What Is Triple-Negative Breast Cancer?

If you have triple-negative breast cancer, it’s important to know that doctors have several treatments to manage it.

The name may sound a little scary when you first hear it, but it’s really just a way for doctors to know what’s causing your cancer. "Triple negative" means it isn’t fueled by any of the three main things -- the hormones estrogen and progesterone and a protein called HER2 -- that drive other forms of the disease. And knowing that helps them figure out how to treat you.

That’s important because triple-negative breast cancer is more aggressive than other forms. It’s more likely to spread beyond your breast, and there’s a higher chance it will come back within the first 3 years after treatment. It’s also more likely to be fatal within the first 5 years. But once you pass those milestones, your odds of beating it are about the same as someone with any other type of breast cancer.

One other thing about this kind of cancer: It doesn’t respond to some of the medications that work for other types. But that doesn’t mean it can’t be treated. Once you’re diagnosed, your doctor will work with you to decide the best treatment plan.

Causes of Triple-Negative Breast Cancer

Doctors aren't sure what makes you more likely to get this type. Not many women do -- it only affects about 10% to 20% of those who have breast cancer. You're most at risk if you:

  • Are African-American or Latina
  • Are young
  • Have an abnormal change in the BRCA1 breast cancer gene (your doctor might call this a "mutation")

Triple-Negative Breast Cancer Symptoms

The signs are often the same as those of other kinds, including:

  • A lump or mass in the breast
  • Breast pain or redness
  • A nipple that turns inward or has a discharge

Getting a Diagnosis

There's no way to know which type you have until you’re tested by a doctor. When doctors find an area in your breast that isn’t normal, they’ll cut out a little bit of the tissue to test the cells. This is called a biopsy.

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A doctor called a pathologist will look at your biopsied tissue under a microscope. The structure will tell him if the cells are normal, precancerous, or cancerous. If it’s cancer, he’ll do more tests to figure out the exact kind. If your cells don’t test positive for estrogen, progesterone, or HER2 receptors, then it’s triple-negative. It might take a couple of weeks to get biopsy results.

The doctor will also “stage” your cancer. That’s what they call it when they figure out how much of it there is and where it’s located in your body.

Questions for Your Doctor

  • What medications do you recommend?
  • What stage is my cancer -- has it spread to lymph nodes (glands near the breast) or other areas?
  • Should I have chemotherapy before or after surgery?
  • What type of surgery will I need?
  • Will I need radiation treatments?

Treatment

Other types of breast cancer respond to drugs that affect the hormone or protein driving them. This is called targeted treatment. There isn’t one yet for triple-negative breast cancer, but research is underway to find one. What doctors use most right now is a combination of chemotherapy, surgery, and radiation.

Chemotherapy, a medicine that kills cancer cells, will likely be the first thing your doctor tries. You can get it by a needle into a vein or in a pill. When it’s caught early, this type of cancer may respond better to chemo than others do. 

If you have a large tumor and your doctor wants to operate, he may tell you to have chemo first. This may shrink the growth and make the operation easier. You might hear this called neoadjuvant therapy. Or he may operate first, then follow up with chemotherapy.

Surgery can be one of two types. Many doctors think that because this type of cancer is aggressive, it’s best to do a mastectomy to remove the entire breast. This tends to happen if:

  • You have several tumors
  • The cancer is in your skin
  • You have a tumor in your nipple
  • You already had cancer in that breast
  • The tumor is large
  • There are calcium deposits or other abnormal cells in your breast

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But there hasn’t been a lot of research on the subject. Your doctor may decide it’s OK to do a lumpectomy and remove only the tumor and the tissues around it.

Radiation is often used after surgery to kill any cancer cells still in the area. The goal is to stop the cancer from coming back. It’s more common after a lumpectomy.

Think about a clinical trial. With so much research on new treatments, it’s a good idea to ask your doctor if this might be right for you. Clinical trials help scientists test new drugs to see if they’re safe and if they work. It's often a good way to get a new medicine that isn't available to everyone.

Taking Care of Yourself

After your treatment is over, your doctor will want to see you often to make sure the cancer doesn't return. For the first 3 years, you'll likely see him every 3 to 6 months. For 2 years after that, you'll probably visit every 6 to 12 months. Once you've been cancer-free for 6 years, you'll probably go back only once a year. Tell the doctor right away if you develop any new symptoms or if you have pain or other problems that relate to your breasts.

What to Expect

Treatment may make triple-negative breast cancer go away. It depends on the size of your tumor, how quickly your cancer grows, and whether the cancer has spread to the lymph nodes or other parts of your body. The treatments may cause side effects like nausea, vomiting, pain, fatigue, or mental fuzziness (which is sometimes called “chemo brain”).

Although triple-negative breast cancer is more likely to return to another part of your body than other forms, the risk that this will happen drops over time. Five years after diagnosis, about 77% of triple-negative breast cancer patients are still alive.

Getting Support

No one will understand what you’re going through better than someone else who has this type of breast cancer. In addition to information about the disease, organizations like the American Cancer Society (www.cancer.org) and the Triple Negative Breast Cancer Foundation (www.tnbcfoundation.org) can connect you with support groups. You can also check online for groups that meet locally, either through a church or community center.

And don’t forget to tell the people around you what’s going on -- and to ask for help when you need it. It’s up to you who you tell and when, but the more you share with family and friends, the better equipped they’ll be to lend a hand when you need it.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on December 17, 2017

Sources

SOURCES:

Triple Negative Breast Cancer Foundation: “Understanding Triple Negative Breast Cancer.”

Breastcancer.org: “How Triple-Negative Breast Cancer Behaves and Looks.”

Anders, C. 100 Questions & Answers About Triple Negative Breast Cancer, Jones & Bartlett Learning, 2012.

American Cancer Society: “Cancer Staging.”

Medscape: “First-line Treatment of Triple-Negative and Basal-Like Breast Cancers.”

National Breast Cancer Foundation: “Triple Negative Breast Cancer.”

BreastCancer.org: “Treatment for Triple Negative Breast Cancer.”

Triple Negative Breast Cancer Foundation: “Guide to Understanding Triple Negative Breast Cancer,” “Survivorship.”

American Cancer Society: “Signs and symptoms of breast cancer,” “How is breast cancer classified?” 

Susan G. Komen: “Facts for life: Triple negative breast cancer.”

Stanley Lipkowitz, MD, PhD, chief, Women's Malignancies Branch; senior investigator, National Cancer Institute Center for Cancer Research.

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