How Triple-Negative Breast Cancer Is Diagnosed

Results from a breast biopsy play a crucial role

In This Article

Triple-negative breast cancer is an aggressive form of breast cancer which makes up approximately 10% to 15% of breast cancer diagnoses. This type of breast cancer means that the three most common types of receptors responsible for tumor growth in the breast (estrogen receptor, progesterone receptor, and HER2) are missing, so standard routes of treatment which target these receptors will not be effective. This can make the prognosis for triple-negative breast cancer worse than estrogen receptor positive breast cancer in the first five years after diagnosis. Once a patient with a triple-negative breast cancer diagnosis has been in remission for longer than five years, the differences in prognosis are reduced.

Diagnosing triple-negative breast cancer doesn’t take any additional time due to the lack of these receptors compared to other forms of breast cancer. What can cause a delay in diagnosis is a lapse in awareness, whether it be neglecting self-checks, physical examinations, or frequent mammograms, depending on your age.

Self-Checks

One of the most effective ways to detect triple-negative breast cancer early is to get in the habit of doing regular breast self-exams at home. While research has been conflicting over the years as to whether or not self-exams have proven effective enough to be part of a breast cancer screening schedule (and because of this, the American Cancer Society does not recommend regular breast self-exams) it’s important to be familiar with how your breasts look and feel so that you can report any changes to your doctor.

Breasts can be naturally lumpy due to tissue buildup, benign conditions, or hormone fluctuations (particularly during the week of your menstrual cycle) and giving yourself a self-exam at least once a month will help you distinguish between what feels normal for your breasts and what does not. When done combined with other screening tools (like a mammogram), a self-exam may spark you to mention any concerns to your doctor, which could lead to an earlier triple-negative breast cancer diagnosis.

When performing a self-exam, it’s important to keep in mind:

  • The time of month you’re doing the exam. If you still have a menstrual cycle, do your exam several days after it ends, when your hormones have balanced out.
  • Some lumps may be normal. Different areas of the breast and armpit may have lumps or small bumps that are benign. If you’re concerned it’s always worth a mention to your doctor but keep in mind that not all lumps may be directly linked to triple-negative breast cancer.
  • Don’t forget to check your nipples. Make note if there are any indents, bumps, or discharge.

Physical Examination

While the American Cancer Society puts clinical exams and self-exams in the same category, no longer recommending them for breast cancer screening protocols, this doesn’t mean these tests shouldn’t be done. In fact, most physicians will still give you a clinical breast exam, especially if you are in your 20s or 30s. Your family practitioner or gynecologist may perform a clinical exam during your next visit, and this is essentially the same steps that you’ll take if you do a self-exam at home. If they don’t do one and you’d like them to, it’s important to let them know that during your visit as well as ask them about any concerns you may have about your breast health.

Imaging

Whether you’ve made an appointment with your doctor because you’re concerned about a lump you may have found during a self-exam, or your doctor has recommended additional testing after a clinical exam, there are a number of labs and tests used to diagnosis all breast cancers, including triple-negative breast cancer.

The usual order of labs and tests to diagnosis triple-negative breast cancer are:

  • Diagnostic mammograms: Different from screening mammograms, which are routinely given to women in their 40s, a diagnostic mammogram will give a more detailed X-ray of what’s going on in the breast, showing multiple views as well as the ability to zoom in on an the area of the breast in question to see if any abnormalities are present and what exactly they are.
  • Ultrasound: If you are under 30 years old, pregnant, or breastfeeding, your doctor may recommend an ultrasound to examine any breast lumps, which will show if any masses are present in the breasts and whether they appear solid or liquid-filled. Ultrasounds are also given after a screening mammogram that shows masses in the breast.
  • Magnetic resonance imaging (MRI): A doctor may recommend an MRI to get an idea of the extent of the condition. This test will show a detailed view of the breast tissue, helping your doctor get an idea of what (if any) tissue areas are diseased.

Labs and Tests

Depending on the results from a patient’s imaging, a doctor may recommend a biopsy of the breast area as a next step. A biopsy is the only test that can definitively determine if the abnormal area in the breast is cancerous and if it is triple-negative breast cancer.

To do a biopsy, tissues or fluid are removed from the breast area and examined under a microscope. Removal is done by three common procedures depending on the patient’s breast mass size, density, and location: fine-needle aspiration, core needle biopsy, and surgical biopsy. In some cases, a doctor may choose to do a fine-needle or core biopsy and then later a surgical biopsy in the event cancer cells are found to determine the type and stage of breast cancer.

If a patient’s biopsy comes back positive, the next step is to test for hormone receptors. The test is done on tissue from a biopsy using a procedure called immunohistochemical staining and this will show if a patient’s breast cancer is progesterone receptor-positive, estrogen receptor-positive, or neither. The second test will be a HER2/neu test that will look at the breast tissue, or possibly a blood draw to determine if the sample is HER2 positive, meaning the cancer may have a large amount of protein genes that will make the cancer grow and spread more rapidly.

If both the hormone receptor test and the HER2/neu test all come back negative, this is what becomes diagnosed as triple-negative breast cancer, which will affect the treatment plan a patient and doctor will discuss.

Differential Diagnoses

There are many benign breast conditions that do not turn into triple-negative breast cancer. These include:

While these conditions may not increase your risk of developing triple-negative (or any) breast cancer, they don’t decrease your overall risk of developing breast cancer (one in eight women in the U.S.), so it’s important to stay on top of your breast screening schedule even after discovering a benign breast cancer condition. 

A Word From Verywell

Feeling a lump in your breast can be distressing, but it’s important to keep in mind that 80% of women who have a breast biopsy do not have breast cancer. And while it’s impossible to determine if you have triple-negative breast cancer without getting the appropriate tests, making sure you get the required imaging you need first to help determine what tests are appropriate for diagnosis can make all the difference when it comes to diagnosis and treatment. Have peace of mind knowing that breast lumps can be a normal part of tissue makeup but stay vigilant enough to notice any differences in your breast as well as getting the appropriate screenings and checks to keep your breasts healthy.

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Article Sources

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