its usually not curable.
TNBC has a high recurrence rate, which is greatest within the first 3 years. However, theres a sharp reduction in recurrence after 5 years. Therefore, there are no long post-therapy regimens.
TNBC occurs most often in:
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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.
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Tnbc: A Different Type Of Breast Cancer
Knowing breast cancer basics can help you understand how triple-negative breast cancer is different from other types of breast cancer. To find out what type of breast cancer you have, your doctors search for the presence or absence of receptors, proteins that live inside or on the surface of a cell and bind to something in the body to cause the cell to react. You may have heard of the estrogen receptor , progesterone receptor and human epidermal growth factor receptor 2 . In estrogen receptor-positive breast cancer, progesterone receptor-positive breast cancer and HER2-positive breast cancer, treatment includes medicines that prevent, slow or stop cancer growth by targeting those receptors. But triple-negative breast cancers need different types of treatments because they are estrogen receptor-negative, progesterone receptor-negative and HER2-negative. Medicines like tamoxifen, which targets the estrogen receptor, and trastuzumab , which targets HER2, are not helpful in treating triple-negative breast cancer. Instead, chemotherapy has been shown to be the most effective treatment for triple-negative breast cancer.
Four Key Steps In Making Treatment Decisions For Older Patients With Triple
Following initial screening and preferably a geriatric assessment, management of the older patient with triple-negative breast cancer can be broken down into four steps:
First, determine whether the medical goal of treatment is to improve the chance for cure or palliation, and convey this information to the patient and family.
Second, query the patient as to what is important to her and what her goals are for being treated. The patient and family may not always agree on these goals, and it is critical that discord be resolved early.
Third, using geriatric assessmentbased data and appropriate tools and models, including estimates of life expectancy for the individual patient, calculate the risks and benefits of treatment.
Last, present these risks-and-benefits data to the patient and family using shared decision making and in language that they can understand, to finalize the plan for care.
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Your Prognosis Depends On Several Factors
- The size of your cancer
- Whether your tumor has spread to other areas of your body
- The type of breast cancer you have
- The hormone receptor and HER2 status of your tumor
- The rate of cell growth
- Your age and menopausal status
- Your general health
Each person is different, and your doctor will likely run several tests before giving you a formal prognosis.
Stages Of Breast Cancer
The stage of breast cancer is based on the size and location of the tumor, as well as whether the cancer has spread beyond the part of the breast in which it originated. To determine the stage of breast cancer, healthcare professionals use a scale of stage 0 to stage 4.
Stage 0 breast cancers are isolated in one part of the breast, such as a duct or lobule, and show no sign of spreading into other tissue.
Stage 1 is typically localized, although further local growth or spread may cause the cancer to move into stage 2.
In stage 3, the cancer may be larger and has affected the lymph system. Stage 4 cancer has spread beyond the breast and nearby lymph nodes, and into other organs and tissues of the body.
In addition to stages, breast cancers are given grades based on the size, shape, and activity of the cells in the tumor. A higher-grade cancer means a greater percentage of cells look and act abnormal, or they no longer resemble normal, healthy cells.
On a scale of 1 to 3, with 3 being the most serious, TNBC is often labeled grade 3.
American Cancer Society , the symptoms of TNBC can be the same as those for other types of breast cancer. ACS recommends regular screenings such as mammograms to detect breast cancer before symptoms appear, the time when treatment is most effective.
Other signs of breast cancer include:
Any of these signs can be caused by other conditions. But it is always good to have them checked out by your healthcare professional.
- radiation therapy
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