Coffee with Komen – Understanding Triple-Negative Breast Cancer

by Monet Williams Bowling, MD

Getting a pathology report and understanding that pathology report are two different things. After meeting with your breast surgical oncologist, we would like to think that all patients understand the biology of their cancer, but it is often clear that patients leave confused and have more questions than ever.

When discussing the biology of a tumor cell we use terms that describe the receptors on the outer rim of a tumor cell.  Those descriptors are:

  • ER (Estrogen)
  • PR (Progesterone)
  • and Her2 (Her 2- Neu)

About 10-20 percent of breast cancers — more than one out of every 10 — are found to be triple-negative, which means the breast cancer cells tested negative for estrogen receptors (ER-), progesterone receptors (PR-), and HER2 (HER2-). Testing negative for all three means the cancer is triple-negative.

These negative results mean the growth of the cancer is not supported by the hormones estrogen and progesterone, or by the presence of too many HER2 receptors. Therefore, triple-negative breast cancer does not respond to hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin (chemical name: trastuzumab). However, other medicines can be used to treat triple-negative breast cancer.

In general, triple-negative breast cancers tend to be more aggressive than other types of breast cancer. Studies have shown that triple-negative breast cancer is more likely to spread beyond the breast and more likely to return after treatment. These risks appear to be greatest in the first few years after treatment. As years go by, the risks of the triple-negative breast cancer recurring become similar to those risk levels for other types of breast cancer.

Five-year survival rates also tend to be lower for triple-negative breast cancer. A 2007 study of more than 50,000 women with all stages of breast cancer found that 77 percent of women with triple-negative breast cancer survived at least five years, versus 93 percent of women with other types of breast cancer. Factors such as the grade and stage of the breast cancer will influence an individual woman’s prognosis.

The higher the grade, the less the cancer cells resemble normal, healthy breast cells in their appearance and growth patterns. Triple-negative breast cancers often are a higher stage at the time of diagnosis and often tend to be Grade 3 on a scale of a 1 to 3 system.

Triple-negative breast cancers can often be termed “basal-like,” which means the cells resemble the basal cells that line the breast ducts. This is a new subtype of breast cancer that researchers have identified using gene analysis technology. Like other types of breast cancer, basal-like cancers can be linked to family history, or they can happen without any apparent family link. Basal-like cancers tend to be more aggressive, higher grade cancers — just like triple-negative breast cancers. It is believed that most triple-negative breast cancers are of the basal-like cell type.

New studies show that 10-15 percent of triple-negative cancers are BRCA1 mutation carriers, giving us grounds to discuss genetic testing with triple negative patients.

It’s difficult to predict who will likely get triple-negative breast cancer, but there is some research that shows it is more likely to affect:

  • Younger people. Triple-negative breast cancer is more likely to occur before age 40 or 50, versus age 60 or older, which is more typical for other breast cancer types.
  • African-American and Hispanic women. Triple-negative breast cancer most commonly affects African-American women, followed by Hispanic women. Some studies have found that black women were three times more likely to develop triple-negative breast cancer than white women.
  • People with a BRCA1 When people with an inherited BRCA1 mutation develop breast cancer, especially before age 50, it is usually found to be triple-negative.

Treating Triple-Negative Breast Cancer

It could make a person feel very upset and scared to find out that their cancer is more aggressive than other types and does not respond to treatments such as hormonal therapy and Herceptin. But triple-negative breast cancer can be treated with chemotherapy and radiation therapy, along with newer treatments that are coming from the chemotherapy world.

Triple-negative breast cancer is typically treated with a combination of therapies such as surgery, radiation therapy, and chemotherapy. Some research has shown that triple-negative breast cancers actually respond better to chemotherapy than breast cancers that are hormone-receptor-positive. Working as your own best advocate and listening to your treatment team is a good way to know what plan of care will work best for you.

Researchers continue to work in hopes to find the best approach to treat triple-negative breast cancer. Some clinical trials are comparing the effectiveness of various older and newer chemotherapy medications, used in different combinations, for treating triple-negative breast cancer. Other clinical trials are trying to find out whether some targeted therapies are effective against triple-negative breast cancer. This continues to be an area of ongoing research with many new drugs on the horizon depending on your grade and stage at the time of diagnosis.

Although a diagnosis of triple-negative breast cancer may seem very daunting, advancements in the field of medicine are improving the effectiveness with which oncologists can fight this type of cancer. There are many combination therapies that exist today to treat this type of breast cancer. As a board-certified breast surgeon and surgical oncologist leading the Hendricks Regional Health breast care team, I understand firsthand that it requires a multidisciplinary approach to take care of these patients.

We have come a long way in the last 30 years in better understanding breast cancer, and we will continue to push forward until we have discovered the best treatments and ultimately, the cures.

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