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"I promise, Suzy... Even if it takes the rest of my life." - Nancy G. Brinker, founder of Susan G. Komen for the Cure

What is Triple Negative Breast Cancer?


Just in recent years, Triple Negative Breast Cancer has sparked interest in the news where instead of calling the tumor as ER-negative, PR-negative, and HER2-negative; researchers began using the shorthand term, "Triple Negative," dubbed the "new type" type of cancer. Being Triple Negative, you don't have a targeted therapy and that your only treatment option is chemotherapy.

Triple Negative is seen in about 15% of all breast cancers. Triple Negative is a very aggressive cancer that tends to strike younger women, pre-menopause, especially among African-American women and women who have BRCA1 mutations. The tumor tends to be fast growing and is less likely to show up on an annual mammogram. TN is more likely to metastasis early on; has a high rate of recurrence in the first 2-3 years from diagnosis and has a poorer prognosis than other types of breast cancer due to lack of specific, targeted treatment for TNBC.

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Triple Negative Breast Cancer, The Ugly Truth

I have been advocating the importance of self breast exams especially among younger women since most triple-negative tumors are not detected by mammograms due to the breast tissue density in women. Also, triple-negative tumors may be growing rapidly between image screenings. Many women that have asked me about my cancer, I have told them that if you suspect a lump, don't delay, you need to see your doctor and get a mammogram; early detection is the key to having a better outcome with a triple-negative diagnosis.

We need to bring awareness to this sub-type,Triple Negative Breast Cancer and BRCA testing; helping younger women realize the importance of self breast exams and that early detection will save more lives from this dreaded disease. Women need to be educated and many are not; on the importance of BRCA genetic counseling which is highly recommended at time of TNBC diagnosis to determine the best course of treatment. Patients having both TNBC and being BRCA1 positive; doctors often recommend the option of bilateral mastectomy and removal of ovaries and fallopian tubes as part of their treatment to greatly reduce the risk of further breast cancer and ovarian cancer in which BRCA is associated with.

Just a few years ago, no one even heard of TNBC, a type of breast cancer that researchers knew a little about. Triple-Negative is one of the most aggressive tumors ever seen by doctors. The first reference of "Triple Negative" Breast Cancer in medical literature was in October 2005. Focused studies for TNBC had only been conducted in the last few years. Triple Negative Breast Cancer had recently become a hot area of research for targeted therapy and the latest in clinical trials in the study of breast cancer at all of the big research institutions including top-rated cancer center in the country, MD Anderson, which is the first institution to look exclusively at women with Triple Negative Breast Cancer.

Triple Negative tumors lacks expression of estrogen receptor (ER) and progesterone receptor (PR), along with the absence of human epidermal growth factor receptor-2 overexpression (HER2) portraying a critical clinical challenge because this type of cancer doesn't respond to hormone therapy or other available targeted agents; Standard Chemotherapy remains the only treatment available and only effective in about 40% of patients; and in those that do relapse, the cancer becomes highly resistant and quickly results in death. The average time from recurrence to death is about 9 months.

DR. O’SHAUGHNESSY: Metastatic cancer that is triple-negative is difficult to treat because our therapies are generally short-lived in their benefit, if they benefit patients at all. There is a subset of triple-negative metastatic patients who really don’t have responsive disease to any of our standard therapies.

Triple Negative Breast Cancer accounts for about 15% of all breast cancers and is responsible for about 25% of all breast cancer deaths. Triple-Negative is characterized as a rapid growing breast cancer with a relatively poorer outcome; usually diagnosed at a late stage, shorter survival rate, more likely to metastasize and has a high risk of early recurrence between 2-3 years after diagnosis.
Triple Negative Breast Cancer tends to strike younger women. Pre-menopause women in their 20's or 30's are more susceptible to Triple Negative Breast Cancer and, African-American women are at highest risk. TNBC is  the #1 cause in breast cancer deaths in African-American women and only 14% are alive 5 years after diagnosis according to a study.
Women that carry the BRCA1 gene mutation which is associated with hereditary breast cancer are also at risk  for 90% of BRCA-1 carriers are also Triple Negative, therefore genetic testing should be done since both of which also have aggressive clinical courses. Inherited BRCA -1 gene mutation carriers has an upward 80% life time risk of developing breast cancer and about 50% risk of developing ovarian cancer. but 20% of TNBC has BRCA mutations.

News correspondent, Jennifer Griffin and news anchor, Robin Roberts are TNBC survivors.

* It is discouraging some knowing that there has been very little advancement in research since my diagnosis in 2009, and that Triple Negative Breast Cancer still remains a medical unmet need for an effective treatment.

* In 2009, Susan G. Komen for the Cure and Triple Negative Foundation teamed up to fund a $7.5million Promise Grant over 5 years to researchers looking at an antibody in hope of developing a targeted long-term therapy for triple negative tumors.

* Researchers have learned just in the past several months that TNBC is an extremely complex disease. TNBC is not just one disease but 6 different subtypes of it in itself. Also, each tumor displays multiple "clonal genotypes" with each cancer at a different stage in the evolutionary process at the time of diagnosis which explains why TNBC patients responds so differently to, or is resistance to treatment. Each TNBC tumor is  genomically unique. Therefore, Clincal trials will need to be designed as "personalized" treatments for individual patients.
Research will study patient responses to treatment at the genetic level and look at ways to improve therapies and outcomes for patients."

* The clinical drug, PARP inhibitors prevents cancer cells from repairing it's own DNA

* Developing inhibitors that target a protein, RSK2 which eliminates TNBC cells completely.

* Study to determine if an experimental drug, Entinostat, can reprogram tumor cells to express a protein called an estrogen receptor to make them sensitive to hormone therapy.
    * A research study showed that natural fruit, blueberries gave preliminary promising results of controlling tumor growth, reduction of metastasis, and causing cell death in triple-negative breast cancer cells, at more than double the rate observed in untreated cells.

    Many women who are diagnosed with Triple Negative Breast Cancer are often left in the dark about what triple-negative means for them at time of diagnosis. Often, these women turn to the Internet searching for answers as I did too... the facts are scary... learning the aggressiveness of triple-negative and poorer prognosis due to no effective targeted therapy for this type of breast cancer.

    Tho, we do not know what fuels Triple Negative Breast Cancer, I have been told that changing my life style; low-fat diet, regular exercise, less stress and being physically fit significantly reduces my chance of TNBC recurrence.

    Reference: http://www.ascopost.com/issues/november-15-2011/researchers-explore-reasons-for-higher-risk-of-triple-negative-breast-cancer-in-underserved-african-american-women.aspx

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