Questions for your Breast Surgeon and Medical Oncologist:
- What exactly is triple negative breast cancer?
- Will I need Chemotherapy?
- What are the benefits of Neoadjuvant Chemo?
- Isn’t Neoadjuvant Chemo recommended more now?
- Do I qualify for BRCA genetic testing?
- Should I consider a Clinical Trial?
What is “Triple Negative” breast cancer?
“Triple Negative” breast cancers are fast growing tumors that more frequently spread beyond the breast to other parts of the body. Because of this, they are a bigger threat to your life than most other types of cancers of similar size with a different receptor pattern. These cancers are called “triple negative” because the three most important breast cancer “receptors” on the surface of the cells are not present (negative). When present, these receptors are used as targets to attack the cancer with medications. When absent, the main medical therapy is chemotherapy.
Your Breast Surgeon will know your “receptor pattern” within days after your initial breast biopsy. These results are often not communicated to you early on in your decision process. Although only 15% of breast cancers are “triple negative,” it is imperative that you specifically ask your surgeon immediately, and well before surgery, “What are my receptor results?” Take our video lesson on “MyTumor Receptors” to learn more.
“Triple Negative” is treated with Chemotherapy
These cancers are often sensitive to chemotherapy and it is offered to almost everyone healthy enough to tolerate it. Chemotherapy is obviously a more intense cancer treatment than hormonal therapy (pills). But unfortunately, since triple negative cancers do not have “Estrogen receptors” (ER negative), hormonal therapy is not helpful at all. The time to cure triple negative cancer is now, not when it recurs later. Chemotherapy and surgery is the standard for treating triple negative breast cancer. You will make better treatment choices when you are well informed about treating triple negative breast cancer before meeting with your medical oncologist.
Ask about the benefits of “Neoadjuvant Chemo”
What is often overlooked are the benefits of offering neoadjuvant chemotherapy for patients with triple negative, “Early-Stage” (I & II) breast cancer. There may be distinct advantages (listed below) to having chemotherapy before surgery, not after surgery if you have a triple negative tumor. The decision to consider neoadjuvant chemotherapy always begins with your breast surgeon. Breast surgeons choose the initial direction of your entire breast cancer treatment plan. You must address this “cutting edge” treatment option well before surgery to benefit from neoadjuvant chemotherapy. Do not be afraid to ask. This is a very important question. Take our video lesson on “Neoadjuvant Chemotherapy” to better understand this treatment approach.
The Potential Benefits of Neoadjuvant Chemo:
- Begin life-saving chemotherapy earlier
- Reduce the need for a mastectomy
- Improve cosmetic outcomes with a lumpectomy
- Reduce the need for an “Axillary Dissection”
- Allows more time for BRCA genetic testing
- More time to think about “lumpectomy vs. mastectomy”
- Shows your cancer team if the chemo is working
- Can sometimes eliminate all cancer cells before surgery
- May reduce the need for radiation after a mastectomy
Ask for BRCA Genetic Testing
Triple negative breast cancers can be associated with inherited genetic mutations. Any woman who has ever been diagnosed with a triple negative breast cancer at age 60 or younger is at a high risk for carrying the BRCA mutation. If you also have a strong family history of breast or ovarian cancer you are at an even higher risk. Unfortunately, genetic testing is often not offered for triple negative breast cancer patients. It is important to ask for BRCA Genetic Testing in this situation.
The BRCA (Breast Cancer) gene is commonly referred to as “The Breast Cancer Gene.” If someone inherits a broken version (mutation) of this gene at conception, they carry a very high lifetime risk of breast cancer and ovarian cancer. Most breast cancers are not the result of the BRCA mutation. In fact, it is estimated that the BRCA and similar genetic mutations cause only 10 to 15% of all breast cancers. Learn more from our video lesson (here) about “BRCA Genetic Testing.”
African Americans are a higher risk for Triple Negative
African American and women of West African descent are at a higher risk of developing triple negative breast cancers than most other ethnic groups. Thirty percent (30%) of all breast cancers in this group are triple negative. This risk can be three times that for white or Hispanic women.
Younger women are at a higher risk for Triple Negative
Women diagnosed with invasive breast cancer before 40 are at a higher risk for having triple negative disease when compared to older women. Their increased risk for having the BRCA genetic mutation accounts for some of this increased risk. Any women diagnosed before the age of 50 qualifies for genetic testing and should consider genetic counselling.
Ask if you would benefit from a Clinical Trial
New therapies must be studied in clinical trials to make sure they are safe and effective at treating breast cancer. Triple negative breast cancers are currently the focus of intense clinical research. New drug treatments are rapidly being developed for this aggressive cancer. Less than 5% of all breast cancer patients are enrolled in clinical trials. Patients with cancer willing to participate in clinical trials are essential for the advancement of breast cancer care. Ask your medical oncologist if they offer or recommend you participate in a clinical trial for your unique “triple negative” breast cancer situation. If you are interested in “Clinical Trials“ take our video lesson (here).
This excellent PDF booklet (here) “Guide to Understanding Triple Negative Breast Cancer” is designed for patients to understand this unique type of breast cancer. It was created by Living Beyond Breast Cancer and the Triple Negative Breast Cancer Foundation.
The “Triple Negative Breast Cancer Foundation” website is a wonderful resource for patients. This organization strives to educate patients, promote advances and provide a community for women with triple negative breast cancer.
Their page (here), “Neoadjuvant Chemotherapy” is a good overview of the topic. This site was created for patients by the American Society of Breast Surgeons.
Download this booklet (here) “Your Guide to the Breast Pathology Report” to understand your pathology report. On page 45-46 of this booklet, there is a list of “Key Questions” and a “Checklist” of key items to find in your report. This non-profit organization provides excellent online and printable patient resources about breast cancer.
This video for patients from Myriad Genetics is an excellent overview about genetic testing, BRCA mutations, and how they are managed.
To view the video click on the image or (here). Myriad Genetics is global leader in genetic testing and personalized medicine.
This article (here) “Most Patients with Triple Negative Breast Cancer Would Benefit from Genetic Testing” is an excellent overview of the subject. The Breast Cancer Research Foundation is a non-profit organization committed to achieving prevention and a cure for breast cancer.
This audio “podcast” (here) is a detailed review on “Triple Negative Breast Cancer and African American Women” from a patient education workshop in 2016. The event was sponsored by the CancerCare Network and Triple Negative Breast Cancer Foundation.
This website is a resource for learning about participating in clinical trials. BreastCancerTrials.org is a non-profit service that encourages individuals affected by breast cancer to consider participating in clinical trials.
More Detailed References:
Their journal article (here), “Performance and Practice Guidelines for the Use of Neoadjuvant Systemic Therapy in the Management of Breast Cancer” is an overview for physicians about the benefits of neoadjuvant chemotherapy. The document was written by the American Society of Breast Surgeons and published in the Annals of Surgical Oncology.
- NCCN Breast Cancer Clinical Practice Guidelines nccn.org
If you want to get deep into the details, this free 200-page pdf document has guidelines to help clinicians to make treatment recommendations about nearly all aspects of breast cancer. You can easily register (here) as a non-professional to get access.