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Q. Are there any recent research findings or treatment developments for triple-negative breast cancer? With a high risk of recurrence, what is the recommended follow-up? What questions should I ask my doctor?

A.

Triple-negative breast cancer has gained much attention over the past few years, but is still relatively new to researchers. Researchers have discovered that there are many variations of triple-negative breast cancer, and about 15-20% of breast cancer diagnoses in the U.S. are triple negative.

The treatment of triple-negative breast cancer does not vastly differ from other types of breast cancer, and would typically involve the options of surgery, chemotherapy, and radiation. Some of the studies being performed at this time are on already existing chemotherapies; others are on newer medications including PARP inhibitors, angiogenesis drugs, and tyrosine kinase inhibitors.

Because much of triple-negative breast cancer is under investigation, participating in a clinical trial can be helpful to advance research. Depending upon the clinical trial, a patient can join at various stages of treatment and post treatment. The Triple Negative Breast Cancer Foundation has a partnership with EmergingMed that offers a clinical trial matching service in order to make your search faster and easier. You can call them at 877-769-4827 or visit www.emergingmed.com/networks/tnbcf to speak to a clinical trial navigator.

It is very important to discuss a follow-up care plan with your oncology team. During follow-up appointments, you should discuss with your doctor any changes in your body. Typically, a follow-up plan includes physical exams, mammograms, bone health tests, and blood work. Additonal follow-up may involve scans, but that is not as common. A follow-up care plan should best meets your needs and your doctor’s recommendations.

Questions to consider for follow-up visits include:

  • How often are my follow-up appointments?
  • Will the frequency of my appointments change over time?
  • What will happen during these follow-up appointments?
  • Is there anything I can do to improve my lifestyle that may directly impact my risk of recurrence (e.g., changes in nutrition, exercise, or stress levels)?
  • What are common longer-term side effects of my cancer treatment, and how long might they last?
  • Are there any resources to help pay for my medical bills?
  • When is it medically safe to return to work, and should I perform light-duty tasks when going back?
  • Where can I join a support group for post-treatment survivors?

CancerCare offers a variety of educational workshops and publications, along with supportive services for post-treatment survivors. We currently offer face-to face, telephone, and online support groups specifically for people who have completed treatment. View all of CancerCare’s post-treatment resources.

Q. I have heard about triple-negative breast cancer, but I really don't know what it is. Could you explain?

A.

Triple-negative breast cancer is a subtype of breast cancer. Although breast cancer is often referred to as a single disease, there are many types of breast cancer tumors. In fact, breast cancer can be described as a family of diseases. All breast cancers start in the breast. So, they are alike in some ways, but also can be quite different from each other.

Subtypes of breast cancer are generally diagnosed based upon the presence, or lack of, three “receptors” known to fuel most breast cancers: estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2 (HER2). None of these receptors are found in women with triple-negative breast cancer. In other words, a triple-negative breast cancer diagnosis means that the tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative, thus giving rise to the name “triple-negative breast cancer.” Because of its triple-negative status, triple-negative tumors generally do not respond to receptor-targeted treatments. Despite not having a targeted therapy as a treatment option, chemotherapy is an effective treatment. Research shows that triple-negative breast cancer may even respond better to chemotherapy than other types of breast cancer. Surgery and radiation therapy are also usually options.

Q. Is there a way to find triple-negative breast cancer specialists? And are there specific support groups or programs to speak with women with triple-negative breast cancer?

A.

When coping with a diagnosis of triple-negative breast cancer, it is important to ensure that your medical team is well-informed about the latest research and best practices. While we are unable to recommend or endorse a specific doctor, here are some suggestions for seeking out a breast cancer specialist who is experienced with treating triple-negative breast cancer.

  • The National Cancer Institute has designated cancer centers throughout the United States and provides information on doctors practicing in your area. You can access their online database or call them at 800-4-CANCER.

  • Ask your current doctor for a referral. Many people may feel hesitant to ask for a second opinion for fear of creating an uncomfortable relationship with the doctor. But be assured that a second opinion is considered a routine and necessary component of one’s health care plan. In fact, most medical professionals expect their patients to receive a second opinion.

  • Researching clinical trials in your area will allow you to learn which doctors are participating, and get an idea of specialists in the field. A free, confidential resource to locate clinical trials accepting women with triple-negative breast cancer is The Clinical Trials Matching Service website and helpline: 877-769-4827.

  • Contact the local county medical society, hospitals or breast cancer center in your area.

It is perfectly acceptable to ask doctors how many of their patients have TNBC, and how familiar they are with treating this subtype of breast cancer.

To answer your second question, getting support from other women who have experienced triple negative breast cancer can be a valuable tool to feel less alone and more empowered. Organizations such as Living Beyond Breast Cancer and the American Cancer Society provide a service called peer matching, in which you can be paired with a volunteer who had a similar diagnosis. The Triple Negative Breast Cancer Foundation has a very active online forum where people impacted by TNBC discuss various topics. There may be support groups in your area where you can connect with peers, as well. Your oncology social worker is a good resource for local referrals.

Q. Where can I find treatment guidelines and recommendations for triple-negative breast cancer?

A.

Each person’s cancer is different, and so there is no one-size-fits-all treatment for triple-negative breast cancer. New research suggests that even within triple-negative breast cancer, there are many subtypes. Therefore, the best treatment plan is one that your medical team carefully tailors to your unique situation. Generally speaking, treatment for triple-negative breast cancer commonly consists of surgery, chemotherapy (given neo-adjuvantly – before surgery – or adjuvantly – after surgery), and radiation. Even when surgery appears to successfully remove all visible cancer, chemotherapy is often given as systematic therapy, as it treats the whole body by moving through the bloodstream. Chemotherapy adds an extra layer of protection against cancer recurrence because there is a chance that tiny cancer cells could remain in the body after surgery. Triple-negative breast cancer is uniquely chemosensitive, meaning that chemotherapy is a very effective treatment for this subtype of breast cancer. Common chemotherapies for triple negative breast cancer may include an anthracycline such as Adriamycin, alkylating agents such as Cytoxan, and a taxane, such as Taxol or Taxotere. Fluorouracil (5FU) may be given as well. Often a combination of drugs, or a “chemo cocktail,” is given to disable and kill cancer cells. Genetic testing may be conducted to determine if you carry genetic risk factors for recurrence or a second cancer. There is a wealth of information on treatment for triple-negative breast cancer on the Triple Negative Breast Cancer Foundation’s website.

Clinical trials for triple-negative breast cancer should not be overlooked. Clinical trials offer the chance to try new, promising treatments before they are available to the public. Clinical trial participants are volunteers and can withdraw from the trial at any time. Trials move through three phases that analyze different aspects of a medicine such as safety, how well a treatment works for a certain type of cancer, and comparison to how well the new treatment works versus the established, approved treatment. In addition to personal benefit, clinical trials pose an opportunity to contribute to science, and help women in the future who will be diagnosed with triple-negative breast cancer. It is critical to be informed about clinical trials early on, as many trials exclude patients who have received previous treatment. Ask your medical team about clinical trials. You may also search online using BreastCancerTrials.org or The Clinical Trials Matching Service.

I strongly encourage you to speak with your medical team about why a specific treatment plan was recommended for you.