Your oncologist has just informed you that you have triple-negative breast cancer. You have a lot of questions and that’s perfectly normal. The information we can provide will help you to understand proposed care and to cope with this difficult situation.
What is triple-negative breast cancer? Is it frequently observed?
The term ‘triple-negative’ means that the tumour cells express neither hormone receptors (oestrogen and progesterone) nor the HER 2 receptor. This means that certain medicinal treatments (hormonotherapy and anti-HER2 targeted therapies) will not be effective.
Of all breast cancers diagnosed per year, it is estimated that around 10 to 15% are triple-negative. When diagnosed early, patients are often cured of their cancer, even if this type of breast cancer is more serious than other forms.
How is it diagnosed?
Most often, breast cancer is discovered fortuitously on a mammogram. Sometimes patients discover their cancer due to the presence of something abnormal on the breast or the nipple. When a mammogram shows an ‘ACR4’ or ‘ACR5’ abnormality on the breast, there a strong suspicion of breast cancer. The radiologist therefore suggests that a biopsy be performed, i.e. the removal of a sample of breast tissue under local anaesthesia.
The biopsied tumour sample is sent to the anatomopathology laboratory, also called the pathology department. This step is essential for confirming diagnosis and for determining the cancer type. It also enables breast cancer to be characterised, and to test for oestrogen and progesterone receptors, and for HER2. When these tests are negative, the cancer is referred to as triple-negative.
Are there risk factors that promote this type of cancer?
Certain families are at a higher risk of developing triple-negative breast cancer, in particular when several members of the same family have had cancer. If your doctor deems your family to be ‘at risk’, he/she will recommend adapted monitoring and advice from an oncogenetic department.
Can it be cured?
There are 2 distinctive progressive stages:
- the localised stage for which cure is possible (cancer spread is limited to the breast and adjacent lymph nodes in the armpit and the supraclavicular area: stages I, II and III according to AJCC 6th edition international staging.
- the metastatic stage for which cure is no longer possible; we nevertheless can propose efficient treatment to treat this cancer and to help you to survive the disease as long as possible. Cancer is referred to as metatatic when other organs, beyond the breast and the axillary and supraclavicular lymph nodes, are affected (bone, lungs, brain, other lymph nodes, for example).
What treatment is available in 2021?
In the absence of metastases (during curable phases), treatment is the same as that of other types of breast cancer.
Depending on the size of the tumour and of your breast, the surgeon will decide which surgical procedure is possible. He/she will always place priority on conservative breast surgery (referred to as tumorectomy or partial mastectomy), which enables as much healthy tissue as possible to be left untouched. When the tumour is larger and does not permit the conservation of a sufficient zone of healthy tissue, the surgeon removes the entire breast (this is referred to as total or radical mastectomy). The surgeon must also remove all (curettage) or part (sentinel lymph node technique) of the lymph node chain under the armpit on the side of the diseased breast.
Based on how large and agressive the tumour is, it is often recommended that surgery be associated with chemotherapy. When administered before surgery, it is referred to as ‘neoadjuvant’ chemotherapy and when it comes after surgery, we call it ‘adjuvant’ chemotherapy.
This treatment is generally organised after surgery and chemotherapy. It is systematic when partial mastectomy is performed and is discussed on a case-by-case basis after total mastectomy. Radiotherapy consists in delivering small doses of radiation to the operated zone and, sometimes, to lymph nodes, during several sessions over a period of 5 to 6 weeks. The exact number of sessions and weeks is determined by the radiation oncologist after analysis of your medical file and treatment simulation on the radiotherapy machine.
In the presence of metastases (incurable phase)
Surgery of the breast and adjacent lymph nodes is not relevant in this situation, for it would not enable all lesions to be treated. It can be discussed on a case-by-case basis, in certain exceptional circumstances.
Chemotherapy, in these cases, is the principle treatment. It is used alone or in association with intravenous targeted therapies.
TARGETED THERAPIES AND IMMUNOTHERAPY
In 2021, only 4 molecules are used as standard practice, and subject to certain conditions (based on previously administered treatment and on the molecular anomalies of your tumour). They are administered intravenously and associated with weekly Paclitaxel chemotherapy. They can be in the form of immuntherapy drugs (such as atezolizumab), of targeted antoangiogenetic therapies (such as bevacizumab) or therapies targeting cancers associated with genetic predisposition (such as talazoparib or olaparib). The chioce of treatment is made on a case-by-case basis, depending on the specificity of each patient’s cancer.
It can be used to relieve certain symptoms associated with metastasis location.
Advances in our knowledge of disease and its treatment have considerably improved cancer prognosis. Your doctor can propose that you join a clinical trial, whenever an innovative medicinal drug or technique seems appropriate to your specific situation, and before they are available for routine use.
Oncology supportive care
Whether you are in a curative or metastatic situation, oncology supportive care can help improve your quality of life and relieve treatment side effects. In curative settings, it can also improve your chances of recovery.