Triple negative breast cancer

Triple negative breast cancer is a type of breast cancer that does not have receptors for the hormones oestrogen and progesterone or the protein HER2. You will have a small piece of breast tissue removed (biopsy) to test for the receptors.

Triple negative breast cancer is more common in women under 40 and black women. Some women with triple negative breast cancer have a faulty BRCA1 gene.

Staging (the size of the cancer and how far it’s spread) for triple negative breast cancer is the same as for other breast cancers. Tests also show how quickly the cancer is likely to grow (grading). There are three grades of triple negative breast cancer.

Treatment usually combines surgery, radiotherapy and chemotherapy. The surgery you have depends on the size and position of the cancer. You may have part of your breast removed (lumpectomy) or the whole breast (mastectomy). If you have a mastectomy, your doctor will talk to you about possible breast reconstruction.

Radiotherapy and chemotherapy may be given to reduce the risk of cancer coming back. Chemotherapy is given after surgery, or before surgery to shrink a cancer.

What is triple negative breast cancer?

Triple negative breast cancer is a rare type of breast cancer.

Many breast cancers have receptors on the surface of the cancer cells for the hormones oestrogen and progesterone, and less commonly for a protein called HER2. These receptors can stimulate the cancer to grow. After a biopsy or surgery, the tissue that is removed is tested for the receptors.

If you have a breast cancer that doesn’t have any oestrogen, progesterone or HER2 receptors, this is called triple negative breast cancer.

Triple negative breast cancer is found in about 1 in 5 women with breast cancer (15 to 20%). It occurs more commonly in women under the age of 40 and in black women.

Your doctor will use the information about the receptors to help plan your treatment. 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®).

Women with triple negative breast cancer don’t benefit from treatment with hormonal therapy or the targeted therapy drug Herceptin. Chemotherapy is more effective for women with triple negative breast cancer.

Basal cell breast cancer

The term basal cell breast cancer is often linked with triple negative breast cancer. It is a type of breast cancer that is identified when the cancer cells are examined under the microscope. Basal cancers are usually triple negative. And most triple negative breast cancers are basal cell cancers.


Causes and risk factors of triple negative breast cancer

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.


How triple negative breast cancer is diagnosed

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

Stage

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.

Grade

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

Triple negative breast cancer is often treated with a combination of surgery, radiotherapy and chemotherapy.


Surgery for triple negative breast cancer

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.

Wide local excision (breast conserving surgery)

The surgeon removes only the cancer and some of the normal looking tissue all around it (the margin). This is called a wide local excision (WLE).

You will need to have radiotherapy after a WLE to make sure any remaining cancer cells are treated.

The operation removes the least amount of breast tissue, but leaves a small scar and sometimes a small dent in the breast. After a WLE, most women are pleased with the appearance of their breast.

Removing the 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.

Breast reconstruction

If you are having a mastectomy, your surgeon will usually ask if you want a new breast shape made at the same time (immediate breast reconstruction). You can also choose to delay reconstruction until after you’ve completed treatments such as radiotherapy and chemotherapy.

Breast reconstruction is specialised surgery carried out either by a plastic surgeon or oncoplastic surgeon (experts in breast cancer surgery and reconstruction). There are different methods of reconstruction. Your doctor or breast care nurse will discuss them with you.

Surgery to 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 for triple negative breast cancer

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 WLE, 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, Monday to Friday, with a rest at the weekend. Each treatment takes 10 to 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, breast care nurse or radiographer (who gives the radiotherapy) will talk to you about 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 begin to disappear once your treatment has finished.


Chemotherapy for triple negative breast cancer

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. This is 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 for triple negative breast cancer

Targeted therapies (sometimes called biological 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 – clinical trials for triple negative breast cancer

Research trials are trying to find new and better treatments for triple negative breast cancer. Your doctor may ask you to take part in a research trial.

If you decide to take part in a trial, your doctor will discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. You may decide not to take part or to withdraw from a trial at any stage. You will then receive the best standard treatment available.


Your feelings

You may have many different emotions, including anger, resentment, guilt, 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.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.


Follow-up after treatment for triple negative breast cancer

After your treatment, you are likely to have regular follow-up for a few years. Your doctor or breast care nurse will discuss this with you.

Your appointments are a good opportunity to talk to your doctor or breast care nurse about any concerns you may have. If you notice any new symptoms or are worried about anything in between appointments you will be told how you can contact your doctor or nurse for advice.


After treatment for triple negative breast cancer

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.