Triple negative breast cancer

Triple negative breast cancer is a type of breast cancer. Around 15 out of 100 (15%) of breast cancers are of this type.  Read about the symptoms, how it is diagnosed and treated, and what happens after treatment.

What is triple negative breast cancer?

Triple negative breast cancers are cancers whose cells don’t have receptors for:

• the hormones oestrogen and progesterone
• a protein called Her2

Your doctor uses a sample of your cancer to test the cells for these receptors. You might have this test following a biopsy of the cancer, or after surgery to remove it.

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

Some cancer cells have particular proteins called receptors. When certain substances in the body attach to the receptors, they trigger a reaction in the cancer cells that tell them to grow.

• Oestrogen attaches to oestrogen receptors
• Progesterone attaches to progesterone receptors
• Her2 attaches to Her2 receptors

Many breast cancers have receptors for one or more of these substances. But triple negative breast cancers don’t have any of them. So hormone treatment and the targeted cancer drug trastuzumab (Herceptin) don't work for people with triple negative breast cancer.

There are other drugs available to treat triple negative breast cancer.

How common is triple negative breast cancer

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.

Symptoms can include:

• a new lump or thickening in your breast or armpit
• a change in size, shape or feel of your breast
• skin changes in the breast such as puckering, dimpling, a rash or redness of the skin
• fluid leaking from the nipple in a woman who isn’t pregnant or breast feeding
• changes in the position of nipple

Make an appointment to see your GP if you notice anything different or unusual about the look and feel of your breasts.

Diagnosing triple negative breast cancer

In many women the cancer is found during breast screening. But symptoms such as a breast lump can be a sign of breast cancer. So it is important to get any symptoms checked by your doctor.

If you have symptoms and see your GP they refer you to a specialist breast clinic. At the breast clinic the doctor or breast care 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

Depending on your age and whether other family members have had breast cancer, your doctor might refer you for gene testing. This is to find out if there is a fault (mutation) in the BRCA cancer gene.

Treatment for triple negative breast cancer

The main treatments for triple negative breast cancer are surgery, chemotherapy and radiotherapy. 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

Surgery and radiotherapy

You might have surgery to remove:

• an area of the breast (called breast conserving surgery)
• the whole breast (called mastectomy)

When you have your surgery, the surgeon usually takes 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.

After breast conserving surgery you usually have radiotherapy to the rest of the breast tissue.

Chemotherapy

You might have chemotherapy before surgery (known as neo adjuvant treatment). The aim is to shrink a large 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 the operation. The chemotherapy reduces the risk of the breast cancer coming back. You usually have a combination of chemotherapy drugs that might include:

• doxorubicin
• epirubicin
• paclitaxel
• docetaxel
• carboplatin
• cisplatin

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.

Doctors also use chemotherapy for cancer that has spread elsewhere in the body. This is called secondary breast cancer.

Bone strengthening drugs (bisphosphonates)

You might have drugs to prevent or slow down bone thinning (osteoporosis). They can help treat or reduce bone damage caused by the breast cancer. You usually have it alongside your cancer treatment.

You might also have bisphosphonates if you have breast cancer that has spread to the bones, to try and prevent any bone problems and reduce pain.

Follow up

After treatment you usually have regular check ups. At the check ups your doctor or a breast care nurse will examine you and ask about your general health. This is your chance to ask questions and to tell them if anything is worrying you.

How often you have check ups depends on your individual situation but they might go on for at least 5 years. This might include yearly mammograms. 

It’s important to remember that you can contact your doctor or nurse between appointments if you are concerned about a symptom or have questions. You don't have to wait for your next appointment. You can also speak to your GP.

In some hospitals you don't have regular appointments after treatment. But if you have new symptoms or are worried about anything you can phone your doctor or breast care nurse or make an appointment to see them. 

UK guidelines say that everyone who has had treatment for early breast cancer should have a copy of a written care plan. The care plan has information about tests you will have, and signs and symptoms to look out for. It will also include contact details for specialist staff, such as your breast care nurse.

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.

Researchers are looking at different chemotherapy drugs and also combining them with targeted cancer drugs.

Trials for advanced triple negative breast cancer

Trials are comparing different types of chemotherapy to see which are 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 using targeted cancer drugs alongside other treatments. For example, a trial is using a drug called atezolizumab in combination with chemotherapy. Some trials are testing a drug called pembrolizumab. Researchers think that these targeted drugs on their own might help to control the growth of the cancer.