April 2012 Ask The Expert: Research And Treatment Options For Triple-Negative Breast Cancer

During the month of April, get your questions answered about research and treatment options for triple-negative breast cancer.

If you have questions about which groups are at highest risk for developing triple-negative breast cancer, the types of treatments available in early-stage and metastatic disease and the latest research on promising new developments in the pipeline,  ask our expert Edith P. Mitchell, MD, FACP, your question.

We will answer as many questions as possible, but we cannot answer all questions submitted. We will begin posting Dr. Mitchell’s answers in early April and continue to post answers throughout the month;  see our submission form for more information and guidelines, and check back here for updates.

You may also be interested in our April teleconference on Triple-Negative Breast Cancer: Medical Update.

Question: I got two opinions from two different surgeons. One said to do chemo first to reduce the size of the tumor, then do surgery. The other said surgery first, then chemo. My tumor is just under 1 cm and triple-negative. I don't know what to do.  

Dr. Mitchell: They are both correct. The standard treatment for triple-negative breast cancer is surgery followed by chemotherapy. However, because triple-negative breast cancer has a tendency to metastasize (spread to other parts of the body) and recur within the first five years after diagnosis, many doctors recommend chemotherapy before surgery. The goal of chemotherapy is to prevent the breast cancer from coming back and spreading to other parts of the body (metastasis).

Question: Both of my surgeons suggested a lumpectomy. I want a bilateral mastectomy. Should I listen to my surgeon or do what would make me feel less anxious? 

Dr. Mitchell: You should make your decision carefully after talking with not only your breast surgeon, but also a plastic and reconstructive surgeon, medical oncologist and geneticist. Be sure to review all the information and work with your doctor or nurse to develop the best plan.

Question: Is there any research on what activates triple-negative breast cancer? 

Dr. Mitchell: Unfortunately, we do not yet know the cause of triple-negative disease or the factors that initiate the process.

Question: Are there any recommendations on what diet or exercise might prevent a recurrence of triple-negative breast cancer?  

Dr. Mitchell: In general, a healthy diet low in fat and high in vegetables and fruits, maintaining an ideal body weight and moderate exercise are important. You should discuss your follow-up care and plan of action for your post-treatment care, also called a survivorship care plan, with your doctor.

Question: Are there any new treatment options available for TNBC survivors after chemo, surgery and radiation?

Dr. Mitchell: There are currently no standard treatment options available after chemotherapy, surgery and radiation. You should discuss your follow-up and surveillance plan with your doctor.

Question: How much association is there between triple-negative breast cancer and BRCA1 and 2?

Dr. Mitchell: Approximately 7 percent of breast cancer cases are associated with an autosomal dominant pattern of inheritance, which means you only need to get the abnormal gene from one parent in order for you to inherit the disease. One of the parents may often have the disease. Approximately 80 percent of BRCA1-associated tumors will be triple-negative.

http://www.lbbc.org/Learning-From-Others/Ask-the-Expert/2012-04-Triple-Negative-Breast-Cancer