Triple Negative Breast Cancer

Triple-negative breast cancer (TNBC) affects approximately 15% of all breast cancer patients and presents unique challenges in treatment and management. This comprehensive article explores the causes, symptoms, and stages of triple-negative breast cancer, along with current treatment approaches and prevention methods. You will also learn about diagnostic procedures, available triple-negative breast cancer treatments, and essential factors influencing survival rates and recovery outcomes.

What is Triple Negative Breast Cancer?

Triple-negative breast cancer represents a distinct, aggressive, and challenging form of breast cancer characterised by the absence of three specific receptors on cancer cells. When pathologists test breast tumours, they specifically look for proteins that can fuel cancer growth. Breast cancer receives the triple-negative diagnosis when the cancer cells test negative for:

• Oestrogen receptors (ER)
• Progesterone receptors (PR)
• Human Epidermal Growth Factor Receptor 2 (HER2)

This unique characteristic makes triple-negative breast cancer particularly challenging to treat, as the cancer cells lack the common targets that most breast cancer treatments aim for. 

Causes and Risk Factors of Triple Negative Breast Cancer

Genetic factors play a crucial role in TNBC development. The most significant genetic link is the presence of BRCA1 gene mutations, with approximately 70% of breast cancers in women with BRCA1 mutations being triple negative. A smaller percentage of cases are associated with BRCA2 mutations.

Several demographic and personal factors increase TNBC risk:

• Age under 40 years
• African American or Hispanic ethnicity
• Family history of breast cancer
• Dense breast tissue
• Previous radiation exposure
• Extended use of birth control pills (more than 10 years)
• Exposure to certain chemicals, including polychlorinated biphenyl (PCB)
• Obesity in postmenopausal women 
• Lack of physical activity

Symptoms of Triple Negative Breast Cancer

Many cases are discovered during routine mammograms before physical symptoms become apparent.

Patients with TNBC may experience various physical changes in their breast tissue. The following are some common symptoms of TNBC:

• A new lump or mass in the breast
• Changes in breast size or shape
• Swelling in part or all of the breast
• Skin dimpling or pitting (creating an "orange peel" texture)
• Breast pain or warmth
• Redness or thickening of breast skin
• Swollen lymph nodes under the armpit or closer to the collarbone
• Changes in nipple appearance, including:
  • Inversion (turning inward)
  • Discharge (not breast milk)
  • Flaking or peeling skin
  • Pain or tenderness 

What are the Different Stages of Triple Negative Breast Cancer?

Oncologists utilise the TNM staging system, which stands for Tumour, Node, and Metastasis. It helps medical teams develop appropriate cures for triple-negative breast cancer.

The five main stages of TNBC are:

• Stage 0: Cancer cells remain confined to breast ducts and haven't become invasive
• Stage I: Small tumours (less than 2 centimetres) with no lymph node involvement
• Stage II: Tumours between 2-5 centimetres that may affect nearby lymph nodes
• Stage III: Regional advanced cancer that has spread to surrounding tissues and lymph nodes
• Stage IV: Tumour has spread to distant organs such as lungs, liver, bones, or brain

The 5-year relative survival rates for triple-negative breast cancer vary by stage. 

• For localised cancer (confined to the breast), the survival rate is 91%. 
• Regional spread cases show a 66% survival rate
• Distant spread cases have a 12% survival rate.

Complications

Managing complications presents one of the biggest challenges in triple-negative breast cancer (TNBC) treatment. The unique characteristics of this cancer type create specific challenges that patients and doctors must address throughout the treatment journey.

TNBC demonstrates several distinct complications:

• More rapid growth and spread compared to other breast cancers
• Higher likelihood of spreading at initial diagnosis
• Limited treatment options due to lack of hormone receptors
• Increased possibility of recurrence, especially in the first 5 years
• Tendency to spread to specific organs, including the brain, liver, and lungs
• Lower survival rates after recurrence compared to other breast cancer types

Diagnosis

The diagnosis involves two main steps:

• Initial Imaging Tests:
  • Mammogram: Uses low-dose radiation to create detailed breast images
  • Breast Ultrasound: Helps distinguish between fluid-filled cysts and solid tumours
  • Magnetic Resonance Imaging (MRI): Particularly useful for high-risk patients and early detection
• Biopsy: It is done to collect tissue samples. These samples undergo immunohistochemistry (IHC) testing, which examines the cancer cells for three specific proteins: oestrogen receptors, progesterone receptors, and HER2 protein. A diagnosis of triple-negative breast cancer is confirmed when all three tests return negative results.

Treatments for Triple Negative Breast Cancer

Treatment options for triple-negative breast cancer have evolved significantly, with doctors now employing multiple approaches to combat this aggressive form of breast cancer. The treatment strategy typically combines several methods to achieve the best possible outcomes.

Doctors typically recommend the following primary treatment approaches:

• Chemotherapy: Remains the cornerstone of TNBC treatment, often administered before surgery to shrink tumours and after surgery to eliminate remaining cancer cells
• Surgery: Including breast-conserving surgery or mastectomy, depending on tumour size and location
• Radiotherapy: Used after surgery to target any remaining cancer cells
• Immunotherapy: Certain drugs help the immune system recognise and fight cancer cells
• Targeted Therapy: Specific medications for patients with certain genetic mutations, including PARP inhibitors for those with BRCA mutations

When to See a Doctor

Medical attention becomes immediately necessary when patients experience:

• Fever above 38.05°C (100.5°F)
• Persistent chills
• Productive or wet cough
• Severe stomach pain
• Continuous diarrhoea
• Ongoing nausea and vomiting

Prevention

While there is no guaranteed way to prevent triple-negative breast cancer, research suggests that certain lifestyle modifications may help reduce the risk. 

Key preventive measures include:

• Maintaining a healthy body weight through proper nutrition
• Engaging in regular physical activity
• Limiting or avoiding alcohol intake
• Monitoring breast health through regular screenings
• Considering genetic testing if there is a family history of cancer
• Including herbal tea consumption as part of a healthy lifestyle

Conclusion

Knowledge empowers patients to take control of their breast health through regular screenings and lifestyle modifications. Simple changes like regular exercise, healthy eating habits, and prompt medical attention when symptoms arise can make a significant difference in outcomes. Patients who understand TNBC's characteristics and risk factors are better equipped to work with their oncologists, leading to more effective treatment strategies and improved quality of life during their cancer journey.

FAQs

1. How common is triple-negative breast cancer?

Triple-negative breast cancer (TNBC) accounts for 10-15% of all breast cancer diagnoses. This translates to approximately 15 out of every 100 breast cancer cases. The condition affects thousands of individuals annually, with higher prevalence rates among certain demographic groups (African American or Hispanic people).

2. Can you fully recover from triple-negative breast cancer?

Recovery rates vary and depend on the stage of diagnosis. The 5-year relative survival rates are:

• 91% for localised cancer (confined to the breast)
• 66% for regional spread
• 12% for distant spread

3. What not to eat with triple-negative breast cancer?

Dietary recommendations suggest limiting foods that may impact treatment effectiveness. Research indicates avoiding:

• High-fat processed foods
• Excessive red meat consumption
• Foods high in added sugars

Instead, patients should focus on a diet rich in omega-3 fatty acids, fruits, vegetables, and whole grains.

4. What is the root cause of triple-negative breast cancer?

Scientists have identified faulty BRCA1 genes as a significant contributor to TNBC development. When functioning properly, these genes help prevent cancer development. However, mutations can make cells susceptible to genetic alterations, leading to cancer formation.

5. Who gets triple-negative breast cancer?

TNBC predominantly affects specific demographic groups:

• Women under 40 years of age
• Black and Hispanic individuals
• People with BRCA1 gene mutations
• Those with obesity after menopause

6. Does triple-negative always come back?

While TNBC has a higher recurrence rate than other breast cancers, it doesn't always return. Approximately 40% of patients with stage 1-3 TNBC experience recurrence, typically within the first three years after treatment. The risk of recurrence decreases significantly after the five-year mark.

Dr. Satish Pawar

MBBS, MS (General Surgery), DNB (Surgical Oncology), FMAS, FAIS, MNAMS, Fellowship GI Oncology
CARE Medical Center, Tolichowki, Hyderabad, CARE Hospitals, HITEC City, Hyderabad, CARE Hospitals, Banjara Hills, Hyderabad

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