Kenalog Injection: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Triple-Negative Breast Cancer: How We Are Learning To Treat It More Effectively

How triple-negative breast cancer (TNBC) is different from other types of breast cancer, in that it has fewer treatment options and tends to have a worse outlook

That TNBC is more likely to affect Black women and women under 40

How doctors are learning to treat TNBC more effectively

In this webinar, you'll learn how triple-negative breast cancer (TNBC) is different from other subtypes of breast cancer, and how doctors are treating it more effectively with new therapies. Breast cancer expert Kevin Kalinsky, MD, MS, will explain why TNBC tends to be more aggressive and has more limited treatment options than other types of breast cancer. He will also discuss how Black women and younger women are more likely to be diagnosed with TNBC. Finally, he'll share the reasons for the standards of care and emerging therapies that doctors use to treat it more effectively. 

Kevin Kalinsky, MD, MS, is director of the Glenn Family Breast Center at the Winship Cancer Institute of Emory University. He works to improve breast cancer outcomes by aligning research and education with cancer treatment and prevention. He's also an associate professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine. A breast cancer physician and investigator, Dr. Kalinsky leads research focusing on developing new therapeutic approaches for those with breast cancer. 

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What Is The Outlook For People With Triple-negative Breast Cancer (TNBC)?

Triple-negative breast cancer (TNBC) has fewer treatment options than other types of breast cancer. For this reason, the outlook is typically less positive than that of other types. Around 60% of people with stages 1–3 of TNBC will have long-term disease-free survival.

TNBC is an aggressive form of breast cancer that is more likely to recur and spread than other forms of breast cancer.

About 10% of all breast cancers are triple negative. This type of breast cancer is more common among:

females

people younger than 40 years

Black people

people with BRCA1 and PALB2 mutations

In particular, TNBC disproportionately affects non-Hispanic Black females. About 21% of the breast cancers that affect these individuals are triple negative. The rate is double that of other racial and ethnic groups. Research shows that African American people are also nearly twice as likely to die from the disease.

A 2019 study found that roughly 40% of people with stage 1 to stage 3 TNBC will see their cancer return after standard treatment. The remaining 60% will have long-term survival without recurrence.

The outcomes of treatment vary. About 42% of those with this form of cancer will have a rapid relapse after standard treatment. This recurrence typically occurs within the first 2–3 years following the initial diagnosis.

It is not currently possible to predict who will experience a relapse in their cancer, even if they have had intensive chemotherapy.

On average, 77% of people with this cancer will live 5 years after diagnosis compared with those without this form of cancer. This survival rate is 8–16% lower than that of hormone receptor-positive breast cancer, where the cancer cells have estrogen receptors, progesterone receptors, or both.

Triple-negative breast cancer can recur in various areas of the body and at local, regional, and distant levels:

Local means that the cancer remains in the breast and has not spread.

Regional is when the cancer spreads from the breast to lymph nodes and other structures nearby.

Distant refers to cancer that has spread far from the breast to other organs, such as the liver or lungs.

A 2017 study examined the patterns of recurrence among 1,930 people with TNBC. The researchers divided the patients into two age groups: 15% were younger than 40 years at the time of their diagnosis, and 85% were 40 years or older.

The researchers found only a small difference between the two groups in terms of recurrence of the cancer on the local level: 6% of those under 40 versus 5% of those ages 40 or above.

The same study found that the rate of regional recurrence was 2% for both age groups.

The axilla, the area where the shoulder meets the arm, accounted for the majority of the regional recurrence sites. Of the participants with regional recurrence, 3 out of 5 experienced it there, regardless of their age.

Among the participants under the age of 40, 17% experienced distant recurrence. The percentage was lower among those ages 40 or older, at 12%.

The percentages of people experiencing distant recurrence at multiple sites were similar in both age groups: 36% in the younger group and 37% in the older group.

People who experience recurrent breast cancer may experience a range of symptoms, which can vary depending on whether the recurrence is local, regional, or distant.

Individuals who experience localized recurrent breast cancer may experience:

skin swelling in the breast or around it

discolored skin on the breast or around it

new lumps in the breast

new swelling or pulling of the skin at the site of the lumpectomy

new areas in the breast that seem atypically firm

changes to the nipple, such as flattening

thickening either on or near the scar from the mastectomy

bumps on the chest wall, either under or on the skin

Those who experience a regional recurrence of breast cancer may have the following symptoms:

difficulty swallowing

a loss of feeling in the shoulder or arm

constant pain in the shoulder, arm, or chest

a lump near the breastbone, collarbone, or in the lymph nodes under the arm

swelling in the lymph nodes under the arm, near the collarbone or breastbone

swelling in the arm on the same side as the original site of the breast cancer

A distant recurrence of breast cancer may cause various symptoms depending on where the cancer appears. Possible symptoms include:

Although research suggests that about 40% of people who receive treatment for stages 1 to 3 of TNBC will experience a recurrence, 60% will continue to live a disease-free survival.

The American Cancer Society gives 5-year relative survival rates according to whether the cancer is local, regional, or distant. This rate shows the likelihood of someone with this cancer living for 5 years after diagnosis compared with those who do not have this cancer.

The table below shows the 5-year relative survival rates for TNBC at different stages:

It is possible for people with TNBC to live long lives even following a diagnosis. In one case study, a woman in her late 50s who experienced recurrent TNBC that spread to her lungs, liver, and bones was still alive 15 years later.

Triple-negative breast cancer (TNBC) is an aggressive, fast-growing form of breast cancer that is more likely than other forms of breast cancer to recur. About 40% of people with stage 1 to 3 TNBC will experience a recurrence after treatment. However, many of those with TNBC will live long, disease-free lives.

The overall 5-year relative survival rate across all stages of the disease is 77%. It is important to remember that the survival statistics depend on the stage of cancer at the time of diagnosis. As research and treatment continue to advance, the survival rate will also improve over time.

What Types Of Breast Cancer Have The Highest Recurrence Rates?

Aggressive, hard-to-treat breast cancers, such as inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC), are the types most likely to recur.

Although the type of breast cancer you have plays a large role in its recurrence, it's not the only factor.

Breast cancer variables such as tumor size and stage at diagnosis can also influence your risk. Personal factors such as your age and your weight can affect your risk as well.

In this article, we take a closer look at the types of breast cancer most likely to recur and other factors that can increase your risk of recurrence.

Aggressive breast cancers are harder to treat, more likely to spread, and more likely to recur. The two types of breast cancer most likely to recur are inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC). These cancers are described in more detail below.

IBC: IBC is a rare and invasive type of breast cancer. About 1–5% of all people's breast cancer is IBC. IBC causes cancer cells to block lymph vessels in your breast tissue. Lymph vessels are the small tubes that drain lymph fluid from your breast. IBC spreads quickly and is usually stage 3 at the time of diagnosis.

TNBC: About 10–15% of all people's breast cancer is TNBC. Cancer cells that cause TNBC don't have estrogen receptors (ERs) or progesterone receptors (PRs) and don't make any, or much, of a breast cancer-associated protein called HER2. TNBC spreads faster than most other types of breast cancer and has few treatment options.

The type of breast cancer you have is a large risk factor for recurrence, but it's not the only one. There are many other factors that can increase your chances of recurrence. These include:

Stage at diagnosis: The stage of your cancer at diagnosis influences your risk of recurrence. A high stage increases your risk.

Lymph node involvement: Cancers that spread to your lymph nodes are more likely to recur.

Tumor size: Large tumors increase your risk of recurrence.

Tumor margins: A tumor margin is a border between a tumor and the healthy tissue that surrounds it. After a tumor is removed, a sample of the border area is removed and studied in a lab. If any cancer cells are found in this area, it's called a "positive tumor margin." This increases your risk of recurrence.

ER status: ER-positive breast cancer cells can use estrogen to grow and reproduce. These cancers have a higher risk of recurrence and can sometimes recur decades later.

HER2 status: HER2 is a protein often found in people who have breast cancer. High amounts of this protein can increase your risk of recurrence.

BRCA status: Having BRCA1 and BRCA2 gene mutations puts you at a greater risk of recurrence and developing other types of cancers.

Radiation therapy: Electing not to have radiation therapy after a lumpectomy can increase your risk of recurrence. Not completing or receiving other recommended treatments, such as chemotherapy, immunotherapy, endocrine therapy, or targeted therapy, can also increase your risk of recurrence.

Endocrine therapy: If you have hormone-positive breast cancer, your doctor will typically recommend receiving endocrine therapy treatment. Not completing or receiving other recommended treatments, such as chemotherapy, immunotherapy, radiation therapy, or targeted therapy, can also increase your risk of recurrence.

Age: Developing breast cancer while younger than 35 years of age increases your risk of developing breast cancer again.

Obesity: A higher body mass index (BMI) increases your risk of recurrence.

Sedentary lifestyle: A sedentary lifestyle can increase your risk of recurrence.

Smoking: Smoking can also increase your risk of recurrence.

If you had a lumpectomy or a partial mastectomy, you'll typically have a mammogram 6 months to a year after surgery and radiation. During this first year, you'll likely also have monitoring appointments with your doctor or oncologist.

After your initial postcancer mammogram, yearly mammograms are recommended. If you've had a complete mastectomy, you won't need a mammogram on that side, but you'll still need to have yearly mammograms on your remaining breast.

Depending on your individual breast cancer risk factors and your breast density, a doctor may also recommend yearly ultrasounds, MRIs, or both.

The symptoms of breast cancer recurrence depend on where the breast cancer recurs, as noted in this table:

Which breast cancer recurs the most?

Although all types of breast cancer can recur after treatment, the two types of breast cancer that are most likely to come back are inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC).

What type of breast cancer is most likely to metastasize?

HER2 positive and TNBC both have higher rates of metastasis compared to other types of breast cancer, according to this 2020 study.

Which type of breast cancer has the best outlook?

Ductal carcinoma in situ, which is stage 0 (noninvasive), has the best outlook of all types of breast cancers. Generally speaking, the lower the stage at which you receive the cancer diagnosis, the better the outcome.

What percentage of people with breast cancer in remission have a recurrence?

It's difficult to pinpoint recurrence percentage rates. This is because many individual factors affect these rates, such as the stage of their cancer at the time of treatment, the type of treatment they get, or the particular subtype of their cancer.

It's best to speak with your doctor about your risk of recurrence and how to screen for that possibility.

What risk factors can increase your chance of breast cancer recurrence?

Many factors can increase your chances of recurrence, including the type of cancer you have, its stage and size at diagnosis, as well as ER, HER2, and BRCA status.

Other factors such as age, obesity, having a sedentary lifestyle, and smoking can also increase your risk.

Does the risk of breast cancer recurrence decrease over time?

Yes. The risk of breast recurrence is highest in the first 2 years after you receive the initial diagnosis. The risk of recurrence decreases steadily as time passes.

Does the outlook for a person with recurrent breast cancer get worse?

The outlook for a person with recurrent breast cancer depends on multiple factors. For instance:

whether the recurrence is local, regional, or distant

the particular subtype of the cancer (ER, PR, or HER2 positive)

how long it's been since they received diagnosis and treatment for their initial breast cancer

Your treatment team can look at all the factors specific to your recurrence and give you an idea of your overall outlook.

Aggressive and hard-to-treat breast cancers are the types most likely to recur. This includes IBC and TNBC.

The type isn't the only breast cancer factor that can influence recurrence. Factors such as your tumor size, stage at diagnosis, tumor margin, and lymph node involvement, along with treatment choices and personal factors such as age and BMI, also play a role.

The chance of breast cancer recurrence is highest in the first 2 years and decreases with each passing year. But regular mammograms are still important for you if you have breast cancer in remission, no matter how much time has passed.

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