How to identify and treat triple-negative breast cancer - a rare but aggressive form of cancer

• Triple-negative breast cancer is an aggressive cancer that's primarily treated with chemotherapy.
• It affects Black people more than white people and is unusually common amongst Hispanics.
• About 77% of people diagnosed with triple-negative breast cancer survive for at least five years.

About 10% to 15% of all breast cancer cases are due to triple-negative breast cancer. Unlike other types of breast cancer, triple-negative breast cancer is more aggressive and it does not respond to hormonal therapies, meaning treatment options are limited.

However, the five-year survival rate for those with the condition is 77%, meaning 77% of people live at least five years or more after their diagnosis.

"The good news about this subtype of breast cancer is that if the patient successfully gets to five years out from their diagnosis, it is exceedingly rare for the tumors to come back," says Melissa L. Torrey, MD, the medical director of the breast cancer program at Redlands Community Hospital.

What is triple-negative breast cancer?

Triple-negative breast cancer is a form of cancer that's growth is not fueled by the hormones progesterone and estrogen, or by the HER2 protein. Therefore, it tests negative for estrogen and progesterone receptors and excess HER2 protein.

Unlike other breast tumors, which have receptors for one or more of the above hormones or proteins, triple-negative breast cancer cannot be treated with targeted cancer treatments. This means treatment options are more limited than with other types of breast cancer, says Stavroula A. Otis, MD, an oncologist with Providence Health.

You can get a better idea of your risk of triple-negative breast cancer by consulting a genetic counselor. You can also talk to your doctor about early screenings and routine mammograms.

Note: If you have a family history of breast, ovarian, pancreatic, or prostate cancers you may be at an increased risk of BRCA-related cancers including triple-negative breast cancer.

What causes triple-negative breast cancer?

Like most cancers, there isn't a clear cause of triple-negative breast cancer. However, there are risk factors, including:

• Being younger than 40: Unlike other breast cancers, triple-negative breast cancer is most often diagnosed in women who are younger.
• Being Black or Latina: Black people are up to three times more likely than white people to have triple-negative breast cancer, when controlling for factors like age and obesity. Additionally, Hispanic people who develop breast cancer are more likely to have triple-negative breast cancer despite having a lower risk of breast cancer overall compared to other ethnicities.
• Having a BRCA mutation: People with a BRCA gene mutation who develop breast cancer have about a 70% chance of having the triple-negative type. BRCA is a gene mutation that increases the risk for breast and ovarian cancers.

Triple-negative breast cancer symptoms and diagnosis

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Most people discover they have triple-negative breast cancer after noticing a change in their breasts.

If you experience any of the following symptoms or notice any of the following changes, reach out to a healthcare provider immediately:

• A lump in the breast
• Skin irritation or itchiness on the breast or nipple
• Skin dimpling, or the nipple retracting
• Nipple bleeding or discharge

People experiencing these symptoms will often be sent for additional testing, including an ultrasound, mammogram, MRI, and biopsy.

"After the biopsy is done, the pathologists expose the tissue to 'stains' that will show if the tumor cells express estrogen receptors, progesterone receptors, or HER2," says Otis. "If the stains are all negative, then the diagnosis of 'triple negative' breast cancer is made."

Triple-negative breast cancer treatment

Chemotherapy is the main treatment for triple-negative breast cancer since they do not respond to treatments that target specific biomarkers that help cancer cells reproduce.

However, new treatments are constantly being developed.

"With new therapeutics coming down the pipeline, we have more therapies to offer our patients with triple negative breast cancer to prolong their lives and overall survival," Torrey says.

The course of treatment will depend on the stage of the cancer, the patient's age, their health, and other factors. A typical treatment based on staging might look like:

• Stage I-III: At this stage, a chemotherapy course of 18-20 weeks, followed by surgery to remove cancer is common, says Otis. After surgery, a patient might have radiation or additional chemotherapy, including a chemotherapy pill.
• Stage IV: When cancer has spread, treatment consists of chemotherapy and focuses on prolonging life, Torrey says. In some cases, radiation is also used.

Immunotherapy can also be used for some patients with triple-negative breast cancer.

Quick tip: Many people are left with medical bills from cancer treatment, but social workers can help connect patients with financial assistance and charities that help with these bills, Torrey says.

Triple-negative breast cancer prognosis

Overall, 77% of people with a triple-negative breast cancer diagnosis will survive for at least five years, which is when a person is considered cured as long as they have no new cancer. That number jumps to 91% ​​if the cancer is detected early, when it hasn't spread beyond the breasts.

"Many patients with triple-negative breast cancer are cured of their disease," Otis says.

However, a 2014 study found that about 25% of people with triple-negative breast cancer will have a recurrence. The risk is highest in the first three years, Torrey says, so doctors usually monitor patients every three months during that time.

"Triple-negative breast cancer has a much higher risk for relapse as compared to other breast cancer subtypes," Torrey says.

Insider's takeaway

Triple-negative breast cancer is a rare and aggressive form of breast cancer with fewer treatment options than other breast cancer types.

While a diagnosis of triple-negative breast cancer can be terrifying, it is not a death sentence, Torrey says. In fact, 77% of people with the condition survive for at least five years, which is when they are considered to be cancer-free if they have not had an additional recurrence.

Plus, researchers are constantly investigating new treatment options for triple-negative breast cancer. That, combined with early detection due to preventive care like routine mammograms, will continue to improve survival rates, Otis says.

"Other new therapies are always on the horizon, and our arsenal is always increasing," she says. "There are countless long-term survivors of triple-negative breast cancer."

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