Risk factors for triple negative breast cancer

The Life After Cancer Epidemiology (LACE) Study underscores what other research has demonstrated: women with triple negative breast cancer are more likely to:

• be younger at diagnosis
• African American
• overweight and/or obese at diagnosis if premenopausal

The were less likely to breastfeed for long periods—more than four months—and were more likely to not breastfeed if they had at least three children.

The study consisted of 2280 women diagnosed with invasive breast cancer (stages I, II, or IIIA) between 1997 and 2000 and recruited primarily from the Kaiser Permanente Northern California Cancer Registry and the Utah Cancer Registry. They were between 18 and 70 years old and between 11 and 39 months post-diagnosis, free of recurrence, and with no history of other cancers in the five years prior to enrollment.

Tumor subtypes the used and the percentage in that group:

Luminal A: ER positive and/or PR positive, and Her2 negative (73.4%)
Luminal B: ER positive and/or PR positive, and Her2 positive (11.6%)
Triple negative: ER negative, PR negative, and Her2 negative (11.3%)
Her2-overexpressing: ER negative, PR negative, and Her2 positive (3.7%)

Luminal B cases were more likely to be younger at diagnosis and were less likely to consume alcohol or use hormone replacement therapy.

Her2-overexpressing cases were more likely to be younger at diagnosis, less likely to use hormone replacement therapy, and Hispanic or Asian.

Some other interesting stats:

•The majority of the whites (75.3%), Asians (71.4%), Hispanics (68.5%), other (68.5%), and African Americans (59.4%) had luminal A tumors.
• Her2-overexpressing tumors were least common among all races/ethnicities (whites 3.1%, African Americans 3.2%, Asians 6.4%, Hispanics 6.6%, other 5.5%).
• African Americans had the highest prevalence of the triple negative subtype (28.4%) compared with the other races/ethnicities (whites 10.5%, Asians 6.3%, Hispanics 10.7%, other 13.0%).
•African Americans (average age: 56.2) and Asians (average:54.8 years) were more likely to be diagnosed at a younger age.
•Whites were more likely to be diagnosed at an older age (59.8).
•, Asians (59.1%) were less likely to be post-menopausal than whites.
(75.6%), African Americans (71.4%), and other races/ethnicities (72.9%).
• A family history of breast cancer was more common among whites (22.6%) and other
races/ethnicities (24.1%), than among the other groups.
• African Americans and Hispanics had more biological children and were younger during their first pregnancy.
• Whites were more likely to have consumed alcohol while Asians were more likely to have never smoked.
• More whites had used HRT (76.2%).
• Fewer Asians (44.1%) had used oral contraceptives.
• African Americans were more obese at diagnosis.

The study was published in the May 2009 Breast Cancer Research, an open access journal. Download a PDF here.  Or read the abstract.


SOURCE: Kwan, ML, Kushi, L, Weltzien,E, Maring, B, Kutner, S, Fulton, R, Lee, M,Ambrosone, C, Caan,B,  “Epidemiology of breast cancer subtypes in two prospective cohort studies of
breast cancer survivors,” Breast Cancer Research, 2009, 11:R31. 

Bisphosphonate may benefit metastatic hormone negative breast cancers

According to research in the open-access journal,  BMC Cancer, patients with hormone-negative cancer with bone metastases may  benefit from bisphosphonate (BP) treatment.  Of the 317 patients followed, 230 (72.6%) had hormone positive breast cancer and 87 patients (27.4%) had hormone negative.  

Patients with hormone-positive breast cancer showed no benefit from BP.  Those with hormone-negative,  however, showed what researchers called "significant prolonged survival" from the drug. Disease-free survival was more than two years, with fewer than three metastatic sites.  Patients received an average of 17.7 cycles of BP.

Download a PDF of the research here.

New study planned for hormone-negative therapies

Aragon Pharmaceuticals has raised $8 million to discover and develop new therapeutics for the treatment of hormone-negative cancers, with an initial focus on prostate and breast cancer.

The company has been involved in recent discoveries that show that the biology of hormone-negative cancers can be overcome through the creation of a new class of nuclear receptor targeting drugs.

The company will focus on androgen and estrogen receptors.

Read the company's news release here. 

DEAR1 gene could explain triple negative breast cancer

Researchers at the MD Anderson Cancer Center say a newly identified gene, DEAR1, may serve as a biomarker for high risk of local recurrence, especially for younger women with triple negative breast cancer.

They studied tissues from tumors of 123 women whose breast cancer began between ages 25 and 49 and advanced to invasive disease.  Of these, 56 percent had lost DEAR1  ((ductal epithelium-associated ring chromosome 1) expression.  This correlated with a family history of breast cancer and with triple-negative disease.

 

• 58 percent of those without DEAR1 were local recurrence-free survival 15 years after surgery. 

• 95 percent of those with DEAR1 expression were local recurrence-free at 15 years.

The authors suggested that measurement of DEAR1 expression “could be an important marker to stratify early-onset breast cancer patients for increased vigilance in follow-up and adjuvant therapy.”

"The correlation with local recurrence is significant because so many young women have recurrences in the breast, and cancers that do recur tend to be more aggressive," said senior author Ann McNeill Killary, Ph.D., professor in M. D. Anderson's Department of Genetics. "Young age has been considered a risk factor for local recurrence and metastasis. It is important to understand the genetic mechanisms operating in early-onset breast cancer and to determine whether there is a way to identify young women who might be at a higher risk of recurrence."

Read more about the research here.

Three Years Cancer Free

Mammogram: Clear.

Chest X-Ray:  Clear.

Blood tests: Clear.

Symptoms: None.

Yeaaaaaaaaaaaaaaaaaaa!!!!!!!!!!!!!!!!  I reached my third-year anniversary cancer-free.  And, as those who know hormone-negative breast cancer understand, the third year is the biggee.  My chances of recurrence go way down now.  Because this is an aggressive cancer, recurrences hit between one and three years after diagnosis and decline rapidly after that.

I am a happy woman.  And thankful.

Standard chemotherapy more effective than capecitabine for older women

Older women with early-stage triple negative breast cancer had four times the chance of relapse if they were treated with the chemotherapy drug capecitabine (Xeloda ) rather than standard chemotherapy, either cyclophosphamide/methotrexate/fluorouracil, or doxorubicin/cyclophosphamide. Their risk of death was three times higher, according to data published in the May 14 issue of The New England Journal of Medicine.

Capecitabine is taken orally.

Women 65 and older were randomly assigned to standard chemotherapy or capecitabine . Among the patients in the standard chemotherapy group, 133 chose cyclophosphamide/methotrexate/fluorouracil, 184 chose doxorubicin/cyclophosphamide and nine withdrew without choosing a treatment.

CMF was administered in standard doses for six cycles repeated every six weeks.

AC was administered in standard doses for four cycles repeated every three weeks.

Capecitabine was administered in two divided doses for 14 consecutive days every three weeks for six cycles. 

Patients were evaluated at an average of 2.5 years. For all women regardless of receptor status, those in the capecitabine group had double the risk for recurrence and a similar risk for death. Breast cancer was the most common cause of death in the capecitabine group compared with other cancers or cardiovascular disease for patients in the standard chemotherapy group. 

But when women were further evaluated by receptor status, those in the triple negative group fared even worse, with four times the risk of recurrence and three times the risk of death.

Standard chemotherapy also resulted in increased estimated three-year relapse-free survival (85 percent vs. 68 percent) and overall survival (91 percent vs. 86 percent) compared with capecitabine for all women, regardless of hormone status.

Androgen receptors: a new category of triple negative breast cancer?

Another receptor—the androgen receptor—is being studied to help evaluate the aggressiveness of breast cancer tumors and how they react to treatment

“I think we are seeing the birth of a new concept in breast cancer—the androgen-receptor-positive breast cancer,”  says Jose Baselga, M.D., co-chair of the Impakt Breast Cancer Conference in Brussels, Belgium. “This is an important development in finding new targets that we can attack with new drugs in the future.”

Baselga was responding to research presented at the conference on the effects of androgens on chemotherapy.  Patients  who were triple negative breast and who also had androgen receptors tended to react less favorably to chemotherapy than those without the receptors.

This is more evidence of what doctors have been saying for some time:  Cancer is many diseases.  It is important to understand that triple-negative is also more than one disease.  That explains why I was lucky enough to celebrate my third post-diagnosis year cancer-free, while my friend Karen had a recurrence.  I suspect that, even though our diseases were in the same general category of hormone-negative, they were significantly different and I lucked out.

A clinical trials is now underway to target these receptors, with the hopes of using it for prognosis and the development of drug therapy.

The Impakt conference was sponsored by the European Society for Medical Oncology May 7-8, 2009.

 

 

From Dr. Susan Love: "Is TNBC Getting a Bad Rap?"

On the Dr. Susan Love Research Foundation blog, Dr. Love gives a succinct overview of what's happening with triple negative breast cancer research, noting that docs are taking the disease seriously and "help is on the way." (Hurry!)   Check it out. 

Triple Negative Breast Cancer Isn’t Always Deadly

Research at the New York University School of Medicine demonstrates that a diagnosis of triple negative breast cancer (ER-, PR- and Her2-) is not always lethal.  Researchers studied 145 triple negative tumors and found:

•  About 23 percent were moderate or low-grade.

• 11 were low grade, 23 were moderate grade, and 111 were high grade.

• Of the low grade lesions, only one had spread to the lymph nodes.

• Of the medium grade lesions, five had spread.

• Of the high grade lesions, 37 had spread.

"Our preliminary results show that triple negative breast cancers are a heterogeneous group. Although many are high grade lesions, some are moderate or low grade demonstrating a lower rate of lymph node metastasis," said Cecilia Mercado, M.D., an author of the study.

The research was presented at the American Roentgen Ray Society annual meeting, April 14, 2008.

Source:  " Does Histologic Grade Correlate with Nodal Status in Triple-Negative Breast Carcinoma? " Vieira, C. , Mercado, C., Guth, A., Moy, L.,Toth, H., Cangiarella, J.  American Journal of Roentgeonology. 190:A17-A21. 2008.

 

Triple Negative Survivor Story: Josie Garcia

Josie Garcia of Sacramento, California, shared her two-year survival story and positive personal philosophy—after a diagnosis of stage III triple negative—in the Sacramento Press:

Every day we hear of survival stories that stretch as far as distant, war-torn countries. Closer to home, we hear the story of the immigrant, of those rooted in our impoverished neighborhoods, of those affected by the current recession.

Survival is an opportunity at the turn of every day. For the sound-minded, those opportunities rank upwards till reaching the most important meaning for us: life. A life-threatening opportunity is when life grabs hold of your soul and knocks your senses so straight you never realized there was more to life in the "most" way.

Welcome to my survival story, one that has become more common due to medical breakthroughs and outreach. I am a breast cancer survivor. Just before the summer of 2007, at the age of 39, and as a single Mom to a 2-year-old boy, I received a shocking diagnosis: Stage III, triple negative breast cancer, tumor range six to nine centimeters with three enlarged lymph nodes.  Read more

Ixempra Research Offers Hope for Triple Negative Breast Cancer

Bristol-Myers Squibb Company presented research at the 2008 San Antonio Breast Cancer Symposium (SABCS) last December that offers some encouragement for women with triple negative breast cancer.  The company studied Ixempra  (ixabepilone) plus capecitabine compared to capectabine alone in clinical trials

• Of 443 patients with triple negative breast cancer, Ixempra plus capecitabine is the first combination regimen to demonstrate statistically significant progression-free-survival compared to capecitabine  alone.

• Triple negative patients who received Ixempra and capecitabine had an overall response rate of 31 percent compared to 15 percent for patients who received capecitabine alone . The progression-free survival of the combination group was a median of 4.2 months compared to a median of 1.7 months for the capecitabine-treated group.

An article in Medical News Today quotes one of the researchers:

"Patients with advanced, triple negative breast cancer have limited treatment options and a poor prognosis," said Hope S. Rugo, M.D., Clinical Professor of Medicine and Director, Breast Oncology Clinical Trials Program, University of California San Francisco Helen Diller Family Comprehensive Cancer Center. "For this reason, it is important to explore the potential of other current and developmental therapies to discover more and effective treatment options for patients with this specific type of breast cancer."

 

Natural Intervention Helps Chemo

Spending two hours a week in nature watching birds, tending to plants or gardens, sitting by a window with a view of trees or a garden can cut the fatigue that is often associated with cancer treatment. This comes from research in the journal Cancer Nursing.  Here's what I said about it in an article I wrote in Mamm on cancer anxiety:

Research published in 2003 in the journal Cancer Nursing suggests one way to overcome attention problems that’s as simple as, well, a walk in the park. Bernadine Cimprich, R.N., Ph.D., the study’s lead author, studied mental fatigue in a group of women with newly diagnosed breast cancer. They agreed to follow a structured program of “natural intervention,” spending two hours a week in nature—watching birds or trees, tending to plants or gardens. They were also instructed to give their full attention to their surroundings, rather than listening to an iPod or planning a work meeting. The women took standard cognitive tests before intervention began, after surgery, then three, six and twelve months afterward. As compared to patients treated without any nature therapy, participants showed better sustained recovery of their attention skills.

Cimprich, associate professor at the University of Michigan School of Nursing in Ann Arbor, says that the stress of dealing with breast cancer can lead to “attention fatigue,” and that nature therapy helps relax the parts of the brain that help to focus actively on tasks. Catherine Vincent, R.N., Ph.D., was diagnosed with breast cancer in 2003 while working on a postgraduate fellowship with Cimprich, so using natural intervention was a logical approach as she went on her daily walks. “I just inhaled the outdoors,” says Vincent, 59, assistant professor of maternal-child nursing at the University of Illinois at Chicago. Her cancer treatment—which included chemotherapy—went smoothly, which she attributes to the conscious rest she gave her brain. “I know part of it was really paying attention to what I needed,” she says. “Part of it was restoration through natural intervention.”  Read more here. 

How to Counter the Side Effects of Chemo

Toward the end of my chemo treatment, my husband and I decided to celebrate my progress (any excuse for a celebration), so we went to eat at Red Lobster. Their cheese biscuits are one of my favorite parts of a meal there. This time, though, the biscuits tasted like lard. No cheese, no yummy breast taste. Just lard.

Such were the wonders of chemo that nobody told me about.

I learned a great deal on my own, so to spare you that charm, here are some of the side effects of the chemo I had—four rounds of dose-dense Adriamycin (Doxorubicin) and Cytoxan (cyclophosphamide) every two weeks—and some suggestions for how to deal with those effects. AC, as this regimen is called, is fairly common for hormone-negative cancers, including triple-negative,  that have not spread to the lymph nodes.

Chemo, in general, kills fast-growing cells, which are often cancer cells. That’s the good side of those toxins being pumped into you. However, your body has other fast-growing cells that are also affected—in your hair, the lining of your mouth, and digestive tract. Killing these changes your body. And I was not prepared for most of that.

I went through chemo fine, for the most part, given that I was going through chemo. I kept active, ate healthy, and spent marvelous time with my friends and family. But, as with all other aspects of this lovely journey, I could have been better informed.Losing your hair. This chemo effect is the most understood and expected. My doctor told me it would happen in the third week of chemo and, sure enough, that’s when my hair literally began coming out in chunks. Some women prepare for this ahead of time by getting their head shaved before the hair falls out. I wanted to be normal and natural for as long as I could. So, one warm June day, my hair came out like dead grass in an abandoned lot, and I literally pulled the rest out. Yes,  I pulled my hair out, and I will never be able to use that metaphor again. My husband shaved the rest.

Losing your hair is so emblematic of having cancer that the more you can address this head-on (no pun honestly intended), the better. Some women paint their heads; others have friends who also shave theirs in a gesture of solidarity. I just got a couple of pretty cool wigs and simply smiled when people complimented me on my new ‘do.

Whatever makes sense for you.

A friend did tell me that, because I am tall, I would look elegant in long scarves and could make a great fashion statement. I wanted to tell her to make her own damn fashion statement, but I know she was honesty trying to be supportive, so I said nothing. (I found, though, that I could not keep scarves on; they just kept sliding off my stupid bald head.)Changes in your mouth. I did not expect this in the least. Because the cells on the lining of my mouth were killed, I lost a good deal of my sense of taste, which is why those biscuits tasted like lard. My acupuncturist suggested buying some Japanese plum sauce, which has a tangy taste and sort of shook up what taste buds remained. (She also told me the other day that my tongue had looked like raw meat at the time. It did feel especially raw.) I also found that chocolate malts tasted quite good.

The bigger mouth problem, though, was mouth sores. Lots of them. Doctors call this oral mucositis and recommend a variety of things to help it, including “miracle” or “oncology” mouthwashes and antibiotics. I found an over-the-counter version that had hydrogen peroxide. Other than making me foam at the mouth like Cujo, it worked fine. I suspect that a good salt-water rinse would work as well.Digestive tract pokiness. One result of the loss of some of the cells in your digestive tract is that your digestion slows down. This is for sure the nastiest side effect of chemo, and no doctor has ever talked to me about it, but chemo patients talk about it all the time. Serious constipation. Serious. I took a natural laxative, Senna Plus, which worked OK. I often had to overdose, plus I also resorted to plain old-fashioned charmers like Milk of Magnesia.  The Mayo Clinic offers some good information on laxatives here.

I started taking a green drink every morning, a healthy tonic I still take. Green drinks are generally high in fiber and rich in antioxidants and vitamins. So they’re good for getting your digestion going and fighting the cancer. Oprah’s medical guru, Dr. Oz (really, Oz?) has a recipe online for his green drink here.

I actually do two green drinks. In the morning, I have a powdered version that has spirulina, sea grass, organic greens, plus vitamins and minerals, like Barlean’s Green.  In the evening, my husband makes me a fresh juice of carrots, kale, cabbage, and parsley, with apples and lemon for taste. Full of antioxidants and heavy on cancer-fighting cruciferous veggies.

The green drinks together, I think, helped move my digestion along.

I also found that I needed to increase the amount of magnesium I took, which is often a cause of constipation in folks without chemo, especially if they are taking calcium.

And exercise is essential.  I walked two miles most days, and that helped.  The more I walked, the better.Digestion tract speediness. Nausea is another effect we expect, although one oncologist told me that anti-nausea drugs added to the chemo cocktail have eliminated this problem. As if. My husband and I believed this, and we went out for lunch after my first chemo—at the suggestion of a helpful nurse I could strangle. Like a couple of certifiable idiots, we went to a great Italian restaurant where I ate spaghetti with meat sauce. I was sick for hours until I threw up the entire meal. I did not want meat sauce for years after, nor did I want to even walk into that restaurant, as though it were at fault.

I learned to eat small meals on chemo days, usually bland things like soups and toast or crackers.  I had plenty of liquids, and I went to the acupuncturist beforehand. I usually had mild nausea for about 24 hours after chemo, but nothing serious.

My sense of smell, which has always been acute, remained lively, so the smell of even bland things like mashed potatoes often turned me off. We resorted to eating as many fresh foods as we could, which is also a highly healthy way to go.

Three years later, I still think about those lardy biscuits. My taste buds got back into shape within a month or two of chemo. Now, the biscuits taste as they should—creamy, crunchy, and cheesy. I know, though, that behind all those goodies, there is lard. And that is one lesson of chemo I am choosing to ignore.

I will do the green drinks, I will eat healthy most of the time, and I will keep my weight down. Occasionally, though, I want a cheese biscuit or six, lard and all.

For more information, check out my book, Surviving Triple-Negative Breast Cancer.  You can get a free signed copy just by donating $25 to this site.  Click the Donate button on the right to donate through PayPal.   You'll then get an email from me asking how you want your book signed and where you want it sent.  Or you can buy the book directly without a donation.  Thanks!  And hugs.  

Zometa: Not Proven for Hormone-Negative

Zometa (zoledronic acid) has been touted as a life-saving drug, based on research in the February New England Journal of Medicine.    And it looks like the drug has serious potential—for women with hormone-positive disease.  Some things for women with hormone-negative breast cancer, including triple negative, to consider:

• The women studied were all premenopausal who were hormone-positive and were given hormonal therapy—either tamoxifen or Arimidex—plus goserelin (Zoladex) to suppress ovarian function.

• None received adjuvant (after surgery) chemotherapy;

• The study found a 98 percent chance of survival in young women who were given ovarian suppression and hormone therapy drugs but did receive any chemotherapy.

So this could be great news for a narrow group of women.  Unfortunately, this does not include those of us with hormone-negative disease.

The Dr. Susan Love Research Foundation has a great analysis of this. 

Back to the drawing board, docs.  Find us a cure.

(My thanks to the talented Deb Lattimore for sending me Dr. Love’s link.  You can read about Deb’s fight against triple negative, and enjoy her excellent photography, here. )

 

Hidden Sources of Caffeine

Caffeine has been linked to hormone-negative breast cancer, including triple negative. And it can lurk unseen in your diet.

I have been having heart palpitations, so I immediately decided that either 1) the chemo had caused heart failure or 2) I have lung cancer, putting pressure on my heart. After an X-ray showed both lungs and heart normal, I decided to get a clue and start looking at my diet to see what I was doing to cause the palpitations. If I could not find an answer, I would go to the doctor, but I suspected I could take care of this by finding culprits in my diet.

I did.

I discovered caffeine all over the place, which is bad news, because I have been avoiding caffeine, as I noted in an earlier post. Caffeine has been linked to increased risk of hormone-negative breast cancer, including triple negative.

What I learned from honestly assessing my diet:

• I had been adding green tea to my morning smoothie, thinking I was adding a jolt of health. I was, but it also came with a jolt of caffeine. I often link green tea to herbal teas and assume it is caffeine-free. In fact, it has less caffeine than black tea and much less than coffee, but it still has caffeine. Thumpety.

• I had been making some nice, strong decaf coffee daily in my French press. That’s OK, right? Wrong. Decaf has less caffeine, but it is not caffeine free. Researchers at the University of Florida compared caffeine in decaf coffee and found that different brands had from 8.6 mg to 13.9 mg, compared to an average of 85 mg for caffeinated coffee. So, the super-strong stuff I was making—and I was making a good 16 ounces of it—no doubt had the caffeine of one or two cups of regular. Add that to the green tea caffeine and I was getting quite a start to my day. Thumpety thump.

• My beloved Diet Coke still hooks me, and when I fall off the wagon, I do a great job. Restaurants give you free refills, right? Sometimes I embarrass myself with the number of times my glass is refilled. There’s about 47 mg, of caffeine in an 12-ounce serving of Diet Coke. Heaven only knows how many I have at a simple lunch. Thumpety thump thump.

• Dark chocolate is considered by some a cancer fighter because of its high levels of antioxidants and phytochemicals. And it has plenty of caffeine: 31 mg in a 1.45 oz, bar. I used to have a tiny square as a treat after a meal. That gradually expanded to 3,4,5 squares. Thumpety thump thump thump.

So, I reminded myself that I am not a bonehead, that I am supposed to be eating healthy, and that I am supposed to know these things. I cut the hidden caffeine from my diet for three days and, guess, what? No palpitations.

I am frankly a bit embarrassed about this, but I am fairly sure I am not the only person who gets caught in the unhealthy caffeine trap. My heart told me to stop. That is way better than a cancer recurrence.

And searching my own diet was far cheaper, easier, and more successful than going in for heart tests.

Laughing at Triple Negative Breast Cancer

Here's a great story from the Tulsa World:

Trudy Runnels is a 44-year-old mother from Waxahachie, Texas. She has a rare form of metastatic breast cancer (triple- negative). It is not funny. Trudy is.

On a recent afternoon, at Cancer Treatment Centers of America, Runnels and a handful of other cancer patients gathered in a group therapy session. Together, their laughter became medicine.
After all, a funny story can do the most amazing things for a cancer patient, according to Dr. Gerald Ellison, a psychologist who leads the Centers' weekly humor therapy class.

"Laughter stimulates the immune system to produce cells that are very powerful in fighting cancer," Ellison explained. " There are many medical benefits to laughter." Read more here.

University of Alabama to Search for Triple Negative Therapy

One of the reasons triple negative breast cancer is so lethal is because it does not respond to standard follow-up treatment, like tamoxifen or Arimedex, which is a highly successful therapy for hormone-negative cancer, although chemotherapy has been found to be effective for all hormone negative cancers.

Now, Komen for the Cure and the Triple Negative Breast Cancer Foundation have awarded $6.4 million to the University of Alabama at Birmingham to study the development of a drug to be used with chemotherapy to treating triple negative breast cancer.

Researchers will also study ways to predict the therapies that will be most effective against triple negative breast cancer.

More good news--evidence that this cancer has caught researchers' eye. Yea.

Choosing the Best Doc for You.

Doctors are a mixed bag and some are better than others.  That's just natural.  As the old joke goes:  What do you call the person who graduated last in his medical school class?  Doctor.

But you want the best person for you because cancer is a big deal and getting the right treatment is literally a case of life and death.  How to find the right healthcare team to walk this walk with you?  Here are some tips.

1. Trust your gut. If you don’t like the doc, he just might feel the same way, and that could affect your treatment.
2. Get the best care you can afford. If this means heading out of town, do it. Cancer is a big deal; it deserves the best docs. US News and World Report lists the top 50 cancer centers here.
3. Do your research. On the left, I have listed some top websites for breast cancer information. Spend some time with these excellent resources--you'll learn a great deal.
4. Ask questions. A good doctor will take time to answer them. My radiation oncologist even drew a picture for me, explaining how radiation works. More evidence that she was good. She spent more than an hour talking about all types of treatment with me and my husband. And she treated me like a smart adult who could understand her.
5. Write down the answers. I still consult my treatment notebook, in which I wrote what the doctor said—direct quotes in quote marks, journalist that I am. This comes in handy for follow-up research.
6. Call back with questions. This is your life. If things aren’t making sense the way they should, ask.
7. Respect even the worst doctors. First, respect breeds respect. Second, these folks spend their lives around cancer, so they deserve a break. That said, if they are not serving you well, go elsewhere.
8. Find a patient advocate. If you cannot wrap your head around this information, don’t try to go it alone. Better yet, go to a center that has a Nurse Navigator program—these people are trained to help you make sense of treatment. They ask the questions you don’t know to ask, and they understand the answers.
9. Get copies of all your reports, especially your pathology reports. This is how I found out what doctors said about me.

Oprah's Article on Triple Negative

O, the Oprah Magazine, ran an article on triple negative breast cancer a while back:

The Breast Cancer Nobody Is Talking About
By Mary A. Fischer
One virulent, fast-acting type of breast cancer attacks 

more than twice as many young black women as all other women.

In May 2006, as she was getting dressed for work, Lori Booker felt a small lump in her left breast. Only 32, she was concerned but thought it was probably just a cyst and made an appointment to see her gynecologist. With a demanding job as a computer teacher at a Chicago public high school, Lori missed a couple of appointments, and two months later, when she finally had her first mammogram, the lump had doubled in size. A biopsy came back with grim results: She had aggressive, advanced-stage breast cancer. Crying, Lori thought the lab must have made a mistake. "I'm too young for this," she sobbed. more.

TAC Improves Disease-Free Survival for Triple-Negative Breast Cancer

What type of chemo works best for triple negative breast cancer? If it’s early stage but has progressed to the lymph nodes, docetaxel, doxorubicin, and cyclophosphamide (TAC) was the most effective according to research published in the March 2009  Journal of Clinical Oncology.

TAC also worked well for those with luminal B who also took tamoxifen.

(Most patients know doxorubicin as Adriamycin and cyclophosphamide as Cytoxin.)

Researchers assessed different types of breast cancer to determine their value in evaluating patients’ prognoses and their responses to adjuvant chemotherapy (chemo after surgery). The types they studied:

• triple negative (estrogen receptor [ER]–negative, progesterone receptor [PR]–negative, HER2/neu [HER2]–negative).

• HER2 (HER2-positive, ER-negative, PR-negative);

• luminal B (ER-positive and/or PR-positive and either HER2-positive and/or Ki67high);

• luminal A (ER-positive and/or PR-positive and not HER2-positive or Ki67high);

 
They studied 1,350 patients from the Breast Cancer International Research Group (BCIRG) 001 trial. Of these:

•14.5 percent were triple negative, with a three-year disease-free survival (DFS) of 67 percent;

• 8.5 percent were HER2, with a three-year DFS of 68 percent;

• 61.1 percent were luminal B, with a three-year DFS of 82 percent;

• 15.9 percent were luminal A, with a three-year DFS of 91 percent.

Source:

Judith Hugh, John Hanson, Maggie Chon U. Cheang, Torsten O. Nielsen, Charles M. Perou, Charles Dumontet, John Reed, Maryla Krajewska, Isabelle Treilleux, Matthieu Rupin, Emmanuelle Magherini, John Mackey, Miguel Martin, Charles Vogel, “Breast Cancer Subtypes and Response to Docetaxel in Node-Positive Breast Cancer: Use of an Immunohistochemical Definition in the BCIRG 001 Trial,” Journal of Clinical Oncology, 27 (8 ), 1168-1176. 2009.