Triple Negative Breast Cancer
Overview
What is triple negative breast cancer?
Triple negative breast cancer (TNBC) is a rare cancer that affects about 13 in 100,000 women each year. It represents about 15 % of all invasive breast cancers. Triple negative breast cancer is one of three types of breast cancer. It is called as triple negative because it doesn’t have three markers associated with other types of breast cancer, which is important for prognosis and treatment. It’s one of the more challenging breast cancers to treat. But researchers are making steady progress toward more effective treatments. Overall, 77% of women who have triple negative breast cancer are alive five years after diagnosis.
What are breast cancer subtypes and why do they matter?
Your breast cancer subtype is one factor healthcare providers take into account when they’re deciding how to treat your cancer. That’s 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 they’re 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 doesn’t have her-2 neu and hormone receptors, it’s called triple negative.
Who is most likely to have TNBC?
Triple negative breast cancer appears more frequently in women age 40 and younger than in older women. Black and Latina women are more likely to develop TNBC than white women. Women who have the gene change BRCA1 are more likely to develop TNBC than other women. When the BRCA1 gene mutates, it stops preventing cancer and appears to make your body’s cells more vulnerable to cancer.
Is triple negative breast cancer an aggressive form of cancer?
It’s 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 tumor’s size and whether it has spread to your lymph nodes and other parts of your breast. It’s also helpful to know researchers are focusing on ways to slow the spread of TNBC.
Symptoms and Causes
What are symptoms of triple negative breast cancer (TNBC)?
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 doesn’t 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.
- Breast or nipple pain.
- Nipple retraction, when your nipple turns inward.
- Nipple or breast skin that’s 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.
Does this cancer subtype cause certain kinds of cancer?
Inflammatory breast cancer (IBC) is usually triple negative breast cancer
What causes triple negative breast cancer?
Researchers don’t know what causes TNBC, but they think BRCA1 genetic mutation might play a part. The BRCA1 gene is meant to prevent cancer. When it mutates, however, the gene reverses course and makes your cells more vulnerable to cancer.
Diagnosis and Tests
How is triple negative breast cancer diagnosed?
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 tumor’s size and whether it has spread, or after treatment to monitor response to treatment:
Management and Treatment
What is the treatment for triple negative breast cancer?
Healthcare providers and researchers are making significant progress on TNBC treatments. Recent clinical trials are testing new combinations of drugs and new approaches to existing treatments. Some existing treatments are:
- Chemotherapy: Providers might combine chemotherapy and surgery, with chemotherapy being used to shrink your tumor before surgery or after surgery to kill cancer cells throughout your body.
- Surgery: This could be a lumpectomy to remove an individual lump, or a mastectomy to remove an entire breast. Providers then perform a sentinel node biopsy or axillary node surgery to look for signs your breast cancer has spread to your lymph nodes.
- Radiation therapy: Post-surgery radiation therapy helps reduce the chances your cancer will return or recur.
- Immunotherapy: This treatment stimulates your immune system to produce more cancer-fighting cells or help healthy cells identify and attack cancer cells. Immunotherapy can be added to chemotherapy to before surgery to shrink the tumor. You might also receive immunotherapy for about a year after your surgery and post-surgery radiation therapy.
What are these treatments side effects?
Each treatment has different side effects. And each person might have different reactions to these side effects. Ask your healthcare provider about specific treatment side effects. They will explain what they will do to help you manage treatment side effects, and what you can do to help yourself.
Prevention
Can TNBC be prevented?
Researchers don’t 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 can’t 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.
Outlook / Prognosis
What is the prognosis or expected outcome for triple negative breast cancer?
The prognosis for TNBC continues to improve, thanks to recent progress in identifying new treatments and finding new ways to use existing treatments. Like most cancers, the earlier TNBC is diagnosed and treated, the better the prognosis.
Living With
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 they’ve 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 don’t realize this cancer can’t 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.
- You’ll probably need or want help while you’re 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 can’t 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.
When should I see my healthcare provider?
It’s important that you have regular follow-up care with your healthcare providers. They will probably want to do physical examinations every three to six months for the first three years after treatment. They might reduce your visits to every six months during years four and five.
When should I go to the emergency room?
You might also have unusually strong side effects from your cancer treatment. While your healthcare provider likely gave you medication to help control your side effects, you should go to the emergency room if your side effects continue despite medication.
Many cancer treatments affect your immune system, increasing the chance you will develop infections. Symptoms that might require an emergency room visit during treatment are:
- Fever of 100.5 and above.
- Chills.
- Productive or "wet" cough.
- Stomach pain.
- Persistent diarrhea.
- Persistent nausea and vomiting.
What questions should I ask my doctor?
You will have lots of questions about your cancer, starting with your diagnosis. Here are some basic questions you might ask:
- What is triple negative breast cancer?
- How do you know my cancer is triple negative breast cancer?
- Why did I get this cancer?
- Do I need genetic testing?
- Has my breast cancer spread, and if so, how far has it spread?
- What is the stage of my cancer?
- What is my prognosis or expected outcome?
- What treatments do you recommend?
- Why do you recommend those treatments?
- What are those treatment side effects?
- Will I need surgery? If so, what surgery do you recommend and why?
- I’m interested in participating in clinical trials. Are you able to help me find one?
- Do you know if there are any local support groups?
A note from Cleveland Clinic
Triple negative breast cancer is one of the more challenging breast cancers to treat. You might be discouraged by what you have read about triple negative breast cancer. But there are a number of very effective treatments for triple negative breast cancer, including immunotherapy, chemotherapy, surgery and radiation. And every day researchers learn more about this rare cancer. Their knowledge is your power. If you’re concerned you aren’t getting the straight story about your cancer, ask your healthcare provider to walk you through your diagnosis and treatment options.
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