Causes and risk factors

 

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

 

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

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. 

 

Radiation

Radiation 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 may also have radiation to the remaining breast tissue to reduce the risk of the cancer coming back in that area. Some women who have a mastectomy have radiation to the chest.  

The treatment is normally given 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 radiation for breast cancer can lasts up to six weeks. Your cancer doctor will discuss the treatment and possible side effects of radiation with you.

 

Radiation 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 may 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.

 

Chemotherapy

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 will either 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 it is not known 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 Adriamycin, Ellence, and Doxil). 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

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.