People are often surprised to learn that breast cancer isn’t a single disease, but made up of several sub-types. Individual cancer cells contain surface proteins that respond to signals within the body to cause cancer to grow.Some cancer grows in response to the hormones estrogen or progesterone. They’re called ER/PR+ cancers. Other cancers grow in response to a protein called HER2/neu, and are called HER2+ cancer. One of these subtypes is called triple negative breast cancer (TNBC).
About 10-20% of breast cancers test negative for both hormone receptors and HER2 in the lab, which means they are triple-negative. Since hormones are not supporting its growth, the cancer is unlikely to respond to hormonal therapies, including tamoxifen, Arimidex (chemical name: anastrozole), Aromasin (chemical name: exemestane), Femara (chemical name: letrozole), and Faslodex (chemical name: fulvestrant). Triple-negative breast cancer also is unlikely to respond to medications that target HER2, such as Herceptin (chemical name: trastuzumab) or Tykerb (chemical name: lapatinib).
In addition, triple-negative breast cancer:
- Tends to be more aggressive than other types of breast cancer. Studies have shown that triple-negative breast cancer is more likely to spread beyond the breast and more likely to recur (come back) after treatment. These risks appear to be greatest in the first few years after treatment. For example, a study of more than 1,600 women in Canada published in 2007 found that women with triple-negative breast cancer were at higher risk of having the cancer recur outside the breast — but only for the first 3 years. Other studies have reached similar conclusions. As years go by, the risks of the triple-negative breast cancer recurring become similar to those risk levels for other types of breast cancer.
Five-year survival rates also tend to be lower for triple-negative breast cancer. A 2007 study of more than 50,000 women with all stages of breast cancer found that 77% of women with triple-negative breast cancer survived at least 5 years, versus 93% of women with other types of breast cancer. Another study of more than 1,600 women published in 2007 found that women with triple-negative breast cancer had a higher risk of death within 5 years of diagnosis, but not after that time period. The recurrence and survival figures in these and other studies are averages for all women with triple-negative breast cancer. Factors such as the grade and stage of the breast cancer will influence an individual woman’s prognosis.
- Tends to be higher grade than other types of breast cancer. The higher the grade, the less the cancer cells resemble normal, healthy breast cells in their appearance and growth patterns. On a scale of 1 to 3, triple-negative breast cancer often is grade 3.
- Triple Negative Breast Cancer grows rapidly, often has a higher grade and tends to metastasize (spread). Because the cancer grows quickly, its often discovered by the patient between mammograms.
- The fast growth rate means that the standard chemotherapies have a good chance of inducing remission. Triple Negative has a much better response to conventional chemotherapy than other breast cancer subtypes.
- Recurrence, sometimes called relapse, is the return of breast cancer. Breast cancer can recur locally in breast or scar tissue, or distantly in other parts of the body including bones or organs. Cancer that occurs distantly is considered metastatic cancer and is very difficult to arrest, although it’s not untreatable.
- TNBC cases that recur more frequently affect soft tissues and organs such as the lung and brain, rather than bones. It’s important to remember that most people with TNBC don’t have a metastatic recurrence.
- Usually is a cell type called “basal-like.” “Basal-like” means that the cells resemble the basal cells that line the breast ducts. This is a new subtype of breast cancer that researchers have identified using gene analysis technology. Like other types of breast cancer, basal-like cancers can be linked to family history, or they can happen without any apparent family link. Basal-like cancers tend to be more aggressive, higher grade cancers — just like triple-negative breast cancers. It’s believed that most triple-negative breast cancers are of the basal-like cell type.
It can feel upsetting and even scary to find out that you have a form of breast cancer that (1) is often more aggressive than other types and (2) isn’t a good candidate for treatments such as hormonal therapy and Herceptin. But triple-negative breast cancer can be treated with chemotherapy and radiation therapy, and new treatments — such as PARP inhibitors — are showing promise. Researchers are paying a great deal of attention to triple-negative breast cancer and working to find new and better ways to treat it. “This is an exceptionally hot area of research in the breast cancer field,” says George Sledge, M.D., medical oncologist and Breastcancer.org Professional Advisory Board member. “There is immense interest among drug developers, pharmaceutical companies, and breast cancer laboratory researchers in finding targeted therapies for these patients.”
Hidden Benefit
The risk of recurrence for TNBC is greatest within the first three years and declines rapidly after five years. Therefore, there are no long post-therapy regimens. That suggests a hidden benefit: a shortened treatment course. Women with early-stage, slow-growing ER+ cancers are often in treatment for 10 years or more.
Links
