Triple-Negative Breast Cancer

• Estrogen receptor (ER)
• Progesterone receptor (PR)
• Human epidermal growth factor receptor 2 (HER2)

Triple-negative breast cancer contains none of these. This makes treatment more challenging, since several breast cancer therapies target ER, PR and HER2. Lacking these targets, fewer therapies are available to treat triple-negative breast cancer.

TNBC vs. Other Types of Breast Cancer

Because TNBC is defined by what it lacks, it’s often easier to understand it in contrast to other subtypes:

• Hormone receptor-positive breast cancer: Cancer cells that test positive for estrogen receptor, progesterone receptor or both. These cancers typically respond to hormonal therapy.
• HER2-positive breast cancer: Cancer cells that have too much of the HER2 protein, which can be targeted with HER2-directed therapies.
• HER2-negative breast cancer: Cancer cells that test negative for HER2. TNBC is always HER2-negative, in addition to being ER and PR negative.
• Metastatic triple-negative breast cancer: TNBC that has spread beyond the breast and nearby lymph nodes to other parts of the body, also called stage IV triple-negative breast cancer.

Risk Factors for Triple-Negative Breast Cancer

The exact cause of triple-negative breast cancer isn’t fully understood, but according to the National Cancer Institute, several factors are associated with an increased risk of developing this subtype:

• Family history: A strong family history of breast cancer, particularly in close relatives such as a mother, sister or daughter, increases personal risk.
• Genetic mutations: Inherited gene mutations, particularly a BRCA1 gene mutation, and to a lesser extent BRCA2, increase risk. Genetic testing can help identify these mutations.
• Race and ethnicity: Black women and women of Ashkenazi Jewish descent have a higher risk compared to women of other racial and ethnic backgrounds.
• Age: TNBC is more commonly diagnosed in women younger than 40, unlike many other breast cancer types.

International patients please learn more here or call 1.713.441.2340.

Signs & Symptoms of Triple-Negative Breast Cancer

A lump or mass in the breast may feel hard, irregular in shape and different from the rest of the breast tissue

Skin Changes

Changes in the texture or appearance of the breast skin may be warning signs. Examples include dimpling, puckering, redness or thickening of the skin

Changes in Breast Size or Shape

Changes in the shape or size of the affected breast may become apparent upon self-examination. One breast may appear noticeably different compared to the other

Nipple Changes

Unexplained discharge from the nipple, which may be bloody, can occur. Other changes, such as nipple inversion (the nipple turning inward) may also be noticed.

Swelling in the Breast or Underarm

Swelling in the breast or armpit could indicate that the cancer has spread to lymph nodes.

While these symptoms can also be caused by conditions other than cancer, it's important to consult your doctor if you notice any changes.

How Triple-Negative Breast Cancer Is Diagnosed

Many of the same tests used to rule out or diagnose other types of breast cancer are also used to detect triple-negative breast cancers.

Breast Exam

Often beginning with a self-exam, a breast exam performed by a healthcare professional will check for suspected lumps or other changes in the breast and underarm area.

Mammogram

An X-ray of the breast, sometimes called a screening mammogram, is an imaging test that can detect tumors and other abnormalities. It's often the first step in evaluating concerning symptoms.

Breast Ultrasound and Imaging

If a lump is found, an ultrasound or breast MRI may be used to further analyze breast tissue.

Breast Biopsy

This is the definitive way of diagnosing breast cancer. A small sample of breast tissue is removed and examined under a microscope to check for cancer cells.

If a breast cancer diagnosis is made, further analysis of cancer cells will be performed to determine its molecular subtype. Triple-negative breast cancer is diagnosed if the cancer cells lack estrogen receptor, progesterone receptor and HER2.

Genetic Testing

Because TNBC is more closely linked to inherited gene mutations, providers may recommend genetic testing for a BRCA1 gene or BRCA mutation, especially for patients with a family history of breast cancer.

If a breast cancer diagnosis is made, further analysis of cancer cells will be performed to determine its molecular subtype. Triple-negative breast cancer is diagnosed if the cancer cells lack estrogen receptor, progesterone receptor and HER2.

Treatment Options for Triple-Negative Breast Cancer

Effectively treating triple-negative breast cancer takes the right team and right treatment plan. Our breast cancer experts work together to diagnose and treat triple-negative breast cancer at an individualized level.

Your care team may recommend one or more of the following treatment options:

Lumpectomy

Often referred to as breast-conserving surgery, a lumpectomy involves removing the tumor and a small amount of surrounding healthy tissue. Lumpectomies may be followed by radiation therapy to ensure any cancer cells that may remain are destroyed.

Mastectomy

This type of breast cancer surgery involves the removal of the entire breast, and sometimes nearby lymph nodes, to eliminate cancer. A mastectomy may be recommended if the tumor is large or if there's a high risk of recurrence. Breast reconstructive surgery is available at the same time or afterward.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells — to help shrink tumors before surgery or kill any remaining cancer cells afterward. It’s often used to treat triple-negative breast cancer since this type of breast cancer does not respond to targeted therapies.

Radiation 

Radiation therapy uses high-energy rays to target and destroy cancer cells. This type of treatment may be used after surgery to eliminate any remaining cancer cells.

Immunotherapy 

Often used along with chemotherapy, immunotherapy helps the body's immune system fight cancer. In certain cases of triple-negative breast cancer, immunotherapy can be effective in targeting and destroying cancer cells.

Targeted Therapy

For patients with a BRCA1 or BRCA2 mutation, targeted therapies called PARP inhibitors, such as olaparib or talazoparib, may help block cancer cells from repairing their DNA. Antibody-drug conjugates, such as sacituzumab govitecan, are another targeted option that delivers chemotherapy directly to cancer cells while limiting damage to healthy tissue.

Houston Methodist’s Triple-Negative Breast Cancer Clinic 

The Triple-Negative Breast Cancer Clinic at Houston Methodist Dr. Mary and Ron Neal Cancer Center cares for patients diagnosed with or facing recurrence of triple-negative breast cancer. 

Our oncologists, plastic surgeons, nurses, genetic counselors and nutritionists work together to guide patients through:

• Cancer surveillance
• Consultations and treatment options
• Clinical trial enrollment
• Genetic testing and follow-up
• Family planning counseling

We offer personalized care plans based on each patient’s type of breast cancer and unique personal circumstances. Our staff strives to help patients select the most effective and appropriate treatments, therapies or clinical trials.