Pelvic floor physical therapy: 5 questions answered
Triple-Negative Breast Cancer: From Diagnosis To Treatment
If you're like most people, you've likely never heard of triple-negative breast cancer. Or, for that matter, realized there were different types of breast cancer.
As Dr. Prarthna Bhardwaj, a breast medical oncologist at Baystate Regional Cancer Program explains, "There are many types and subtypes of breast cancer. They can be invasive or non-invasive. Factors like these help physicians determine the type of cancer they're dealing with and, more importantly, how it should be treated."
What is Triple-Negative Breast Cancer?Both rare and aggressive, triple-negative breast cancer accounts for 10-15% of all breast cancers. Dr. Bhardwaj says, "TNBC tends to be faster growing. It may often present between mammograms. Its aggressive nature makes it important to begin treatment in a timely manner."
While researchers don't entirely understand what makes TNBC so aggressive, they do understand how it differs from other breast cancers.
"Determining the type of cancer a person has involves looking at the cancer cells to identify different characteristics," explains Dr. Bhardwaj. "Most breast cancer cells have different types of proteins along the edges, called receptors, that allow hormones like estrogen and progesterone to attach and feed the cancer. Another common breast cancer receptor is the HER2, or human epidermal growth factor receptor 2. Like estrogen and progesterone, HER2 feeds cancer and fuels its growth. For most types of breast cancer, treatment targets the identified receptors to help stop or slow the growth of the cancer. Here," she says, "is where TNBC differs. TNBC cells do not have estrogen, progesterone, or HER2 receptors. Hence, the triple-negative name designation."
What are the Risk Factors for TNBC?While people of all ages can develop TNBC, some factors make people more susceptible to the disease. These include:
Mutations in the BRCA1 GeneNormally, the BRCA1 gene helps repair damaged DNA and keep cell growth under control. However, mutations or defects to that gene are associated with an increased risk of breast cancer. Having the BRCA1 gene is associated with an up to 85% lifetime risk of developing TNBC.
AgeTNBC is most common in women and people assigned female at birth (AFAB) in their 40s and 50s, considerably lower than the average age— 62—of non-TNBC breast cancer diagnosis.
RaceCompared to other races, Black and Hispanic women are more likely to develop TNBC.
GeneticsWhile you can't change your genetics or race, there are things you can do to reduce your risk of developing TNBC. These include:
In addition, Dr. Bhardwaj encourages all patients to know their family history as it relates to breast cancer. "If there's any history of breast, ovarian, pancreatic or prostate cancer, talk to your provider about your eligibility for genetic testing, which may inform how often you should be screened for breast cancer and reveal genetic mutations that could increase your risk of TNBC."
Symptoms of TNBCWhile TNBC behaves differently than other breast cancers, its symptoms are the same. They include:
TNBC is often picked up on regular mammograms and/or follow-up ultrasounds.
How is TNBC Diagnosed?As with other forms of breast cancer, a diagnosis is confirmed through a biopsy—removal of breast tissue for examination under a microscope—pathology, in which cells are tested for the estrogen or progesterone receptors and the HER2 protein.
Treatment Options for TNBCAs Dr. Bhardwaj noted, TNBC does not have the receptors present in other types of breast cancers; receptors that make many treatment options so effective for those types of cancer. But that does not mean it's untreatable. In fact, up to 50% of TNBC patients can have their tumors disappear using chemotherapy alone.
And chemotherapy is not the only option.
"Individual treatment plans for TNBC are determined by a number of factors," says Dr. Bhardwaj. "The first being what stage the cancer is in. Like other cancers, TNBC is staged by the number one through four with one indicating it's very early in the disease life and it's very contained and four indicating it's very advanced and has spread outside the breast."
Treatment options for TNBC at the different stages typically include:
Dr. Bhardwaj explains, "Unlike chemotherapy, which is essentially a medicinal cocktail that kills both good and bad cells, antibody-drug conjugates, a new type of treatment for TNBC, targets specific proteins on cancer cells and preferentially dumps chemotherapy into those cells, sparing healthy cells. The result is very promising outcomes for many, many patients."
The latest current five-year survival rates for TNBC, which don't reflect the relatively new introduction of immunotherapy, are as follows:
When it comes to a diagnosis of TNBC, knowledge is power. "Asking questions is the best way to learn what you're up against," says Dr. Bhardwaj. Among the must-ask questions she thinks patients should put to their provider are:
Beyond their provider, patients can tap other resources, including other TNBC patients, for information and support.
"The TNBC Foundation is an amazing resource for patients," says Dr. Bhardwaj. "They have lots of information on treatment options, support groups, publications, and online forums where patients can share experiences and insights about different treatment options, after-surgery tips, palliative care, dealing with family, and more. Much of it is also available in Spanish.
"Locally, Rays of Hope, a program offered through the Baystate Health Breast Network, supports patients throughout their cancer journey and raises much needed funds for clinical trials and other work done at the nearby Rays of Hope Center for Breast Cancer Research."
In addition, Baystate Health lends ongoing support for patients who've completed treatment via the Breast Cancer Survivorship Program.
Dr. Bhardwaj adds, "Breast cancer of any kind is no longer a journey anyone must go through alone. There are a lot of good resources out there—even for cancers as unique as TNBC. Finding answers and support can help you manage every stage of the disease with a clearer mind and help you feel more confident and in control of the decisions you make."
Tips For Making A Thanksgiving Manageable With Cancer
When I felt inclined to spend a holiday alone during breast cancer treatment, I was encouraged to think of ways to make new holidays with my family.
Felicia Mitchell is a survivor of stage 2b HER2-positive breast cancer diagnosed in 2010. Catch up on all of Felicia's blogs here!
I cannot celebrate Thanksgiving without thinking of the year I wanted to cancel it and just curl up into a chair with a book. This was when I was beginning chemotherapy for breast cancer and still working my job while getting used to the roller coaster of experiences. A few days without interacting seemed like a fabulous idea to me.
The idea of any group effort, of any expenditure of mental energy, made me want to get back into bed and pull the covers over my head. Thank goodness my family did not listen to me. Although they would have, if I had been adamant about any choice — they are not bullies. What unfolded instead of a day with me feeling sorry for myself was a day that reminded me why maintaining family ties, even when we feel so tired and unable to connect, is important.
That Thanksgiving worked out well because nobody expected me to do anything. My sister-in-law and brother arrived with a full meal from a chain store, from turkey to pies, augmented by some personal touches like cranberry relish. My sister-in-law and my brother served, washed dishes and brought everything to me. They were in charge, and I accepted pampering.
Also special is the fact that this Thanksgiving Day brought my son, ex-husband and me together as a family, setting a stage for future ways to handle our new normal that coincided with my cancer journey. Our little dog, loving all the attention, enjoyed a special Thanksgiving walk when my son got me out of the house in the afternoon to walk down the road a little bit and back. The cats got some turkey too.
There were only a few pictures taken on that special day. One is of my son and me with Spot. I love the photo not because it is perhaps the last photo of me with all the hair I used to have but because of the look in my son's eyes, a mixture of love and compassionate concern. Another is of me curled sideways into an easy chair, dozing. My brother likes to document everything, not just the jovial moments.
If you are planning a holiday with not only family but also cancer, here are a few tips I learned that Thanksgiving:
These are just a few tips that might allow your Thanksgiving to create a new memory to balance out the harsher memories cancer can sometimes create.
For more news on cancer updates, research, and education, don't forget to subscribe to CURE®'s newsletters here.
Overcoming Hormone Therapy Resistance In Metastatic Breast Cancer
An expert discusses the next steps for patients with metastatic breast cancer after their disease no longer responds to hormone therapy.
When hormone therapy ceases to be effective for ER-positive, HER2-negative metastatic breast cancer, care teams should assess how the cancer cells have adapted and how to treat them accordingly, an expert said.
Over time, cancer cells can evolve and adapt, finding ways to grow and proliferate independently of hormone signals. To address this resistance, healthcare providers may recommend a reevaluation of the cancer, including additional testing to identify any changes in the tumor's biology.
According to the National Cancer Institute, estrogen receptor positive refers to cells that have a protein that binds to the hormone estrogen and require estrogen to grow. HER2 negative refers to cells that minimal to no amount of the protein HER2 on them, and may grow more slowly than those that are considered HER2 positive.
CURE spoke with Dr. Malinda West, who recently co-moderated the CURE® Educated Patient® Updates in Metastatic Breast Cancer event in Madison, Wisconsin. She discussed what are the potential next steps for patients with ER-positive, HER2-negative breast cancer whose disease stops responding to hormone therapy. West is an assistant professor of oncology at University of Wisconsin Carbone Cancer Center in Madison.
Transcript:
Yeah, that's a really tough question, because we try to maximize using endocrine therapy or these targeted therapies based on the cancer DNA, you know, try to leverage these things for as long as we possibly can, because in general, they're less toxic than chemo. Chemo being — it works, it's just nonspecific. So that's where you get all those — you know, get loads of side effects from.
But eventually the natural course of a hormone receptor-positive and HER2-negative breast cancer is eventually, over time and over exposure to treatments, the breast cancer becomes more dysregulated. It becomes where it finds a way to upregulate different cell signaling inside the cancer cell that doesn't rely on the estrogen receptor. And so it becomes tough, but that's exactly you know, — like Dr. [Rubina] Qamar, [the other co-moderator of the event] was saying about retesting the biomarkers and repeating the receptor testing. Sometimes when things just aren't progressing like you would normally expect and it's like this pattern is a little strange, it's a good indication to reevaluate.
For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.
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