Triple-Negative Breast Cancer

A Less Common but More Aggressive Form of Cancer

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Triple-negative breast cancer is a subtype of breast cancer. Estimates place the number of breast cancers that are triple-negative at between 15% and 20%. 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. 

Triple-negative breast cancer tends to be diagnosed later because mammograms are not as effective in spotting them n younger women. Triple-negative tends to be a more aggressive form of breast cancer and is more frequently diagnosed in African-American and Hispanic women.

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.

Symptoms

Although triple-negative breast cancer is a unique type of breast cancer, its symptoms are common to all breast cancers, including:

  • A lump in the breast or armpit area
  • Redness, pain, or swelling in the breast
  • A change in size or shape in the breast
  • Changes in the shape of a nipple (such as an inverted nipple)
  • Flaky and peeling nipple skin
  • Nipple discharge

Because triple-negative breast cancer tends to be diagnosed when the disease is advanced, other more profound symptoms may occur, including a loss of appetite, unexplained weight loss, abdominal pain and bloating, trouble urinating, vision problems, jaundice, and seizures. These later-stage symptoms usually develop when the cancer has metastasized (spread) to distant organs.

Diagnosis

Triple-negative breast cancer is often found during a physical exam rather than with 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.

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 breast cancer is present and if so, identify the type and subtype of 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

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.

Since hormones aren't fueling the cancer's growth, the hormone therapy drugs used to prevent cancer recurrence (such as tamoxifen and aromatase inhibitors) are not effective with triple-negative tumors.

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.

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 successfully treated for triple-negative breast cancer will not experience breast cancer recurrence. The risk tends to be highest during the first five years following the completion of therapy and decrease steadily thereafter.

Coping

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.

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 a 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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Article Sources

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