Surviving Triple Negative Breast Cancer

If you’ve been diagnosed with hormone negative breast cancer, your doctor may have frightened you with the terms aggressive or lethal. Yes, this cancer is more on the march than estrogen positive, but it is survivable—and most women do survive it.  That fact too often gets lost in research reports.

Some stats.

63 percent of women with triple-negative status survive progression-free for three years, compared to 76 percent of hormone-positive women. That’s a lower number, but it still means most women survive. This comes from research in the International Journal of Cancer.

Women with hormone negative had a lower risk of recurrence at five years than hormone positive, according to research at the University of Texas M.D. Anderson Cancer Center. Five years after beginning therapy—chemotherapy, radiation, tamoxifen or all three—those with hormone negative disease faced a seven percent chance of recurrence, while those with hormone positive had a 13 percent chance. Or looking at it another way, 93 percent of those with hormone negative survived after five years while 87 percent of those with hormone positive did.

Docs say that, because more hormone-negative cases relapse within the first three years, women with this disease who are disease-free at five years have especially good odds. And at five years post-diagnosis, they have a better prognosis than women with the less lethal form of cancer.

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Source: Bertucci F, Finetti P, Cervera N, et al: “How basal are triple-negative breast cancers?” International Journal of Cancer. 123:236-240, 2008.

Source: Brewster AM, Hortobagyi GN, Broglio KR, Kau SW, Santa-Maria CA, Arun B, Buzdar AU, Booser DJ, Valero V, Bondy M, Esteva FJ. “Residual risk of breast cancer recurrence 5 years after adjuvant therapy,” Journal of the National Cancer Institute, 100(16):1179-83. 2008.

Triple Negative Breast Cancer: Research Review 2

More take-outs from researchers Carey Anders, M.D., and Lisa A. Carey, M.D., in their research review of triple negative in the journal Oncology October 1, 2008. The entire article is available online.

Most, but not all, triple-negative breast cancers are basal-like.

Triple-negative breast tumors have been correlated with onset at a younger age, higher mean tumor size, higher-grade tumors, and, in some cases, a higher rate of node positivity.

 
Basal-like breast tumors were more likely among women who were younger at the onset of menstruation; have borne several children; were at a younger age at full-term pregnancy; had a shorter duration of breast-feeding; and higher body mass index (BMI) and waist-to-hip ratio (WHR), especially among premenopausal patients.

Women with triple-negative breast cancer were much more likely to develop a recurrence during the first 3 years following therapy with rapid declines thereafter. Translation: We can relax a bit after three years.

Patients with a “pathologic complete response”—meaning all traces of the cancer were eliminated— had excellent outcomes regardless of whether they were hormone positive or negative.

Source: C. Anders and L. A. Carey, “Understanding and Treating Triple-Negative Breast Cancer,” Oncology, Vol. 22, No. 11, October 1, 2008.

Nutrition Affects Hormone Negative Disease: An Overview

In her blog, Breast Cancer Information, Kim Dalzell, a doctor of holistic nutrition and registered dietitian,  offers insight into fighting hormone ngative breast cancer. Some of the points she makes:

Women who scored high on Harvard University's Alternate Healthy Eating Index had a lower risk of estrogen receptor negative breast cancer. The guidelines for this index: a daily intake of 9 servings of fruits and veggies, 7 or more grams of dietary fiber, 30-40 percent less saturated fat than polyunsaturated fats, less than 3 grams of trans fats and consuming 1 ounce of nuts. (February 2006, Journal of Nutrition.)

Women whose diets were deficient in folate, a B vitamin, had an increased estrogen receptor negative breast cancer risk. Folate-rich foods include: fruits like cherries, oranges and strawberries, beans and peas, and dark, green leafy veggies. (August 2005, Cancer Epidemiology Biomarkers and Prevention.)

Alcohol robs the body of folate and other B vitamins, so it's prudent to enjoy alcohol only occasionally, if at all. (August 2005, Cancer Epidemiology Biomarkers and Prevention.)

High intakes of linoleic acid were associated with more than a 300 percent greater risk of estrogen receptor negative disease than estrogen receptor positive disease. Linoleic acids are found in polyunsaturated fats like cottonseed, soybean, and corn oil as well as vegetable-based margarines. (The University of Texas MD Anderson Cancer Center research.)

Among premenopausal women, there was a reduced risk of both estrogen receptor negative and estrogen positive breast cancer for those women who consumed the highest lignan intake. Lignans are found in flaxseed, and to a lesser degree in sesame seeds and kale. (Breast Cancer Research Treatment journal, October 2006.)

New Breast Cancer Classifications

The American Cancer Society explains new classifications of breast cancer based on genetic research on its Web site. 

I quote them directly below.

The current types of breast cancer are based largely on how tumors look under a microscope. A newer classification, based on molecular features, may be better able to predict prognosis and response to several types of breast cancer treatment. The new research suggests there are 4 basic types of breast cancers:

Luminal A and luminal B types: The luminal types are estrogen receptor (ER)-positive, usually low grade, and tend to grow fairly slowly. The gene expression patterns of these cancers are similar to normal cells that line the breast ducts and glands (the lining of a duct or gland is called its lumen). Luminal A cancers have the best prognosis. Luminal B cancers generally grow somewhat faster than the luminal A cancers and their prognosis is not quite as good.

HER2 type: These cancers have extra copies of the HER2 gene and several other genes. They usually have a high-grade appearance under the microscope. These cancers tend to grow more quickly and have a worse prognosis, although they often can be treated successfully with targeted therapies such as trastuzumab (Herceptin) and lapatinib (Tykerb).

Basal type: Most of these cancers are of the so-called "triple negative" type -- that is, they lack estrogen or progesterone receptors and have normal amounts of HER2. The gene expression patterns of these cancers are similar to cells in the deeper basal layers of breast ducts and glands. This type is more common among women with BRCA1 gene mutations. For reasons that are not well understood, this cancer is also more common among younger and African-American women.

These are high-grade cancers that tend to grow quickly and have a poor prognosis. Hormone therapy and anti-HER2 therapies like trastuzumab and lapatinib are not effective against these cancers, although chemotherapy can be helpful. A great deal of research is being done to find better ways to treat these cancers.

It is hoped that these new breast cancer classifications might someday allow doctors to better tailor breast cancer treatments, but more research is needed in this area before this is possible.

Read more about TNBC in my book, Surviving Triple-Negative Breast Cancer.

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New Test Helps Predict Outcomes for Hormone-Negative

A new test can predict the most effective therapy for all women with breast cancer, including those with hormone-receptor-negative—estrogen-negative, progesterone-negative, Her2- negative, or a combination of all three, according to research conducted at Washington University School of Medicine in St. Louis and reported in advance of publication in the Journal of Clinical Oncology. Using a set of 50 genes, the test goes beyond the existing Oncotype DX test to offer diagnostic help that covers the four known types of breast cancer— luminal A, luminal B, HER2-enriched and basal-like. The last three types are generally considered types with a poor prognosis.  

Hormone-negative cancers, especially triple-negative, are most often basal-like.  Luminal A and B are hormone-positive; luminal B grows faster than luminal A.

"Unlike a widely used genomic test [Oncotype DX] that applies only to lymph-node negative, estrogen-receptor positive breast cancer, this new genomic test is broadly applicable for all women diagnosed with breast cancer," says breast cancer specialist Matthew Ellis, M.D., Ph.D., a member of the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University.

In comparing the activity of the 50 genes to how well 133 breast cancer patients responded to chemotherapy, researchers found that the genetic test was highly sensitive and could predict chemotherapy response better than estrogen receptor status, progesterone receptor status or HER2 gene expression status.

Luminal A , a cancer that typically comes with a good prognosis, was not sensitive to chemotherapy, meaning that patients with that type can avoid chemotherapy in favor of hormone-based therapy. Among the poor-prognosis tumor types, basal-like breast cancer was the most sensitive to the chemotherapy and luminal B the least sensitive.

"Luminal B tumors are a very poor prognosis group, and none of the current conventional therapies are particularly effective against it," Ellis says. "The ability to identify luminal B tumors accurately makes it possible to develop better therapies for this type."

The researchers are investigating how each tumor type responds to the more than 50 drugs used for breast cancer. Because the gene set can be used with preserved tumor samples, the researchers plan to study tumor samples from breast cancer cases going back a decade or more. Patients in these cases have already been treated, which means the researchers can assess how well therapies worked for various breast cancer types.

NOTE:  The test is not yet available for consumer use.  I will research this and post additional information on when and where we might be able to have the test.

Hispanic Women Face Multiple Threat of Breast Cancer

Breast cancer in Mexican and Mexican-American women is likely to be

 

• detected at a later stage, leading to higher grade tumors; 

• triple-negative breast cancer, which is more aggressive. 

Mexican and Mexican-American women are also likely to have a family history of breast cancer, suggesting the BRCA gene mutation. 

This comes from preliminary results of a study led by Elena Martinez, Ph.D., of the University of Arizona and Arizona Cancer Center in Tucson and presented at the American Association for Cancer Research Science of Cancer Health Disparities Conference in Arizona. 

Of the 652 women in the study—309 living in the United States and 343 in Mexico—

• Only 22 percent reported that their cancers were found by mammography; the rest were found by palpable lumps, which often means a more advanced form of cancer.
• 28.1% of Mexican women and 19.3% among Mexican-Americans were diagnosed with triple-negative—Estrogen-negative, progesterone-negative and Her2-negative.

• most were overweight, with  high body-mass-indexes.

The limitation of this information:  

• the study has yet to be published—information was presented as an abstract only;
• the sample size was small;
• the sample did not include women without breast cancer for comparison.