Triple-Negative Breast Cancer: Definition, Challenges, and Passion

She can flash back to that dreadful day effortlessly. It was November 19, 2021. At the height of her career, as a registered nurse turned cosmetic tattoo artist, Nancy’s life took an unprecedented turn. She heard her doctor utter the words “it’s cancer” and later learned she was diagnosed with stage 3 triple-negative breast cancer (TNBC) – an aggressive type of cancer with the lowest survival rate of all breast cancers. But what makes TNBC different from other types of breast cancer? Keep reading. We’ll demystify TNBC and find out what Nancy did next.

Every October, it’s difficult to avoid the parade of pink-everything reminders of Breast Cancer Awareness Month. It’s a time devoted to educating everyone about breast cancer, its risk factors, and the importance of lifesaving screening. In the U.S., about 1 in 8 women will develop invasive breast cancer.

There are many types of breast cancer, and TNBC is one. It makes up 10% to 15% of all breast cancers, and about 13 in 100,000 women are diagnosed with TNBC yearly in the U.S.

Understanding TNBC – and the alphabet soup of biomarkers

If you’re diagnosed with breast cancer, your doctors will check for the presence of biomarkers on the surface of the cancer cells. You may have heard the terms estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).

Receptors are like little antennae on the cancer cells that receive signals. Cancer cells that have ER and PR receptors depend on signals (fuel) from the hormones estrogen or progesterone, or both, to grow. These tumors are said to be ER-positive and PR-positive – or hormone receptor-positive (HR-positive) for short. If the hormone receptors are absent, the tumor is HR-negative.

HER2 is another protein that cancer cells use to grow. If the tumor shows high levels of HER2, it’s termed HER2-positive. If no or very few copies of HER2 are found, the tumor is HER2-negative.

Cancers that are HR-positive can be treated with hormone-blocking drugs. Since these cells thrive on hormones, they can’t continue to grow when hormones are blocked.

Tumors that are HER2-positive are treated with medications that block the HER2 receptors on their surface, also preventing them from growing. Some tumors are HR-positive but HER2-negative or vice versa.

For certain cancer cells, all three biomarkers are absent. These tumors are ER-negative, PR-negative, and HER2-negative. This is known as triple-negative breast cancer (TNBC). TNBC usually grows and spreads faster than other types of breast cancer. It’s also more likely to recur (come back) and has fewer treatment options because hormone-blocking or HER2-targeting drugs don’t work.

It all started with a lump

“I felt a painful lump in my right armpit,” Nancy recalls. She contacted her gynecologist, who immediately ordered an ultrasound of her armpit and a mammogram.

The symptoms of TNBC are no different from other common types of breast cancer. They include:

• A lump or mass in the breast or armpit that can be either painless or painful – it can feel hard with uneven edges, or it can be soft and round.
• Skin changes or irritation anywhere in the breast, including the nipple and areola – sometimes the skin may look like an orange peel.
• Swelling of the breast or a change in its appearance.
• Pain in the breast or nipple.
• Changes in the appearance of the nipple – sometimes the nipple may turn inward.
• Nipple discharge.

Although some of these symptoms can also be caused by non-cancerous conditions, you won’t know the exact cause unless you get them checked out. Talk to your healthcare provider immediately if you notice any of these warning signs or anything unusual in or around your breasts or in your body.

The ultrasound of Nancy’s armpit showed an abnormal area. She then underwent a biopsy – where a sample of tissue was taken and sent to the lab to be examined.

Who gets TNBC?

A common misconception is that only Black women get TNBC. This disease can affect anyone of any race, although it tends to be more common in:

• Black and Hispanic individuals.
• People who are younger such as premenopausal women.
• People who have the BRCA1 genetic mutation.

As a Black, 47-year-old premenopausal woman at the time of her diagnosis, Nancy had two risk factors for TNBC. She had no family history of breast cancer and tested negative for the BRCA1 and BRCA2 genes.

Going into survival mode

Nancy’s biopsy showed that the tumor had metastasized (spread) to the lymph nodes in her armpit. She then needed to undergo another biopsy to find the original tumor in her breast and other imaging tests to help her doctors determine the stage of her cancer and the best treatment.

Despite being a nurse, Nancy admits she knew absolutely nothing about TNBC. Still, she knew that educating herself about the disease and her prognosis was imperative, so she took the bull by the horns.

“I immediately went into survival mode, pushing and fighting for every single test or medical appointment that needed to be, or could be, done!” she says.

She also recounts how she always urged her oncologists to disclose the good outcome and the negative ones. Knowing everything possible about her new diagnosis was vital to her.

Treating TNBC: not all breast cancer treatments are created equal

You may be wondering why triple-negative breast cancer is so hard to treat. Because TNBC doesn’t have the same receptors as other types of breast cancer, treatment options are limited. Historically, TNBC patients received chemotherapy, surgery, and radiation therapy.

Thanks to extensive research, the addition of immunotherapy to traditional TNBC treatment has shown promising results in treating TNBC.

In July 2021, the FDA approved a combination of the immunotherapy drug Keytruda (pembrolizumab) with chemotherapy before surgery to treat high-risk, early-stage TNBC. After surgery, the treatment continues with Keytruda alone.

While treatment for TNBC depends on many factors, nowadays, someone with TNBC may receive:

Chemotherapy/Immunotherapy combo may be given first to shrink the tumor while strengthening the immune system.

Surgery to remove the breast (mastectomy) or only the tumor (lumpectomy).

Radiation therapy uses high-energy x-rays to kill any remaining cancer cells.

Immunotherapy continues boosting the immune system to recognize and kill cancer cells.

Newer drugs, like poly ADP-ribose polymerase inhibitors (PARP inhibitors), are also being used to fight against TNBC.

After six exhausting months of the newly-approved combo chemotherapy and immunotherapy, Nancy underwent a mastectomy followed by radiation therapy.

Rechanneling her passion

Common challenges for women after breast cancer treatment is loss of positive self-image and feeling less feminine. Support groups like Look Good Feel Better can help.

When talking about the emotional and physical effects of chemotherapy and mastectomy, Nancy said, “I’m very feminine. I work in the beauty industry. Despite having had a right mastectomy, I’m comfortable with my body. My ‘battle scars’ empower me!”

As a cosmetic tattoo artist providing permanent makeup (PMU) services, several years ago, Nancy created the Beauty on Purpose project offering PMU eyebrow services at no charge to cancer survivors suffering from eyebrow hair loss after chemotherapy. As fate would have it, breast cancer struck her, and she got to experience her clients’ tales of struggle and survival personally.

Just 10 months after her unexpected diagnosis, Nancy returned to her studio where she has now expanded her services to include 3D Areola/Nipple Restoration (paramedical tattoo) for breast cancer survivors following their breast reconstruction journey.

The outlook for TNBC

About 91% of people diagnosed with TNBC live longer than 5 years after diagnosis if the tumor has not spread beyond the breast. If TNBC has spread to nearby lymph nodes, that number decreases to 65%. And only 12% of people with TNBC that has spread to other parts of the body are expected to be alive 5 years after diagnosis.

These numbers may look grim but remember that your prognosis depends on many factors. Recent advances have helped identify new treatments, and more research is happening daily to better understand this disease.

As with any cancer, early detection of TNBC improves your chances of survival. Mammograms and breast self-exam/self-awareness are vital steps to help detect breast cancer early.

Talk to your doctor about your risk factors for TNBC – or any other type of breast cancer – and discuss ways to reduce your risk. There are tools available to assess your risk of breast cancer, and additional screening tests may be recommended based on these results.

Nancy encourages women facing TNBC to keep fighting: “We can’t change the past. The present is surely an uphill battle, but no matter what, we shall not give up!”

It may be unsettling to learn that you have breast cancer and even more so to find out it is TNBC. There is hope thanks to research that’s being made almost daily. Regular mammograms and being vigilant about your breast health are key to early detection and are effective for all types of breast cancer. Wear your pink this month and encourage people to get their mammograms; you might help save their lives!