Triple-Negative Breast Cancer

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

Facts you should know about triple-negative breast cancer

Picture of Breast Cancer Symptoms
Picture of Breast Cancer Symptoms
  • Triple-negative breast cancer is an uncommon kind of breast cancer in which the cancer cells test negative for three common markers, the estrogen receptor (ER), progesterone receptor (PR), and a protein involved in cell growth known as HER2.
  • The triple-negative status of a cancer means that anti-hormonal therapies and therapies targeted against the HER2 protein are not effective.
  • About 10%-20% of all breast cancers are triple-negative.
  • Doctors usually treat triple-negative breast cancers with surgery, chemotherapy, and in many cases, radiation therapy.
  • Triple-negative cancers have a more aggressive course than other breast cancers and are more likely to recur over the first few years after diagnosis. After 5 years, the likelihood of recurrence decreases.
  • A majority of cases of breast cancer in women with a BRCA-1 mutation (inherited mutation in the breast cancer susceptibility gene-1) are triple-negative.

What is triple-negative breast cancer?

Breast cancer is a malignancy (a collection of cancer cells) arising from the cells of the breast. Triple-negative breast cancer means the cancer does not express three common markers often found on breast cancer cells: the estrogen receptor (ER), progesterone receptor (PR), and a protein involved in cell growth known as HER2. Triple-negative breast cancer makes up about 10%-20% of all breast cancers.

What causes triple-negative breast cancer?

Although there are known risk factors for the development of any kind of breast cancer, doctors do not understand the exact cause of breast cancer. Normal cells become cancer cells due to changes or mutations in the DNA. While people inherit some DNA changes, others acquire these DNA changes during a person's life.

What are causes and risk factors for triple-negative breast cancer?

The following are risk factors for any type of breast cancer, including triple-negative breast cancer:

  • Increasing age
  • Family history of breast cancer
  • Personal history of breast cancer
  • Certain kinds of benign breast disease (atypical hyperplasia)
  • Young age at menstruation or late menopause
  • Dense breast tissue
  • Radiation exposure
  • Having never given birth or giving birth for the first time after age 30
  • Overweight and obesity
  • Postmenopausal hormone therapy use
  • Alcohol consumption
  • Genetic risk factors (BRCA-1 and BRCA-2 mutations)

Unlike most breast cancer, which is more common in Caucasian women, triple-negative breast cancer is more common in African-American and Hispanic women. It is also more likely to occur in younger women. About 70% of cancers that occur in women with a BRCA-1 mutation are triple-negative.

SLIDESHOW

Breast Cancer Diagnosis and Treatment See Slideshow
A hard, painless lump is the most common sign of triple-negative breast cancer.

Triple-Negative Breast Cancer

Breast Lump

There are many causes of breast lumps. Some of these causes are harmless, while others can be painful and/or dangerous. Causes of breast lumps include infections, injuries, non-cancerous growths, and cancer.

Breast cancer is the second leading cause of cancer-related deaths in women in the United States. Currently, death rates from breast cancer are declining. The decline in death rates may be due to a combination of earlier detection and better screening as well as improved treatments. While most breast lumps are harmless (benign), every breast lump should be evaluated by a doctor to exclude or establish a diagnosis of cancer.

What are triple-negative breast cancer symptoms and signs?

Triple-negative breast cancers may not cause any symptoms at all. When they do cause signs and symptoms, a painless hard mass in the breast is the most common sign.

Other symptoms and signs are less common and can include

What tests and exams diagnose triple-negative breast cancer?

The diagnosis of triple-negative breast cancer requires a sampling of tissue from the breast, known as a breast biopsy. Medical professionals may perform the biopsy using imaging techniques, such as mammography or others, for guidance. If the biopsy shows cancer, they may perform other tests on the biopsy sample (or on a sample of tumor removed surgically) to determine the precise type of cancer. In particular, they commonly perform tests for expression of the estrogen receptor (ER), progesterone receptor (PR), and HER2 protein as a first step. If these tests are all negative, they classify the cancer as triple-negative breast cancer.

What is the staging of triple-negative breast cancer?

Staging is the process of determining the extent of the cancer and its spread in the body. Together with the type of cancer, staging helps determine the appropriate therapy and predict the chances for survival.

To determine if the cancer has spread, medical professionals may use several different imaging techniques, including X-ray, CT scans, bone scans, and PET scans. Staging depends upon the size of a tumor and the extent to which it spread to lymph nodes or distant sites and organs in the body. Examination of lymph nodes removed at surgery and the results of ER, PR, and HER2 tests performed on the tumor tissue also help determine the stage of a tumor. Stage I is the lowest stage, while stage IV is the highest stage and refers to tumors that have metastasized, or spread to areas distant from the breast.

SLIDESHOW

Breast Cancer Diagnosis and Treatment See Slideshow

What is the treatment for triple-negative breast cancer?

Most doctors specifically adjust breast cancer treatments to the type of cancer and the staging group.

Surgery

Many women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer consist of breast-conserving surgery (lumpectomy, or partial removal of the breast) and mastectomy (complete removal of the breast).

Radiation therapy

Radiation therapy destroys cancer cells with high-energy rays. Doctors commonly administer radiation therapy to patients after breast cancer surgery, most commonly after lumpectomy.

Chemotherapy

Doctors typically recommend chemotherapy for the treatment of triple-negative breast cancers larger than 0.5 cm. Unlike cancers that express hormone receptors (ER and PR) or HER2, anti-hormonal therapy or HER2-targeted therapy is not effective. Medical professionals administer chemotherapy treatments by intravenous injection or by mouth.

Types of chemotherapy include the following:

  • Adjuvant chemotherapy is chemotherapy given after surgery to remove the cancer or after mastectomy.
  • Neoadjuvant chemotherapy is chemotherapy given before surgery. Although there seems to be no advantage to long-term survival whether a patient receives the therapy before or after surgery, it may be advantageous in some cases to give the chemotherapy before surgery to see if the cancer responds and to shrink the cancer before surgical removal.
  • Chemotherapy for advanced cancer: If the cancer has metastasized to distant sites in the body, chemotherapy can be used for treatment. The immunotherapy medicine atezolizumab (Tecentriq) in combination with the chemotherapy medicine Abraxane is also used for some cases of metastatic triple-negative breast cancer.

Other therapies for triple-negative breast cancer

In March 2019, the U.S. Food and Drug Administration (FDA) approved a new combination therapy for metastatic triple-negative breast cancer consisting of a combination of an immunotherapy drug and chemotherapy.

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What is the survival rate (prognosis) for triple negative breast cancer?

Survival rates are a way to discuss the prognosis and outlook of a cancer diagnosis. The number most frequently mentioned is 5-year survival. Many patients live much longer, and some die earlier from causes other than breast cancer. With a constant change and improvement in therapies, these numbers also change. Current 5-year survival statistics are based on patients who were diagnosed at least 5 years ago and may have received different therapies than are available today.

Below are the statistics from the National Cancer Institute's SEER database for survival of all patients with breast cancer, by tumor stage:

Stage5-Year Survival Rate
I100%
II93%
III72%
IV22%

Patients with triple-negative breast cancer tend to have a worse prognosis, although the American Cancer Society does not report specific survival statistics in their patient materials for people with triple-negative breast cancer. One study in 2007 showed that 77% of women with triple-negative breast cancer survived for at least 5 years, compared with 93% of women with other types of breast cancer. A 2009 study of a smaller number of patients did not show a difference in survival between the types of breast cancer. Recent research focused on looking at the group of triple-negative breast cancers to try to identify subtypes of this group that may have a more favorable prognosis. While survival rates for many people with the disease may be somewhat lower, with effective treatments, the majority of people with triple-negative breast cancer will survive without recurrence of disease.

What is the recurrence rate for triple negative breast cancer?

  • The chances that a triple-negative breast cancer will recur, or come back after treatment, are greater than with other breast cancers.
  • This risk of recurrence is greatest at about 3 years after diagnosis.
  • Recurrences in the early years are more likely to occur in the lungs or brain and less commonly in the bones than other types of breast cancers.
  • However, the risk of late recurrence after 5 years is more common with other types of breast cancer and is less common for people with triple-negative cancer.

Is it possible to prevent triple-negative breast cancer?

There is no guaranteed way to prevent breast cancer, but modifying your lifestyle risk factors (exercising, maintaining a healthy body weight, etc.) can help decrease the risk. Following the American Cancer Society's guidelines for screening and early detection can help with identifying cancers at an early stage when treatment is most effective.

Women with a strong family history of breast cancer should undergo genetic testing. In some cases, the use of medications or surgery may be considered for the prevention of breast cancer in high-risk women, after consultation with a health care professional and a meeting with a genetic counselor.

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Medically Reviewed on 7/18/2019
References
American Cancer Society. "Breast cancer." <https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis.html>.

BreastCancer.org. "Triple negative breast cancer." March 13, 2019. <https://www.breastcancer.org/symptoms/diagnosis/trip_neg>.

Susan G. Komen Foundation. "Triple negative breast cancer." <https://ww5.komen.org/BreastCancer/TripleNegativeBreastCancer.html>.
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