Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) is a rare type of breast cancer. It is a distinct subtype of breast cancer characterised by the absence of estrogen receptors (ER), progesterone receptors (PR), and the human epidermal growth factor receptor 2 (HER2).

Dr Jesse Hu

Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Risk Factors and Prevalence

TNBC is distinguished by several risk factors that differ somewhat from other types of breast cancer.

BRCA1 Mutations: Women with mutations in the BRCA1 gene have a higher risk of developing TNBC. This gene typically helps repair DNA breaks and prevent cancer, but its function is impaired when mutated.

Age and Ethnicity: TNBC is more commonly diagnosed in women under the age of 50. It is also more prevalent among African American and Hispanic women compared to women of European descent.

Reproductive History: Although early menstruation and late menopause increase the duration of estrogen exposure, this factor is less relevant for TNBC, as it does not depend on estrogen like other forms of breast cancer.

Access to Healthcare: Disparities in access to healthcare services can influence the frequency of screenings and early detection rates, impacting the prevalence and outcomes of TNBC among different populations.

Stages of Triple-Negative Breast Cancer

The TNM cancer staging system guides treatment planning. In this system, ‘T’ represents the size of the tumour, ‘N’ denotes whether the cancer has spread to lymph nodes, and ‘M’ indicates metastasis or the spread of cancer to other parts of the body.

The stages of breast cancer are described as follows:

Stage 0: The cancer is noninvasive and confined within the breast ducts.
Stage I: Cancer cells have begun to invade surrounding breast tissue.
Stage II: The tumour measures 2 to 5 centimetres and may have spread to the lymph nodes. Larger tumours that have not spread to lymph nodes are also included in this stage.
Stage III: The cancer extends beyond its original location to nearby tissues and lymph nodes, yet has not reached distant organs. This stage is often referred to as locally advanced breast cancer.
Stage IV: Cancer has metastasised in the body and is known as metastatic breast cancer.

Symptoms

The symptoms of TNBC are similar to those of other types of breast cancer but can often appear more abruptly and progress more rapidly.

Lump or Mass

The most common symptom is a lump or mass in the breast that feels different from the surrounding tissue.

Changes in Breast Appearance

This includes changes in size, shape, or appearance of the breast or nipple, such as dimpling, puckering, or redness.

Nipple Discharge

Any discharge, particularly when it is bloody or clear, might be a sign of breast cancer.

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Diagnostic Tools

Mammography

A mammography is often the first diagnostic test used, and it can detect abnormalities in breast tissue.

Ultrasound

An ultrasound is useful for examining the characteristics of a breast lump detected by physical exam or mammography.

Biopsy

The definitive diagnosis of TNBC is made through a biopsy, where a sample of breast tissue is removed and examined under a microscope. The absence of ER, PR, and HER2 is confirmed to classify the cancer as triple negative.

Magnetic Resonance Imaging (MRI)

MRI provides detailed images of breast tissue, and this is especially useful in younger women with dense breast tissue.

Treatment Options

Treatment strategies generally involve a combination of surgery, chemotherapy, and radiation therapy, along with emerging targeted therapies.

Surgery: Depending on the stage and location of the tumour, options include lumpectomy, which involves removing the tumour and a small margin of surrounding tissue, or mastectomy, which involves removing one or both breasts.

Chemotherapy: TNBC often requires chemotherapy, which is often administered before surgery (neoadjuvant chemotherapy) to shrink the tumour or after surgery (adjuvant chemotherapy) to eliminate any remaining cancer cells.

Radiation Therapy: Radiation therapy is typically used following surgery to eliminate residual cancer cells in the breast, chest wall, or axilla (armpit area).

Immunotherapy: Certain patients with TNBC may benefit from immunotherapy treatments, which help the immune system recognise and attack cancer cells.

PARP Inhibitors: For patients with BRCA mutations, PARP inhibitors, which interfere with DNA repair mechanisms in cancer cells, have shown effectiveness.

Clinical Trials: Ongoing research is crucial for TNBC, and patients may be eligible for clinical trials that provide access to new, investigational therapies that are not widely available.

The choice of treatment depends on the cancer stage, the patient’s overall health, and the tumour’s characteristics.

Challenges in Treating TNBC

Treating TNBC poses significant challenges due to its aggressive nature and lack of targeted therapies.

High Recurrence Rate

TNBC has a higher risk of recurrence compared to other breast cancer types, particularly within the first 3-5 years after treatment.

Early Metastasis

TNBC is more likely to spread and metastasise early in the disease process, often affecting the lungs, brain, and bones.

Limited Treatment Options

The absence of specific molecular targets restricts the use of targeted therapies that are available for other subtypes of breast cancer.

Dr Jesse Hu

Consultant General Surgeon, Breast, Thyroid & Endocrine Surgery

Dr Jesse specialises in managing both benign and malignant breast and thyroid conditions, which also includes breast pain, breast lumps, breastfeeding problems, neck lumps, amongst others.

Her dual expertise in cancer removal and plastic surgery techniques expands the design of individualized treatments, leading to holistic patient outcomes.

Dr Jesse was part of the teaching faculties of both NUS Yong Loo Lin School of Medicine and Lee Kong Chian School of Medicine, where she teaches and mentors the next generation of medical students and trainee doctors.

Surgical training at NUS School of Medicine
FRCS (Fellow of the Royal College of Surgeons) Edinburgh, UK in 2014
Completed 2 Health Manpower Development Program (HMDP) fellowships at Oxford University Hospital, UK in 2016

Dr Jesse is recognized as an authority in breast cancer and thyroid surgery and a sought-after conference speaker.

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Triple-Negative Breast Cancer

Frequently Asked
Questions

How often should someone at high risk for TNBC be screened?

People at high risk for TNBC, such as those with a known BRCA1 mutation, are often advised to start screening earlier and may need more frequent screenings, typically annually.

What is the role of physical activity in managing TNBC?

Physical activity is generally recommended for cancer patients and survivors to improve overall health and quality of life. For TNBC patients, regular exercise can help mitigate the side effects of treatment and improve psychological well-being.

Can triple-negative breast cancer be prevented?

Currently, there is no guaranteed method to prevent triple-negative breast cancer or any form of breast cancer. Understanding the risk factors and implementing certain lifestyle changes can help reduce the overall risk. Key preventive measures include maintaining a healthy weight, engaging in regular physical activity, and limiting alcohol consumption.

Triple-Negative Breast Cancer

Risk Factors and Prevalence

Stages of Triple-Negative Breast Cancer