When You Are First Diagnosed With Triple Negative Breast Cancer

Triple negative breast cancer, often shortened to TNBC, affects 1 in 6 people with breast cancer. There are similarities, but also differences, between TNBC and other types of breast cancer. That means some, but not all, of your treatments and experiences will be the same as for other people newly diagnosed with breast cancer.

This webpage is intended for people who have been diagnosed with TNBC with no visible sign that the cancer has spread; we hope it will help you to understand your treatment options, enable you to ask questions to your oncologist and cope effectively with the physical and emotional pressures.

What decides how my cancer will be treated?

When breast cancer, including TNBC, is caught early it can often be cured by a combination of surgery, with or without radiotherapy, and drug treatment; this drug treatment is given to deal with any seedlings, or metastases, that may have already spread but are too small to be seen. 

Treatment is given with the aim of curing your TNBC so it is important you get the best treatment and understand that treatment.

You will probably have had a ‘biopsy’, where a small part of a breast lump was taken away to see whether it was a cancer; once the laboratory had shown it was indeed a cancer, they will have done extra tests to see what type of breast cancer you have. You may also have X-rays,  scans and blood tests .

Your surgeon and your oncologist (cancer doctor) will recommend the best treatment for you depending on the results of these tests, and in particular: 

• The size of the cancer size, which can be measured from a breast scan or in the laboratory after the cancer has been removed

• Its grade, which is how nasty or “aggressive” the cancer cells look under the microscope

• And whether the cancer has spread to the lymph glands in the armpit.

The laboratory will also have looked for oestrogen, progesterone and human epidermal growth factor 2 receptors, but with your cancer being triple negative, these receptors were not present. 

What are the main treatments for TNBC?

Treatment for TNBC that has not spread is usually a combination of surgery, with or without radiotherapy, and drug treatment.  While surgery and radiotherapy, the “local” treatments to treat the cancer in your breast are the same as for other types of breast cancer, the drug treatments are different for people with TNBC.

Surgery
Your surgeon will discuss whether they recommend a ‘lumpectomy’ to remove just the cancer or if a mastectomy is necessary to surgically remove the whole breast. They may also discuss removing one or more lymph glands in the armpit. You might want to discuss breast reconstruction with your surgical team if a mastectomy is planned.

Radiotherapy
Most people who have a lumpectomy then have a course of radiotherapy to the breast to reduce the risk of the cancer coming back in the breast; some people who have had a mastectomy will also be recommended to have radiotherapy to the chest wall to reduce the risk of the cancer coming back there.

Drug treatment with chemotherapy
This is given if the doctors suspect that the cancer may have thrown off seedlings of cancer cells,or metastases, which are too small to be seen but might cause problems in years to come. This is more likely if the cancer is larger, higher grade and/or has spread to some lymph glands in the armpit.

• Because you have TNBC, you would not benefit from hormone therapies used for cancers with ‘positive’ receptors, such as tamoxifen or letrozole, or from targeted treatments such as trastuzumab (Herceptin)

• Chemotherapy does, however, reduce the risk of TNBC coming back. The chemotherapy drugs you may receive are used not only in people with breast cancer but also for other cancers, and are known to often work well. Some types of chemotherapy, such as the drug carboplatin, may to work better against TNBC

• Most chemotherapy is given intravenously, often every 3 weeks, but sometimes weekly or every 2 weeks; one chemotherapy drug, called capecitabine, is a tablet.

• Chemotherapy does have side effects but these are well known and can usually be controlled. Your oncology team will provide you with detailed information about the side effects of the particular chemotherapy drugs that you are to have.

• You might receive chemotherapy before or after your surgery/radiotherapy

  • If you have chemotherapy before your operation, it is called neo-adjuvant treatment

    • You may have breast scans to see how well the cancer in your breast is shrinking

    • Treatment is usually given over 12 – 24 weeks

  • If you have chemotherapy after your operation, it is called adjuvant treatment

    • The chemotherapy is usually intravenous

    • Treatment is usually given for 18 – 24 weeks

    • You might also be offered 6 months of treatment with capecitabine tablets if you received neo-adjuvant chemotherapy before surgery, depending on how well the earlier treatment worked

• Your oncologist may also discuss oral or intravenous treatment with a bisphosphonate for 3 – 5 years. These are drugs that strengthen the bones, but also reduce the risk of breast cancer coming back (but only in women who are post-menopausal (or pre-menopausal and given other treatment to stop their periods)

• New treatments are being developed for people with TNBC and your oncology team may discuss clinical trials of such treatments.

What can I do to help my recovery?

There is a lot of evidence that staying positive, fit, active and healthy can help with your recovery.  Ignore ‘myths’ on the internet and use only authoritative sources of information such as Cancer Research UK, Macmillan Cancer Relief, BreastCancerNow and the UK Charity for TNBC. You may also want to meet other people with TNBC to share experience and tips. There are many excellent local support groups that your oncologist or breast cancer nurse may know about, although these will usually not be specifically for people with TNBC.

Where can I find support while I undergo treatment?

The focus of the UK Charity for TNBC is to provide information to people with TNBC and fund scientific research into targeted treatments and eventually, a cure for TNBC.   We also provide up to date information on our website.

There are many other charities that also provide excellent support, giving advice on a wide range of day to day coping strategies and where to find support for you, your family and friends.

Below are some great resources - please click on the logo to view their website: