An oncologist explains what makes this subtype unique.
Although awareness of breast cancer has grown immensely in the 21st century, most people might be inclined to think of breast cancer as one single disease that affects everyone the same. Unless you or someone you know has had breast cancer, you might not realize that there are different types of breast cancer with unique qualities, all of which must be considered when choosing the appropriate treatment.
One category of breast cancer is triple-negative breast cancer (TNBC). To classify the type of breast cancer, doctors look for specific receptors on the surface of the cancer cells, according to Amy Tiersten, MD, oncologist at the Dubin Breast Center at Mount Sinai Hospital in New York City. These receptors fuel the growth of the breast cancer.
“There are three possible receptors,” says Dr. Tiersten. “Think of [receptors] as baseball mitts that sit on the surface of the cell. There are hormone receptors, estrogen and progesterone, and then there’s a protein called HER2.”
For example, some breast cancers will have estrogen receptors, which would be called a hormone receptor-positive breast cancer, while others might have HER2 receptors, which would be called a HER2 receptor-positive breast cancer.
“A triple-negative breast cancer just means that none of those three receptors are present,” says Dr. Tiersten. “[It’s] not that it’s triply bad, but that there are three possible receptors which are absent on those cells.”
Knowing which receptors are present on the cancer cells is important because it greatly impacts treatment options. Because the receptors impact cancer growth, therapies can target the receptors to shrink or eliminate breast cancer tumors.
Here’s how receptors on breast cancer cells influence treatment decisions:
Hormone receptor-positive breast cancer (which contain estrogen or progesterone receptors on the breast cancer cells) can be treated with hormone therapy.
HER2 receptor-positive breast cancer can be treated with targeted therapy for breast cancer that specifically goes after HER2 proteins.
Triple-negative breast cancer does not respond to neither hormone therapy nor targeted therapy because it is lacking all three receptors. It does, however, respond to chemotherapy better than other types of breast cancer. Learn more about treating triple-negative breast cancer here.
TNBC accounts for “about 15 to 20 percent of all breast cancers,” says Dr. Tiersten. “It’s associated with a younger-age diagnosis, [and] it’s a more common type of breast cancer among African American women.”
This type of breast cancer is also the most common among people who have the BRCA1 gene mutation, according to the National Cancer Institute. The BRCA1 gene is something everyone has, and it’s responsible for repairing DNA.
However, in some people, the BRCA1 gene undergoes a change (or mutation), and this makes the gene more likely to become cancerous. The BRCA1 mutation can also be inherited, so it runs in families. “About 80 percent of patients who have a BRCA1 mutation have triple-negative breast cancer,” says Dr. Tiersten.
00:00:00,000 --> 00:00:03,590
00:00:03,590 --> 00:00:07,886
About 15 to 20% of all breast
cancers are triple negative.
00:00:07,886 --> 00:00:12,558
00:00:12,558 --> 00:00:14,728
There are different subtypes of cancer,
00:00:14,728 --> 00:00:19,200
based on what receptors are expressed on
the surface of the breast cancer cell.
00:00:19,200 --> 00:00:22,090
There are hormone receptors,
estrogen and progesterone, and
00:00:22,090 --> 00:00:23,950
then there's a protein called HER2.
00:00:25,290 --> 00:00:29,120
All three of those are important because
there are certain targeted therapies
00:00:29,120 --> 00:00:30,540
to those receptors.
00:00:31,640 --> 00:00:35,910
A triple negative breast cancer just
means that none of those three receptors
00:00:35,910 --> 00:00:36,830
00:00:36,830 --> 00:00:43,430
It is characterized by the lack of having
those targeted therapies to treat it.
00:00:43,430 --> 00:00:48,767
Triple negative breast cancers
are inherently more aggressive.
00:00:48,767 --> 00:00:52,520
They are what's called
00:00:52,520 --> 00:00:56,510
So the cells look very different from
normal breast cells under the microscope.
00:00:56,510 --> 00:01:01,630
Surgery plays the same role in general for
all different subtypes of breast cancer,
00:01:01,630 --> 00:01:05,910
if the cancer is picked up in the setting
where it hasn't spread to another part of
00:01:05,910 --> 00:01:08,700
the body, which is the vast
majority of breast cancers.
00:01:08,700 --> 00:01:12,680
Patients have the option of either
lumpectomy with radiation therapy or
00:01:12,680 --> 00:01:13,710
00:01:13,710 --> 00:01:19,080
There's nothing really specific to that
about triple negative breast cancer.
00:01:19,080 --> 00:01:23,660
Because triple negative breast cancer is
actually very sensitive to chemotherapy,
00:01:23,660 --> 00:01:27,190
we sometimes, in certain stages
have triple negative breast cancer,
00:01:27,190 --> 00:01:29,590
give chemotherapy before surgery.
00:01:29,590 --> 00:01:34,540
There's really been huge advances in the
field in terms of what we had to offer.
00:01:34,540 --> 00:01:38,990
Immunotherapy and PARP inhibitors and
other biological therapies really have
00:01:38,990 --> 00:01:43,942
the potential to improve the outcome for
these women in terms of reducing risk for
00:01:43,942 --> 00:01:46,660
recurrence as they move into
the earlier stage arena,
00:01:46,660 --> 00:01:50,809
as well as life-prolonging therapies for
patients with more advanced disease.
00:01:50,809 --> 00:01:59,095
BRCA mutations: cancer risk and genetic testing. Bethesda, MD: National Cancer Institute, 2018. (Accessed on April 9, 2019 at https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet.)
Epidemiology, risk factors and the clinical approach to ER/PR negative, HER2-negative (triple-negative) breast cancer. Waltham, MA: UpToDate, 2019. (Accessed on April 9, 2019 at https://www.uptodate.com/contents/epidemiology-risk-factors-and-the-clinical-approach-to-er-pr-negative-her2-negative-triple-negative-breast-cancer.)
Triple negative breast cancer. Dallas, TX: Susan G. Komen, 2019. (Accessed on April 9, 2019 at https://ww5.komen.org/BreastCancer/TripleNegativeBreastCancer.html.)
Triple negative breast cancer. Frisco, TX: National Breast Cancer Foundation, Inc. (Accessed on April 9, 2019 at https://www.nationalbreastcancer.org/triple-negative-breast-cancer.)
What is triple-negative breast cancer? Atlanta, GA: Centers for Disease Control and Prevention. (Accessed on April 9, 2019 at https://www.cdc.gov/cancer/breast/triple-negative.htm.)