Triple Negative: A Breast Cancer Subtype

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Triple negative breast cancer is a subtype of breast cancer. Estimates put the number of breast cancers that are triple negative at 15 to 20 percent. It tends to occur more often in younger women. Triple-negative breast cancer is also more likely to occur in women that carry a BRCA mutation, especially if they are diagnosed at a young age. This cancer is often found during a physical exam rather than in a screening mammography as a mammogram is not as reliable a screening tool for young women as it is for older women. As a result, triple negative breast cancers are frequently diagnosed at a later stage. They are more frequently diagnosed in African-American and Hispanic/Latina women. Triple negative tends to be a more aggressive breast cancer.

Triple negative breast cancer takes its name from the fact it is estrogen negativeprogesterone negative, and HER2 negative. This means it doesn’t have estrogen receptors, progesterone receptors, or HER2 receptors, which are proteins known to fuel the growth of breast cancer.

Breast tumors that test positive for one of the receptors mentioned above usually respond to hormone therapy, which is taken in pill form, daily for five or more years, after completing active treatment. One such hormone therapy drug, tamoxifen, in use for decades, continues to be prescribed for premenopausal and postmenopausal women as well as men who tested estrogen-positive.

Aromatase inhibitors, a more recent class of hormone drugs suitable for postmenopausal women, have proven to be even more effective than tamoxifen in reducing the risk of a breast cancer recurrence. Hormone therapy is not effective with triple negative tumors. Triple negative patients do not have the peace of mind of knowing that for five or more years they will have the benefit of taking a hormone therapy known to substantially reduce the risk of a breast cancer recurrence. While research is ongoing to identify targeted therapies and there are medications in the pipeline that look promising, at present none are available for use with triple negative breast cancer.

How Is Triple Negative Breast Cancer Diagnosed?

Triple Negative Breast Cancer is determined following surgery by a pathologist who examines the tumor tissue that was removed. Using a microscope, the pathologist can determine whether or not a breast cancer is present and if so, identify the type and subtype of the breast cancer. The pathologist also evaluates the lymph nodes to see if any cancer has spread beyond the breast. The pathologist will also test to determine hormonal and genetic features in the tissue.

The pathologist’s report will give a cancer care team the information they need to develop a plan that is most appropriate for successfully treating a specific type and subtype of breast cancer.

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Treatment Options

Triple Negative Breast Cancer is treated as most other breast cancers in the active stage of treatment, with surgery to remove the cancer, radiation as indicated following a lumpectomy for early-stage disease, and chemotherapy. Since triple negative tests negative for estrogen receptors, progesterone receptors, and HER2 receptors, it isn’t treated with hormone or targeted therapy. 

Chemotherapy works very well as a treatment for triple negative breast cancer. Usually, chemotherapy is given following surgery, but it may be given before surgery to shrink a woman’s tumor to a size that can be removed with a lumpectomy and not require a mastectomy.

Fear of Recurrence

When active treatment is over, fear of recurrence often sets in for those treated for triple negative breast cancer. Since hormone therapy, given after active treatment to reduce the risk of recurrence would not be effective, there is no further treatment. Instead, women must learn to manage their fear and get on with their lives. The good news is that most women treated for triple negative breast cancer never get a metastatic recurrence or a new breast cancer.

A survivor of triple negative breast cancer, not unlike a survivor of any life threatening disease, may initially wonder when fear of recurrence is not the first thought when waking and the last thought before bed. Hearing about someone else being diagnosed can bring fear to the surface once again. Weeks before a scheduled medical visit or waiting for the results of a mammogram or a scan may cause a significant rise in anxiety as thoughts of recurrence return.

Life as a Survivor

Adjusting takes time, the process can be sped up by not going it alone. Support groups for women treated for triple negative breast cancer can play a key role in healing. Women with triple negative often feel isolated as they rarely meet others with a triple negative diagnosis. When they join a breast cancer group, they are often the only one in the group with a triple negative diagnosis. While they can relate to common experiences such as side effects, they cannot relate to treatment that others in the group are discussing which don’t apply to them.

Being in an online group or a face to face group with others that share common experiences helps each member to realize that she has done everything that can be done medically to beat her cancer. Mutual support will help women focus on living in and enjoying each day and getting on with life.

Support groups work because they relieve the aloneness of coping on your own and bring you together with others dealing with similar situations. 

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Support groups can be places of bonding, making forever friends, and finding the understanding every survivor needs to get beyond her cancer experience. 

The following organizations have online programs and support groups that give women coping with triple negative breast cancer the opportunity to meet and learn from each other. 

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