When You Are First Diagnosed with Triple Negative Breast Cancer
The purpose of this page is to explain to you, and your family and friends, what will happen around the time that you are diagnosed with triple negative breast cancer or TNBC.
If you have just been told that you have triple negative breast cancer (TNBC), your brain is probably trying to understand, and come to terms with, what this means. The word ‘cancer’ is scary enough and you may never have heard of triple negative breast cancer.
What is Triple Negative Breast Cancer?
You can see what triple negative breast cancer is, who is more likely to be affected, what it means in terms of your treatment here.
It can be difficult to know what to ask in a busy clinic at an extremely scary, stressful and emotional time. Indeed, after “cancer” most people hear little else. This is why a Breast Cancer Nurse is so important, and why we developed this website and printable pamphlet. Hopefully, you, your family and patients will find answers to your questions.
When is Triple Negative Breast Cancer diagnosed?
Most people are first diagnosed with breast cancer when it is detectable only in the breast, and sometimes the lymph glands in the armpit. This is called “early” or “primary” breast cancer the diagnosis of TNBC will be usually made from a biopsy taken from a lump in the breast.
If, despite treatment for early/primary disease, the breast cancer later spreads to other parts of the body another biopsy might be taken to see if the type of breast cancer has changed.
In some cases a cancer that was originally hormone receptor (HR) positive or HER2 receptor positive may become triple negative.
In other cases a triple negative breast cancer may be HR positive or HER2 positive when in a second biopsy.
Where there is a change in the type of breast cancer this can affect how your cancer is then treated as different drugs may be more or less likely to work.
Although most people have early/primary breast cancer when first diagnosed, in a minority of people the cancer has visibly spread to other parts of the body when it is first detected. These people have metastatic/secondary breast cancer at diagnosis. Again, in some cases they may have another biopsy in the future and the type of cancer can change.
What does the “stage” of my cancer mean?
All breast cancers can be “staged” to reflect how widespread the cancer is, or is not.
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Stage 1 cancers are small but might be found in lymph nodes in the armpit.
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Stage 2 cancers are larger but still only in the breast or nearby lymph nodes (or both).
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Stage 3 cancers have spread to the nearby, skin over the breast or to the chest wall.
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Stage 4 cancers have spread to other parts of the body such as the bones or lungs.
What will decide how my cancer will be treated?
Your medical team will want to discuss with you what treatment they think will benefit you most, but also what is important to you and what you want.
In people diagnosed with early/primary triple negative breast cancer:
“Early” or “primary” triple negative breast cancer is Stage 1 to Stage 3 and usually treated with surgery, with or without radiotherapy in the same way as other types of breast cancer.
Other important features of the cancer are:
How large it is
Its grade, which is how it looks under the microscope, with grade 1 being the least aggressive and grade 3 the most aggressive
Whether or not it has spread to the lymph glands or nodes in the armpit (or axilla)
Although the cancer cannot be seen elsewhere, “seedlings” or metastases too small to be seen may have escaped that could allow the cancer to come back elsewhere in the body in the future. That risk is greater for tumours that are larger, higher grade and/or have spread to the lymph glands.
TNBC is more likely to come back, or spread, than other types of breast cancer, but it is important to remember that:
Not all triple negative breast cancers come back and spread
The chances of that happening can be significantly reduced with drug treatment.
Those drugs get into the blood so can reach cancer seedlings wherever they are, and are tailored to the cancer being triple negative. This treatment given before and/or after surgery (with or without radiotherapy) reduces the risk of TNBC coming back or spreading meaning more people are cured.
There is more information about adjuvant or neo-adjuvant drug therapy here.
In people with metastatic or advanced triple negative breast cancer
(either when first diagnosed with breast cancer or after previous treatment for early/primary disease):
“Metastatic” or “advanced” triple negative breast cancer is Stage 4 and mainly treated with drugs that get into the blood and can reach cancer metastases wherever they are to shrink or control them.
Chemotherapy, and in some people also immunotherapy or targeted therapy, will be chosen because it is TNBC rather than any other type of breast cancer.
Other treatments for metastatic/advanced TNBC are basically the same as for other types of breast cancer. Radiotherapy can treat individual cancer metastases, for example in the bone. Likewise, surgery can be used to treat individual metastasis, for example “pinning” or replacing a bone weakened by cancer. Finally, and again in people where the cancer has spread to the bone, there are drugs that strengthen the bones reducing problems caused by bone metastases.
There is more information about this drug therapy for metastatic/advanced TNBC here.
Frequently Asked Questions
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“Staging” is how your medical team may describe how large you breast cancer is and whether it has spread to the nearby lymph glands or more widely.
This is the same for triple negative breast cancers as for other types of breast cancer and can involve physical examination, scans and examination of the cancer in the laboratory after it has been removed surgically
Stage 2 breast cancers are more than 2 cm in size and still contained in the breast but may have spread to some of the nearby lymph glands.
Click here for more information on Stages 1 - 4. -
“Prognosis” is a medical term that describes what the outcomes are likely to be for someone with a particular medical condition. It is used for people with a range of medical conditions, not limited to breast cancer or to triple negative breast cancer.
Most people diagnosed with triple negative breast cancer (TNBC) can be cured if their cancer is found and treated early. They have, therefore, a good prognosis although it cannot be guaranteed that they are cured despite treatment with surgery with or without radiotherapy, and drugs.
You may hear it said that TNBC is more ‘aggressive’. That is because, even when it is diagnosed and treated early, TNBC is more likely to come back and spread than other types of breast cancer. Nevertheless, people diagnosed with early TNBC are treated with the aim of curing them.
After someone with early TNBC has been treated, the chances of their cancer coming back and spreading are greatest in the next 2 – 3 years. It is unusual for TNBC to come back and spread more than 5 years after the cancer was first diagnosed and treated but it can sometimes happen.
When someone with TNBC is first diagnosed if there are already signs that it has spread to other parts of the body, or if a cancer diagnosed and treated early comes back and spreads to another part of the body, unfortunately these cancers cannot be cured. The prognosis for people with metastatic TNBC is not, therefore, what we would like it to be.
This is also true for other types of metastatic breast cancer, not just TNBC. Those with with metastatic TNBC can still be treated, and their cancer controlled, with the aim of them living longer and with a better quality of life than would otherwise be the case.There are an increasing number of drugs becoming available to treat people with metastatic TNBC and newer treatments are being tested in clinical trials.