Triple Negative Breast Cancer: Why this is different?

If you have been told you have triple negative breast cancer, you might not understand what that means with regard to the treatment you will get and your prognosis.  Triple negative breast cancer is in a class by itself because the treatment is different.   

First let’s look at what the term “triple negative” means.  There are three tumor markers that all breast cancers are tested for.  Most breast cancer patients know what these markers are.  Tumors are tested for estrogen receptors and progesterone receptors and for overexpression of HER2 receptors.  The estrogen and progesterone receptors determine whether or not your cancer’s growth is hormone dependent and hence whether or not you will be treated with hormone blockers.  The HER2 status determines whether or not you will receive a year’s worth of a therapy called Herceptin or some other HER2 blocker.  Triple negative tumors do not have the hormone receptors or an overexpression of the HER2 receptors and therefore will not be treated with hormone therapy or anti-HER2 therapy.

Triple negative tumors tend to be more aggressive than other breast cancers.  They are usually high grade which means that they look more like a cancer cell than a normal breast cell. The good news, however, is that they are very responsive to chemotherapy. For this reason, women with triple negative breast cancer may receive chemotherapy before surgery. Here are some of the advantages to getting the chemotherapy up front:

  • Oncologists can see how the tumor responds to chemotherapy and switch therapies if necessary
  • It may allow larger tumors to shrink enough that they can be treated with a lumpectomy instead of a mastectomy
  • It gets systemic therapy (meaning therapy that goes throughout the body) started right away 

Because these tumors are more aggressive than other breast cancers, the survival for the first five years is not as good.  However, once patients pass the five year mark, survivals tend to even out with other breast cancers. 

 In addition, these tumors tend to occur in younger women, and there is a higher incidence in African American women.  BRCA genetic mutations are also more common in young patients with triple negative cancer so testing for that genetic mutation should be considered in this group of patients.

 Triple negative tumors are in a separate category of breast cancers because both their treatment and prognosis are different.  They do not respond to anti-hormone or anti-HER2 therapies, but they are very responsive to chemotherapy.  Survival with triple negative cancer is not as good for the first five years, which is why treatment tends to be more aggressive.  Triple negative cancer also occurs more commonly in young women and African American women and is associated with the BRCA genetic mutation.

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