Triple negative breast cancer
Triple negative breast cancer is found in about 1 in 5 women with breast cancer (15-20%). This information describes triple negative breast cancer and its symptoms, diagnosis and treatment. It should ideally be read with our general information about breast cancer.
Triple negative breast cancer
Back to top
Women who develop breast cancer under the age of 40 are more likely to have triple negative breast cancer than older women with breast cancer. Black women with breast cancer are more likely to have triple negative breast cancer than white women with breast cancer.
Many breast cancers have receptors for the hormones oestrogen and progesterone, or less commonly for a protein called HER2. These receptors can stimulate the cancers to grow. After surgery, the tissue that is removed from a woman’s breast is tested for receptors.
Women who have breast cancer with hormone receptors are prescribed hormonal treatments, such as tamoxifen or anastrozole. Women with breast cancers that have high levels of HER2 receptors are given a drug called trastuzumab (Herceptin®).
If you have a breast cancer that doesn’t have any oestrogen, progesterone or HER2 receptors, this is called triple negative breast cancer. Women with triple negative breast cancer don’t benefit from treatment with hormonal therapy or Herceptin. Chemotherapy is more effective for women with triple negative breast cancer.
Basal cell breast cancer
Back to top
The term basal cell breast cancer is often linked with triple negative breast cancer. Basal cell is a type of breast cancer that is identified when the cancer cells are examined under the microscope.
Most triple negative breast cancers are basal cell cancer and basal cancers are usually triple negative.
Causes and risk factors
Back to top
The risk factors for triple negative breast cancer aren’t clear. Breast cancers that depend on hormones to grow are linked with risk factors to do with having children, such as how old a woman was when she had her first child. Triple negative breast cancer doesn’t seem to share these risk factors.
Most women with triple negative breast cancer don’t have a strong history of breast cancer in their family (hereditary breast cancer). However, some women with triple negative breast cancer have a faulty gene called BRCA1. This gene is inherited from a parent and can cause breast cancer to run in families. Most breast cancers caused by BRCA1 are triple negative.
Diagnosis of triple negative breast cancer
Back to top
Tests for triple negative breast cancer are the same as tests for any other type of breast cancer. The most important test is removing a small piece of tissue (biopsy) from the breast. The tissue is examined under a microscope for cancer cells. You may also have other tests to find out if the cancer has spread outside the breast.
Staging and grading of triple negative breast cancer
Back to top
The stage of a cancer is based on its size and how far it has spread. This information helps your specialist decide on the most appropriate treatment for you. Triple negative breast cancer is staged in the same way as other types of breast cancer.
The grade of a cancer is how the cancer cells look when they’re examined under a microscope. The grade gives an idea of how quickly the cancer may develop.
There are three grades:
grade 1 (low-grade)
grade 2 (moderate or intermediate grade)
grade 3 (high-grade).
Triple negative breast cancer is often (but not always) high-grade. This means that the cells look more abnormal than a low-grade cancer and grow more quickly. Chemotherapy is often more effective against cells that are faster growing, which is why it’s an important treatment for triple negative breast cancer.
Treatment of triple negative breast cancer
Back to top
Triple negative breast cancer is often treated with a combination of surgery, radiotherapy and chemotherapy.
The type of surgery you have will depend on the size and position of the cancer. You and your breast surgeon will decide which operation is best for your individual situation.
Lumpectomy (wide local excision)
This is the removal of a breast lump, together with some surrounding tissue. A lumpectomy is usually followed by radiotherapy treatment to the remaining breast tissue. This is known as breast-conserving therapy. The operation removes the least amount of breast tissue, but leaves a small scar and sometimes a small dent in the breast. For most women, the appearance of their breast after a lumpectomy is good.
Removal of the whole breast (mastectomy)
In some situations, the surgeon may advise a mastectomy. There are different reasons for this. For example, it may be because the lump is large in proportion to the rest of the breast tissue or because there are several areas of cancer in different parts of the breast. Your surgeon will explain more about this. Some women choose to have a mastectomy.
Checking and removing the lymph nodes
The surgeon usually removes some or all of the lymph nodes in your armpit to check if they contain any cancer cells.
There are different ways of checking and removing the lymph nodes. Some women may have a procedure called a sentinel lymph node biopsy to check the lymph nodes. If the sentinel node (the first node/nodes that lymph fluid from the breast drains into) doesn’t contain cancer cells, you won’t need to have any more nodes removed.
Radiotherapy treats cancer using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It’s usually given after surgery and chemotherapy.
If you’ve had a lumpectomy, you will also have radiotherapy to the remaining breast tissue to reduce the risk of the cancer coming back in that area. Some women who have a mastectomy have radiotherapy to the chest.
The treatment is normally given in the hospital radiotherapy department as a series of short daily sessions, from Monday-Friday, with a rest at the weekend. Each treatment takes 10-15 minutes. A course of radiotherapy for breast cancer usually lasts for three weeks. Your cancer doctor will discuss the treatment and possible side effects of radiotherapy with you.
Radiotherapy to the breast can cause side effects, such as reddening and soreness of the skin. If you are dark skinned, your skin may get darker or have a blue or black tinge. Your doctor can prescribe creams to soothe your skin if it becomes sore and flaky. Usually any skin reaction settles down 2-4 weeks after radiotherapy. You’ll be given advice on how to look after your skin.
You’re likely to feel tired during treatment and this may continue for a month or two after it. Get plenty of rest, but balance this with gentle, regular exercise - such as short walks - which will give you more energy.
Side effects usually gradually disappear once your treatment has finished.
After surgery, chemotherapy is the main treatment for triple negative breast cancer. Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. It’s given to reduce the chance of the cancer coming back, known as adjuvant therapy. It can also be given before surgery to shrink a cancer. This is known as neo-adjuvant therapy.
Women with triple negative breast cancer are usually given chemotherapy even when the cancer is low-grade or hasn’t spread to the lymph nodes in the armpit.
You’ll have the chemotherapy drugs by injection into a vein (intravenously) or as tablets. Chemotherapy into the vein is given as a session of treatment, usually over a few hours. This is followed by a rest period of a few weeks, which gives your body time to recover from the side effects.
Chemotherapy can cause side effects, but many of these can be well controlled and usually improve when treatment is over. Some of the side effects are an increased risk of infection, tiredness, feeling sick (nausea) and hair loss.
Always let your cancer doctor or specialist nurse know about any side effects you have. There are usually ways in which they can be controlled or improved.
The drugs used
Triple negative breast cancer responds well to chemotherapy but we don’t know exactly which drugs are the most effective. Research trials are trying to find out more about this.
The standard chemotherapy for women with early breast cancer includes drugs called anthracyclines (such as doxorubicin or epirubicin). If you have triple negative breast cancer you may also have another type of chemotherapy drug called a taxane. The drugs that are used are docetaxel (Taxotere®) or paclitaxel (Taxol®). Studies have shown that including a taxane gives some women with early breast cancer more protection. But doctors are still trying to find out which group of women is most likely to benefit from this.
Targeted therapies are drugs that work by targeting specific characteristics in cancer cells. They may be given with chemotherapy. Trials are trying to find out more about how helpful targeted therapies are in treating triple negative breast cancer.
Research trials for triple negative breast cancer
Back to top
Research trials are trying to find new and better treatments for triple negative breast cancer.
The Triple Negative Trial (TNT) is for women whose breast cancer has come back or spread after treatment. The TNT trial is trying to find out if the chemotherapy drug carboplatin is better at slowing down the growth of triple negative breast cancer than docetaxel (Taxotere).
You may experience many different emotions, including anxiety and fear. These are all normal reactions and are part of the process many people go through in trying to come to terms with their condition. You may find it helpful to talk things over with your doctor or nurse, or with one of our cancer support specialists. Family members and close friends can also offer support.
After your treatment, you'll need regular check-ups (which will include a physical examination) and mammograms. These check-ups are usually frequent at first but will eventually lessen to once a year.
Your appointments are a good opportunity to talk to your doctor about any concerns you may have. But if you notice any new symptoms or are worried about anything in between appointments you can contact your doctor or nurse for advice.
After treatment for triple negative breast cancer
Back to top
At the end of treatment you may still feel tired. This will gradually improve and it’s important to give yourself time to recover.
You may find that you still have a lot of different feelings and worry about your cancer coming back. This usually gets easier with time as the focus of your life shifts back to the day-to-day things that occupied you before.
Triple negative breast cancer is sometimes described as a faster growing type of breast cancer. But the risk of it coming back depends on the same factors as other types of breast cancer. If triple negative breast cancer doesn’t come back within five years, there may be a lower chance of it coming back compared to some other types of breast cancer.
This information has been compiled using a number of reliable sources, including:
Breast cancer (early & locally advanced): diagnosis and treatment. 2009. National Institute for Health and Clinical Excellence (NICE).
Foulkes W et al. Triple-negative breast cancer. The New England Journal of Medicine. 2010. 363: 1533-4406.
Cleator S, Heller W, Coombes R. Triple-negative breast cancer: therapeutic options. The Lancet Oncology. 2007. Volume 8. Issue 3: 235–244.
Bland K, Copeland E. The Breast: comprehensive management of benign and malignant diseases. 4th edition. 2009. Saunders. Philadelphia.
With thanks to Professor Andrew Tutt, Consultant Clinical Oncologist; and all the people affected by cancer who reviewed this information. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.