Triple negative breast cancer is an uncommon type of breast cancer. The main treatments are surgery and chemotherapy.
What triple negative breast cancer is
Triple negative breast cancers are cancers whose cells don’t have receptors for:
- the hormones oestrogen and progesterone
- Her2 protein
Your doctor uses a sample of your cancer to test the cells for these receptors. You might have this testing following a biopsy, or surgery to remove your cancer.
A rare type of breast cancer known as basal type breast cancer is usually triple negative. Some women with triple negative breast cancer also have a BRCA1 gene fault. BRCA1 is one of the gene faults that can increase the risk of breast cancer within families.
Some men have triple negative breast cancer but this is very rare. Most men have oestrogen receptors in their cancer cells.
Breast cancer receptors
Receptors are proteins that some cancer cells have. When specific substances in your body attach to specific receptors, they trigger a reaction in the cell. When they are triggered, these different receptors can tell cancer cells to grow.
Oestrogen attaches to oestrogen receptors. Progesterone attaches to progesterone receptors. And Her2 attaches to Her2 receptors. Many breast cancers have one or more of these receptors. Triple negative breast cancers don’t have any of them. So hormone treatment and the biological therapy trastuzumab (Herceptin) wouldn't benefit people with triple negative breast cancer.
How common is triple negative breast cancer
Only around 15 out of every 100 breast cancers (15%) are triple negative.
Symptoms of triple negative breast cancer
The symptoms of triple negative breast cancer are similar to other breast cancer types. Make an appointment to see your GP if you notice anything different or unusual about the look and feel of your breasts.
- a lump or thickening in an area of the breast
- a change in the size, shape or feel of the breast
- dimpling of the skin
- a change in the shape of your nipple, particularly if it turns in, sinks into the breast, or has an irregular shape
- a blood stained discharge from the nipple
- a rash on a nipple or surrounding area
- a swelling or lump in the armpit
Diagnosing triple negative breast cancer
You go to a specialist breast clinic. At the breast clinic the doctor or specialist nurse takes your medical history and examines your breasts. They also feel for any swollen (enlarged) lymph nodes under your arms and at the base of your neck.
You have some of the following tests:
- a mammogram (an x-ray of the breasts)
- an ultrasound (you are more likely to have this instead of a mammogram if you are under 35)
- a biopsy – your doctor or nurse take a small sample of cells or tissue from your breast to look at under a microscope
Treatment for triple negative breast cancer
The main treatments for triple negative breast cancer include surgery and chemotherapy. The treatment you need depends on:
- where the cancer is
- the size of the cancer and whether it has spread (the stage)
- how abnormal the cells look under the microscope (the grade)
- your general health
You might have surgery to remove:
- an area of the breast (wide local excision or lumpectomy)
- the whole breast (mastectomy)
When you have your surgery, the surgeon might take out some of the lymph nodes under your arm. They test these nodes to see if they contain cancer cells. The surgeon might check the lymph nodes closest to the breast using a procedure called sentinel lymph node biopsy. Testing the lymph nodes helps to find the stage of the cancer and decide on further treatment.
You usually have radiotherapy to the rest of the breast tissue after a wide local excision (lumpectomy).
You might have chemotherapy before surgery. This could shrink the cancer enough to make an operation possible. Or it might mean that you can have an area of the breast removed, instead of needing a mastectomy.
You usually have chemotherapy after your operation. The chemotherapy reduces the risk of the breast cancer coming back. You usually have a combination of chemotherapy drugs. This includes an anthracycline, such as doxorubicin or epirubicin.
Doctors also use chemotherapy for cancer that has spread elsewhere in the body. This is called advanced breast cancer. You usually have a combination of different drugs. This might include a drug such as doxorubicin or epirubicin. And a taxane drug, such as paclitaxel or docetaxel.
Researchers are still looking into the best chemotherapy combinations. And they want to find out whether adding other drugs could improve the results of treatment.
You have regular check ups once you finish your treatment. At your check up appointments your doctor or specialist nurse examines you and asks about your general health.
This is your chance to ask questions and to tell your doctor if anything is worrying you.
It’s important to remember that you can still contact someone if you are worried about a symptom between appointments. Don’t just leave it. Speak to your GP, or contact your consultant or specialist nurse.
How often you have check ups depends on your individual situation.
Trials for early stage triple negative breast cancer
Your doctor or nurse might ask you to take part in a trial to improve treatments for triple negative breast cancer.
Doctors are testing a hormone therapy called enzalutamide for breast cancer with androgen receptors. Androgens are hormones made in both men and women. Some triple negative breast cancers have androgen receptors.
Doctors also want to find out whether certain types of biological therapy can prevent breast cancer coming back. Trials are looking at drugs called such as olaparib and LCL161.
Trials for advanced triple negative breast cancer
Trials are comparing different types of chemotherapy to see which one is better at treating advanced disease. For example, researchers are waiting for the results of the Triple Negative Trial (TNT) to find out whether it is better to use carboplatin or docetaxel.
Research is looking at the use of biological therapies alongside other treatments. For example, a trial is using a drug called atezolizumab in combination with chemotherapy.
Researchers think that biological therapy on its own might help to control the growth of the cancer. Trials are testing a monoclonal antibody called pembrolizumab.