Triple Negative Breast Cancer

Triple negative breast cancer (TNBC) is a type of breast cancer that grows and spreads quickly. It’s called triple negative because the cancer cells lack three receptors that are often found in breast cancer: estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2 protein).

Hormone-targeted treatments may be effective for the types of breast cancer where these receptors are present. But with triple negative breast cancer, hormone therapy won’t work. Therefore, people with TNBC often need more aggressive treatments, like chemotherapy. 

TNBC is more common in younger women, Black women, Hispanic women and women with a family history of breast cancer. Certain genetic mutations, such as those in the BRCA1 and BRCA2 genes, can significantly increase the risk of developing TNBC.

You can’t prevent TNBC, but if you have a family history of breast, pancreatic or prostate cancer, talk to your health care provider about genetic testing for the BRCA gene.

Detecting and diagnosing triple negative breast cancer 

Signs and symptoms of triple negative breast cancer are the same as other types of breast cancer. It is also detected like any type of breast cancer.

You may feel a lump when you’re showering or dressing, or a lump might be spotted when you have a mammogram. Your provider may also find a lump during a clinical breast exam during your regular wellness check.

Be sure to contact a health care provider if you notice:

• A lump or mass in your breast or underarm
• Changes in breast size, shape or texture
• Redness, dimpling or skin changes on your breast
• A nipple that changes position, turns inward or leaks fluid 

It’s important to have regular mammograms since they can find breast cancer sooner when it may be more easily treated. Many experts recommend mammograms every year, beginning at age 40. If you’re at higher risk for breast cancer, your provider may recommend earlier and/or more frequent mammograms. It’s important to discuss your risk for breast cancer with your healthcare provider.

If you have a lump in your breast, your provider may want you to have an ultrasound, mammogram, or MRI to examine the lump more closely. They may also recommend a biopsy, a procedure where a small tissue sample is removed to check for cancer cells.

If the biopsy shows that you have breast cancer, the cancer cells will be checked to see if they test negative for the three receptors. If they do, triple negative breast cancer is diagnosed. If you have TNBC, your provider may also recommend genetic testing for the BRCA gene. Genetic testing may be considered for all patients diagnosed with breast cancer.

The stages of triple negative breast cancer are the same as other types of breast cancer:

• Stage 0: The cancer is only in the breast ducts.
• Stage 1: The cancer cells are in nearby breast tissue.
• Stage 2: The tumor is two to five centimeters across and/or may have spread to nearby lymph nodes.
• Stage 3: The cancer is considered locally advanced and has spread to nearby lymph nodes and tissue.
• Stage 4: Also called metastatic breast cancer, the cancer has spread to other places like the bones, brain, liver or lungs.

Treating triple negative breast cancer 

A team of health care providers including oncologists, surgeons, radiation oncologists and other specialists will work with you to put together a personalized treatment plan for TNBC.

Because TNBC can grow and spread quickly, it usually needs aggressive treatment. The good news is that newer treatments have improved the five-year survival rate for TNBC, especially if it is diagnosed in earlier stages.

Treatment may include:   

• Surgery to either remove the lump and a small amount of nearby tissue (lumpectomy) or to remove the breast (mastectomy). Your provider will explain which surgery may be right for you, depending on the size and location of the tumor.
• Chemotherapy, a treatment that uses powerful drugs to target and destroy cancer cells throughout the body. 
• Radiation therapy, which uses high-energy rays to target and destroy breast cancer cells. You may have radiation therapy after surgery to get rid of any remaining cancer cells and make it less likely that the cancer will come back.
• Immunotherapy, such as pembrolizumab (Keytruda) or sacituzumab govitecan-hziy (Trodelvy), which use your immune system to target and destroy cancer cells.
• Targeted therapies may be options if you have certain genetic mutations. For example, poly ADP-ribose polymerase (PARP) inhibitors may be used in some cases. 

Your care team will help you understand your treatment options so you can make the best decisions about your care.

It's important to be aware of potential side effects of treatment and to address any concerns with your health care provider.

Coping with triple negative breast cancer

It can be tough emotionally to cope with TNBC, so connecting with support is important. Talk to your health care provider about your challenges. They may be able to connect you with resources such as:

• Counseling and therapy
• Supportive care
• Nutritional support
• Local or online support groups or communities for people with TNBC
• Integrative oncology
• Specialized breast cancer programs
• A high-risk breast cancer clinic

Be sure to lean on your friends and family as well. They can give you emotional support and help with things like rides to appointments and getting your daily tasks done.   

Healthy living during and after treatment

It’s important to take care of yourself as well as you can when you’re facing TNBC. It can help to:

• Choose a balanced, nutritious diet
• Stay as physically active as you can be—activity can help fight fatigue
• Cope with stress using strategies like mindfulness, meditation and relaxation techniques
• Limit alcohol and avoid tobacco
• Attend your follow-up appointments and screenings
• Check with your provider about the best way to stay up to date on vaccinations
• Connect with support

Long-term effects of triple negative breast cancer

After you’ve finished your cancer treatment, you’ll need regular follow-up visits with your provider to check your overall health. Be sure to talk to your provider about any symptoms or concerns, such as:

• New breast or axillary masses (lumps) or changes to the skin or nipple
• Problems with your bones, heart or other organs
• Changes in the way you think, such as memory loss
• Mental health challenges, such as anxiety or depression