A GUIDE TO TRIPLE NEGATIVE BREAST CANCER
INTRODUCTION
There are some receptors like Estrogen receptors (ER) and progesterone receptors (PR; also called PgR) that are commonly found in breast cancer, but Triple-negative breast cancer is a kind of breast cancer in which no receptors are found. These hormone receptors work as indicators of cancer during the test that helps the doctors to determine the treatment options, but in the case of triple-negative breast cancer it is difficult still chemotherapy can be effective. Triple-negative breast cancer contributes to about 10-15% of all breast cancers. Most commonly found in women of age group younger than 40%.
Signs and symptoms of triple-negative breast cancer
• Swelling in all or part of the breast, dimpling of the skin, pain in breast and nipple, sometimes nipple turns inward (Nipple retraction).
• The nipple and the skin of the breast become red, dry, flaking or thickened, nipple discharge (other than breast milk).
• Swollen lymph nodes are also found. (Sometimes breast cancer spreads to the lymph nodes present under the arm or around the collar bone and forms a lump or swelling there).
Image Source- http://healthandsymptoms.com/cancer/breast-cancer/triple-negative-breast-cancer-things-know/
Some common features of triple-negative breast cancer
• Than other types of breast cancer Triple-negative breast cancer is more aggressive and has a poorer prognosis, this is mainly because there are fewer targeted medicines are used to treat triple-negative breast cancer. From some studies, it was found that triple-negative breast cancer is more likely to spread beyond the breast and the chances of reoccurrence are more after treatment.
• It is considered to be a higher grade than other types of breast cancer. When the grade of cancer is higher the cancer cells resemble less normal, less healthy breast cells are found and drastic changes in their appearance and growth patterns are noticed. On a scale of 1 to 3, triple-negative breast cancer often is grade 3 which is a more dangerous one.
• In Triple-negative breast cancer the cell type called “basal-like,” which means that the cells resemble the basal cells that line the breast ducts. Basal-like cancers are more aggressive in nature and are considered higher-grade cancer. Most of the basal-like breast cancers are triple-negative breast cancer but not all basal-like breast cancers are triple-negative, and most of the triple-negative breast cancer is basal-like but not all triple-negative breast cancers are basal-like.
Image Source- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682754/
From different studies and surveys, it was concluded that Triple-negative breast cancer is mostly diagnosed in Black women and Hispanic women. In Asian women and non-Hispanic white women, triple-negative breast cancer is less common than other types of cancer. Triple-negative breast cancer is more likely to be diagnosed in Black women and Hispanic women. Asian women and non-Hispanic white women are less likely to be diagnosed with this type of cancer.
DIAGNOSIS
Now a days there are a lot of tests are available, which can be used to diagnose breast cancer.
Mammography
Diagnostic mammography is similar to screening mammography except it takes more pictures of the inside of the breast. It is recommended by the doctors when someone experiences some symptoms, signs, like new lumps in the breast area or nipple discharge. It is also recommended when something suspicious found on a screening test.
Breast Ultrasound
In the case of breast ultrasound, sound waves are used to produce a picture of the breast tissue. An ultrasound can distinguish between a solid mass and fluid-filled cysts, which are not cancer and harder to identify on mammograms. Ultrasound is widely and easily available, and no exposure to radiation and also cost-effective.
Breast Magnetic Resonance Imaging
It uses magnetic fields instead of x-rays and produces detailed images of the body. A dye known as a contrast medium is given before the scan that helps to create a clear picture of possible cancer. The dye is simply injected into the patient’s vein before the examination. A breast MRI may be used after a woman has been diagnosed with cancer to find out how much the disease has grown throughout the breast or to check the other breast for cancer.
Image Source- https://www.researchgate.net/figure/MRI-finding-for-triple-negative-breast-cancer-in-42-year-old-woman-T1-weighted-sagittal_fig1_274233088
Breast Biopsy
In a breast biopsy, a small amount of tissue is extracted for examination under a microscope. Other tests suggest the presence of cancer while biopsy can make a definite diagnosis and give us a particular result.
Fine Needle Aspiration Biopsy- in the type of Biopsy, a thin needle is used to remove a small number of cells from the breast region. It is an invasive method so it might cause pain.
Core Needle Biopsy- In this type of biopsy, a wider needle is used to remove a larger amount of cells from the breast region. This is an efficient invasive imaging test.
Surgical Biopsy - This is a type of biopsy in which a large amount of tissue, a lump, or mass is collected for examination under a microscope.
Image-Guided Biopsy - In this type of biopsy method tissue samples are collected to make a diagnosis. It is done under image guidance. In this case, the images or pictures are taken through a CT scan, an ultrasound, or an X-ray.
TREATMENT OF TRIPLE-NEGATIVE BREAST CANCER
The treatment of Triple-negative breast cancer is done with a combination of surgery, radiation therapy, and chemotherapy.
Neoadjuvant chemotherapy
In the case of cancer treatment, Neoadjuvant chemotherapy is the use of chemotherapy to reduce the size of a tumor prior to the main treatment course. The doctors recommend Neoadjuvant chemotherapy (NACT) mostly when a tumor is too large to be operable or in cases when other vital organs may be impacted by a tumor’s growth. The effectiveness of neoadjuvant treatment can be judged by looking at the tissue removed during surgery and make sure there are no active cancer cells are present. If there are no active cancer cells are present, then the stage is called as “pathologic complete response” or pCR.
Poly ADP Ribose Polymerase Inhibitors
PARP inhibitors are substances that block an enzyme in cells called PARP. The work of PARP is to help in damaged DNA repairing. Poly ADP ribose polymerase such inhibitors such as Lynparza (chemical name: olaparib) and Talzenna (chemical name: talazoparib), have been used to treat advanced-stage HER2-negative breast cancer in people with a BRCA1 or BRCA2 mutation. The poly ADP-ribose polymerase (PARP) enzyme helps in fixing the damages held in DNA both in healthy and cancer cells. From many studies, it was found that medicines that help in inhibiting the PARP enzyme and makes it even harder for cancer cells with a BRCA1 or BRCA2 mutation to fix DNA damage. This makes the conditions harder for the cancer cells to survive.
EGFR inhibitors
In most cases or about 60% of triple-negative breast tumors, EGFR expression is found.
For inoperable Triple Negative Breast Cancers a combination of EGFR inhibitor Panitumumab, with standard chemotherapeutic agents is used and found to be effective.
Immunotherapy
Immunotherapy is a cancer treatment that helps and improves our immune system and makes it stronger enough to fight cancer. Immunotherapy medicines help our immune system to work harder or smarter and attack the cancer cells and destroy them. A combination of Tecentriq (chemical name: atezolizumab- The immunotherapy medicine) with Abraxane (chemical name: albumin-bound paclitaxel or nab-paclitaxel- the chemotherapy medicine) is used to treat metastatic triple-negative, PD-L1-positive breast cancer. In this case, Tecentriq inhibits PD-L1, which allows immune system cells to locate the cancer cells and kill them.
CONCLUSION
Triple-Negative Breast Cancer is a very complex disease to understand and diagnose. This is both confusing and frustrating for researchers and physicians, as well as the patients. To date, the researchers are trying their best to improve the treatment and diagnosis method and care of triple-negative breast cancer patients.
REFERENCES
- https://www.cdc.gov/cancer/breast/triple-negative.htm
- Aysola K, Desai A, Welch C, Xu J, Qin Y, Reddy V, Matthews R, Owens C, Okoli J, Beech DJ, Piyathilake CJ, Reddy SP, Rao VN. Triple Negative Breast Cancer - An Overview. Hereditary Genet. 2013;2013(Suppl 2):001. doi: 10.4172/2161-1041.S2-001. PMID: 25285241; PMCID: PMC4181680.
- Mehanna J, Haddad FG, Eid R, Lambertini M, Kourie HR. Triple-negative breast cancer: current perspective on the evolving therapeutic landscape. Int J Womens Health. 2019 Jul 31;11:431-437. doi: 10.2147/IJWH.S178349. PMID: 31447592; PMCID: PMC6682754.
- https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html
- https://www.breastcancer.org/symptoms/diagnosis/trip_neg
- https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/finding-breast-cancer-during-pregnancy.html
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