How Do Doctors Treat Triple Negative Breast Cancer?

Surgery, Chemotherapy, Radiation, and More

Your cancer treatment team will use the same tests they typically use for other types of breast cancer to figure out the best treatments for triple-negative breast cancer (TNBC). The treatment plan will be based on several factors, including tumor size and grade and whether the cancer has traveled to lymph nodes and other parts of the body. Treatment for TNBC generally includes standard methods (surgery and medication) to treat the cancer and alternative, complementary therapies to treat symptoms of the cancer and side effects of treatment. 

What is TNBC?

Being diagnosed with breast cancer is a frightening experience, and being diagnosed with triple negative breast cancer (TNBC) carries an additional burden due to the potential for recurrence. Currently, researchers are working to find a targeted therapy that will help to reduce the risk of recurrence for those diagnosed with TNBC, but one does not exist at this time.

What We Know About TNBC

  • Every 30 minutes, a woman in the United States is diagnosed with triple negative breast cancer.
  • TNBC tends to be a more aggressive breast cancer.
  •  It is more likely to recur and harder to treat because there are no targeted therapies
  •  If it does occur, it tends to do so in the first 5 years following active treatment.
  •  Chemotherapy has proven a successful treatment for most triple-negative breast cancers.

Surgery

Your doctor will likely recommend surgery, with the goal of removing the cancer from the affected breast. Depending on the size and grade of the tumor and whether the cancer has spread, your doctor will suggest either a lumpectomy or a mastectomy. An axillary lymph dissection may also be done.

In a lumpectomy surgery, the surgeon will remove the tumor and the tissue around it. A mastectomy removes the breast, nipple, areola and most of the underlying skin. An axillary lymph node dissection is done if nearby lymph nodes are affected by the cancer.

Lumpectomy

A lumpectomy surgery, also known a breast conserving surgery, removes breast cancer while preserving as much of the breast as possible. During this surgery, the surgeon will remove the tumor and any surrounding tissue. 

Lumpectomies are recommended for people whose cancers are not invasive, but if the cancer has spread throughout the breast or if the tumor is too big, a mastectomy is recommend.

Lumpectomies are associated with a higher risk for a recurrence of the breast cancer. In fact, one 2011 study shows the chance of recurrence after a lumpectomy is 50.9 percent within three years and 30.2 percent between three and five years. As a result, researchers suggest more frequent surveillance during the first four to six yours after lumpectomy.

Most people with need radiation therapy after a lumpectomy surgery to destroy remaining cancers and prevent a recurrence (return) of the cancer. Radiation has negative side effects associated with it, including:

  • Damage to surrounding tissues
  • Fatigue
  • Breast pain
  • Low white blood cell counts
  • Skin reactions that may include itching, redness, and soreness

Mastectomy

A mastectomy removes the entire breast in an effort to eradicate the breast cancer.  

There are five different types of mastectomy procedures.

  • Simple: This type of mastectomy involves removal of the entire breast but does not remove any lymph nodes from the underarm or any muscle underneath the breast. In addition to treating TNBC, this procedure is often recommended for women who have stage zero breast cancer and/or are high risk for developing breast cancer due to family history.   
  • Modified radical: This type of mastectomy removes the entire breast and nearby lymph nodes. No muscle is removed. The lymph nodes are removed for examination to determine if the cancer has spread beyond the breast.
  • Radical: A radical mastectomy is the most invasive in that it involves removal of the entire breast, underarm lymph nodes, and chest muscles. This procedure is recommended when the cancer has invaded the chest muscles in the breast.
  • Partial: A partial mastectomy is similar to a lumpectomy because it removes part of the breast affected by the cancer and some of the surrounding issue. There is more tissue removed, which distinguishes it from a lumpectomy.
  • Nipple-sparing: A nipple sparing surgery removes the entire breast but preserves the nipple and, in some cases, the areola, for breast reconstruction surgery later down the road.

A mastectomy has the greater chance to prevent a recurrence and lowers the need for additional surgery. Moreover, people who have mastectomies usually don’t need radiation therapy. However, because a mastectomy is invasive surgery, it will require a longer hospital stay and recovery, in comparison to a lumpectomy. 

Moreover, there is an increased risk for side effects, including:

  • Severe pain, tenderness and swelling
  • Numbness in the chest or arm
  • Nerve pain
  • Blood buildup at the surgery site

A mastectomy involves the removal of the entire breast, which can have a psychological effect on some women. Many women will, therefore, choose breast construction following a mastectomy. Breast reconstruction is life-changing for women who have lost a breast, or both breasts, due to cancer, but it also means more surgery, costs and recovery.

Axillary Lymph Node Dissection            

Axillary lymph node dissection is usually done as part of a lumpectomy or mastectomy surgery.  The surgeon may remove a small group of lymph nodes or all of the ones located in the axilla, the rounded area beneath the shoulder where the arm and body meet. Sample tissues from these nodes are sent to a pathology lab for testing. 

Your doctor will want to know if the lymph nodes are clear for cancer or if they are positive (contain cancer). This information will be helpful in determining the staging of the cancer, whether you will need more treatment, and how aggressive the treatments need to be.

Additional Therapies

In addition to surgery, TNBC is also treated with radiation and chemotherapy. 

Chemotherapy

Chemotherapy is a medicine that kills cancer cells.  It may be the first treatment suggested for treating TNBC. It is given intravenously (by needle through a vein) or in pill form. When it is caught early, TNBC may respond to chemotherapy better than other cancers do. TNBC tumors have been found to be sensitive to chemotherapy with a pathological response in up to 31 percent of people.

If chemotherapy is given prior to surgery, it is done to shrink the tumor and make surgery easier. Chemotherapy is also used after surgery if the tumor is large or if lymph nodes are involved. 

Radiation Therapy

Radiation therapy can treat TNBC by killing cancer cells left after surgery. It will help to protect against recurrence. Radiation is usually given using an external beam on the affected area of the breast.  It may be given after a lumpectomy to kill any remaining cancer left in the breast or underarm area. It may also be used after a mastectomy if the surgery has found the cancer to be close to the chest wall or nearby lymph nodes.

Clinical Trials

A clinical trial might be part of treatment plan. In fact, for some people with TNBC clinical trials offer the best access to new and emerging therapies especially if conventional therapies have not worked. To participate, a person will need to meet certain requirements with their diagnosis, prior treatments and overall health. Your doctor may have more information on clinical trials you may qualify for or you can check the National Cancer Institute's searchable database

Breast Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Complementary Alternative Medicine (CAM)

CAM treatments can help lessen the side effects of radiation and chemotherapy. They can help you to manage the stress of treatment and living with TNBC. CAM therapies can also help you to practice self-care rather than relying on doctors for every aspect of your health and well-being.

Many of these therapies have their roots in Eastern medicine, treatments and natural therapies for nourish the body’s natural healing ability. Most CAM therapies are forms of holistic medicine, which means they seek to restore health and balance in the whole person and not just the body. They focus on the mind, emotions and spirit, in addition to the physical body.

CAM therapies include:

  • Traditional Chinese medicine, including acupuncture, tai chi, herbs, and massage to unblock energy lines throughout the body
  • Ayurveda medicine, an ancient system from India, which includes certain foods, mediation and massage to harmonize the body, mind and spirit.
  • Naturopathy and homeopathy, which use herbs and other natural products to help the body to heal

Many CAM therapies have proven effective for managing side effects of cancer treatment, relieving pain, and improving quality of life. For example, acupuncture may help relieve symptoms of breast cancer and side effects of treatment. The practice involves the use of sterile, thin needles in specific points on the skin to stimulate the nervous system. 

According to the National Center for Complementary and Integrative Health, acupuncture may help with relieving fatigue, controlling hot flashes, and reducing vomiting, nausea, and even pain. Acupuncture is not without it risks, and side effects may include infection, bleeding, and swelling.

While CAM treatments are effective and helpful, not all are safe. Further, it is important to keep in mind these therapies are complementary and should not replace your doctor’s treatment plan. 

Why Don't Targeted Therapies Work for TNBC?

Despite the success of targeted therapy in various types of breast cancers, targeted therapy has not been successful in improving treatment outcomes for people with TNBC. The simple reason to why has to do with the idea that treatment and prognosis for breast cancer is based on the subtype. For example, hormone receptor cancers can be successfully treated using hormone therapies.  

Breast cancer is not one disease. The term "breast cancer" encompasses several types and subtypes of cancers that occur in the breast; they are diagnosed by whether or not they have receptors that fuel most breast cancers. These receptors include the estrogen receptor, or ER; the progesterone receptor, or PR and the human epidermal growth factor receptor 2, or HER2  

When these receptors are present, they help the cancer treatment team decide how best to treat the specific type of cancer. ER-positive breast cancer, PR positive breast cancer, and HER2 positive breast cancer, treatment include medications that prevent, slow or stop cancer growth by targeting those receptors. These medications are given following the end of active treatment, which includes surgery, chemotherapy and/or radiation therapy. Drugs such as tamoxifen and aromatase inhibitors target the estrogen receptor. The target drug for HER2 is Herceptin.

Triple negative is a breast cancer subtype that does not have any of these three important receptors, which are used as targets for cancer treatment. Its name comes from the fact that it is negative for ER, PR, and HER2 receptors. Because triple-negative doesn’t have any of these receptors, this subtype of breast cancer does not respond to tamoxifen and Herceptin.

A Word From Verywell

Triple-negative breast cancer can be harder to treat than other types of breast cancer. Your long-term outlook will depend on a variety of factors, including the number of tumors, their size and grade, whether there are lymph nodes are involved. 

The survival rate after a TNBC recurrence tends to be shorter than it is for other breast cancers. Most relapses occur in the first five years, with the peak time being three years after surgery. Fortunately, relapse rates significantly decline after that. Further, the majority of research suggests that people successfully treated do not have relapses and that available treatments can be successful.

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