Hope and help for triple-negative (TNBC) and other forms of hormone-negative breast cancer.
Wednesday, November 17, 2010
Review of Triple-Negative
The New England Journal of Medicine published an excellent article overview of triple-negative breast cancer--when it started, how it differs from other cancers, typical patterns of metastases, prognosis....
9 comments:
Anonymous
said...
Patricia, Thanks for this and all of your links and information. I am confused by the article's definition of "complete pathological response." The fn says it is based upon the tissue removed at surgery (if I read correctly). I come up on one-year after diagnosis in January and finished treatment two weeks ago. Nodes clean, was cancer free in June scan and August breast MRI. Is that a complete pathological response? Thanks.
I have noticed that the beginnings of all of these articles still state that patients with TNBC carry a "poor prognosis"....I'd like to believe that's not neccessarily the case, for my mother's sake as well as all the other ladies'. Thanks for the article, Pat. :-) Lisa
Lisa: Yes, that is an unfortunate--and inaccurate--generalization. Which is especially frustrating as researchers are typically so precise. Meanwhile, I keep interviewing long-term survivors. Let's assume your mom will be one. Pat
I agree with Lisa. Almost every article I read said that. I just don't understand why they state it like that. I wonder if they mean that TNBC has a worse prognosis than hormone positive, but not generally a "poor prognosis". This is so scary for those of us who are just starting our journey through this. In my gut, the more I learn about tnbc and the more people I meet that are 4-20 years out, I realize that the majority of women do survive. It does not have a poor prognosis overall, hang it there Lisa. Your mom will be a survivor.
Thanks to all of you for your support and encouragement. Pat, in your experience with interviewing these women, did you find that even those with lymph node involvement could survive? My mother's tumor was 2cm by 3cm, with at least one dirty node. It's so frightening and discouraging to hear all the negative stats.... Lisa
The long-term survivors I have interviewed were not diagnosed with triple-negative--just hormone-negative, as they did not start using TNBC until 2006. So they were not tested for Her2-neu. The longest-living survivor of hormone-negative is at nearly 30 years, and she had seven affected nodes. She is a neighbor of mine at our Colorado cabin and I know her because she comes and rides horses with my sister-in-law. Her son was a baby when she was diagnosed--she had to wean him. He is now 30. Woot! woot! Pat
Hi all Thanks again Pat for posting these articles. The authors refer to 'complete pathological response' only in regard to neoadjunct chemo. If chemo wiped out the tumor before surgery, that is CPR and a very good sign. If you had surgery before chemo, they have no idea if your particular tumor responds to a particular chemo regime. As for TNBC, it has a 'poorer' prognosis compared to ER+ cancer but if you were to compare it to pancreatic cancer, you'd say 'excellent prognosis'. Still newbies reading the word 'poor' get the wind knocked out of them. All terms should be defined by the authors.
Thanks, Sue. I did not think through my earlier response enough, so I deleted it to reduce the risk of confusion. You are correct that only neo-adjuvant therapy (before surgery) can truly show a PCR, which refers to no clinical evidence of cancer because of a response to chemo. Clear margins are another issue and that term refers to surgery, not chemo. But that is the most docs can say when you have adjuvant therapy (after surgery) because, as you say, they cannot tell definitely if all the cancer is gone, even though they may believe they have removed all the tumor, with clear margins. As for the aggressiveness of TNBC, that is true for the first three years; after that, in multiple studies, TNBC women fare better. And, increasingly, researchers are determining that TNBC is really a group of cancers, with some far less aggressive than others. Also, I love your blog.
9 comments:
Patricia, Thanks for this and all of your links and information. I am confused by the article's definition of "complete pathological response." The fn says it is based upon the tissue removed at surgery (if I read correctly). I come up on one-year after diagnosis in January and finished treatment two weeks ago. Nodes clean, was cancer free in June scan and August breast MRI. Is that a complete pathological response? Thanks.
I have noticed that the beginnings of all of these articles still state that patients with TNBC carry a "poor prognosis"....I'd like to believe that's not neccessarily the case, for my mother's sake as well as all the other ladies'.
Thanks for the article, Pat. :-)
Lisa
Lisa: Yes, that is an unfortunate--and inaccurate--generalization. Which is especially frustrating as researchers are typically so precise. Meanwhile, I keep interviewing long-term survivors. Let's assume your mom will be one. Pat
I agree with Lisa. Almost every article I read said that. I just don't understand why they state it like that. I wonder if they mean that TNBC has a worse prognosis than hormone positive, but not generally a "poor prognosis".
This is so scary for those of us who are just starting our journey through this.
In my gut, the more I learn about tnbc and the more people I meet that are 4-20 years out, I realize that the majority of women do survive. It does not have a poor prognosis overall, hang it there Lisa. Your mom will be a survivor.
Thanks to all of you for your support and encouragement. Pat, in your experience with interviewing these women, did you find that even those with lymph node involvement could survive? My mother's tumor was 2cm by 3cm, with at least one dirty node.
It's so frightening and discouraging to hear all the negative stats....
Lisa
The long-term survivors I have interviewed were not diagnosed with triple-negative--just hormone-negative, as they did not start using TNBC until 2006. So they were not tested for Her2-neu. The longest-living survivor of hormone-negative is at nearly 30 years, and she had seven affected nodes. She is a neighbor of mine at our Colorado cabin and I know her because she comes and rides horses with my sister-in-law. Her son was a baby when she was diagnosed--she had to wean him. He is now 30. Woot! woot! Pat
Hi all
Thanks again Pat for posting these articles. The authors refer to 'complete pathological response' only in regard to neoadjunct chemo. If chemo wiped out the tumor before surgery, that is CPR and a very good sign. If you had surgery before chemo, they have no idea if your particular tumor responds to a particular chemo regime.
As for TNBC, it has a 'poorer' prognosis compared to ER+ cancer but if you were to compare it to pancreatic cancer, you'd say 'excellent prognosis'. Still newbies reading the word 'poor' get the wind knocked out of them. All terms should be defined by the authors.
Thanks, Sue. I did not think through my earlier response enough, so I deleted it to reduce the risk of confusion. You are correct that only neo-adjuvant therapy (before surgery) can truly show a PCR, which refers to no clinical evidence of cancer because of a response to chemo. Clear margins are another issue and that term refers to surgery, not chemo. But that is the most docs can say when you have adjuvant therapy (after surgery) because, as you say, they cannot tell definitely if all the cancer is gone, even though they may believe they have removed all the tumor, with clear margins. As for the aggressiveness of TNBC, that is true for the first three years; after that, in multiple studies, TNBC women fare better. And, increasingly, researchers are determining that TNBC is really a group of cancers, with some far less aggressive than others. Also, I love your blog.
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