1. What is triple negative breast cancer?
Triple negative breast cancer is the name given to breast cancer that is:
- Oestrogen receptor negative (ER-negative)
- Progesterone receptor negative (PR-negative)
Oestrogen and progesterone receptors
Some breast cancers use oestrogen in the body to help them to grow. This type of breast cancer is called oestrogen receptor positive (ER-positive).
Invasive breast cancers are tested to see if they are ER-positive using tissue from a biopsy or after surgery. Tests will also be done to see if your breast cancer is progesterone receptor positive (PR-positive). Progesterone is another hormone.
If breast cancer does not have oestrogen receptors, it’s called oestrogen receptor negative (ER-negative). If it does not have progesterone receptors, it’s called progesterone receptor negative (PR-negative).
Some breast cancer cells have a higher-than-normal level of a protein called on their surface, which makes them grow more quickly. These are known as HER2-positive breast cancers.
Invasive breast cancers are tested for HER2 levels using tissue from a or surgery.
If breast cancer cells have a normal level of HER2 on their surface, they’re known as HER2-negative.
If your cancer does not have oestrogen and progesterone receptors and is HER2-negative, you have triple negative breast cancer.
2. How common is triple negative breast cancer?
Family history: Assessing your breast cancer risk
Around 15% of all breast cancers are triple negative.
Triple negative breast cancer is more common in:
- Women who have inherited an altered BRCA gene (particularly BRCA1)
- Black women
- Women who have not yet reached the menopause
- Women under 40
Some types of primary breast cancer are more likely to be triple negative than others. These include medullary and metaplastic breast cancer. However, most people with triple negative breast cancer have invasive breast cancer (no special type) as this is the most common type of breast cancer in general.
Triple negative breast cancer can be:
- Primary breast cancer – has not spread beyond the breast or lymph nodes under the arm
- Locally advanced breast cancer – has spread to the tissues and lymph nodes around the chest, neck and under the breastbone
- Secondary breast cancer – has spread to another part of the body, such as the bones, lungs, liver or brain
3. Triple negative breast cancer prognosis (outlook)
Research has shown that the risk of triple negative breast cancer coming back or spreading is higher than some types of breast cancer in the first few years. However, after around 5 years the risks are similar to, and may be lower than, other types of breast cancer.
4. Genetic testing
If you have triple negative breast cancer, you’re more likely to have an altered BRCA1 gene than someone whose breast cancer is hormone receptor positive.
If you were diagnosed with triple negative breast cancer under the age of 60, you should be offered a referral to a specialist family history clinic or a regional genetics clinic to discuss genetic testing, regardless of your family history of breast cancer.
If you’re over 60, you may also be referred to a specialist genetics clinic to discuss genetic testing. If this is right for your situation, your treatment team will discuss this with you.
5. Treatment for triple negative breast cancer
Triple negative breast cancer can be treated with a combination of:
Research has shown chemotherapy generally has a larger benefit for triple negative breast cancer compared to oestrogen receptor positive breast cancer. Chemotherapy for triple negative breast cancer is often given before surgery. The drugs used are likely to include or cisplatin.
Some breast cancer treatments, such as hormone (endocrine) therapy and HER2 targeted therapies are of no benefit to people with triple negative breast cancer
Chemotherapy destroys cancer cells using anti-cancer drugs.
Chemotherapy given before surgery is called primary or neo-adjuvant chemotherapy. You may have it to:
- Slow the growth of a rapidly growing breast cancer
- Shrink a larger breast cancer before surgery, which may mean you can have breast-conserving surgery rather than a mastectomy
- Destroy any cancer cells that may have spread elsewhere in the body
Chemotherapy given after surgery is called adjuvant chemotherapy. You may have it after surgery for primary breast cancer to reduce the risk of cancer returning or spreading.
You might have it on its own or alongside other treatments.
Secondary breast cancer
Chemotherapy can be used to treat secondary breast cancer. You may have it to:
- Control or slow the growth of secondary breast cancer
- Relieve some of your symptoms
You might have it on its own or alongside other treatments.
If you have primary breast cancer you will usually have surgery to remove the cancer. The 2 main types of breast surgery are:
- Breast-conserving surgery, also known as wide local excision or lumpectomy – removal of the cancer with a margin (border) of normal breast tissue around it
- Mastectomy – removal of all the breast tissue, including the nipple area
Your treatment team will explain why they think a particular operation is best for you.
Most women who have a mastectomy will have the option to have breast reconstruction if they wish.
Radiotherapy uses high energy x-rays to destroy cancer cells.
If you have breast-conserving surgery, you’ll usually be offered radiotherapy to the breast. This is to reduce the risk of the cancer coming back in the same breast. You may also have radiotherapy to the lymph nodes under the arm or above the collar bone.
Radiotherapy is sometimes given to the chest wall after a mastectomy, for example if cancer cells have spread to the under the arm.
This group of drugs can reduce the risk of breast cancer spreading in women who have been through the menopause. They can be used if the menopause happened naturally or because of breast cancer treatment.
Bisphosphonates can be given as a tablet or into a vein (intravenously).
Your treatment team can tell you if bisphosphonates would be suitable for you.
Bisphosphonates slow down or prevent loss of bone tissue. They may also be prescribed:
- For people who are at risk of, or who have,
- As treatment for secondary breast cancer in the bone (when cancer that started in the breast has spread to the bones)
Targeted (biological) therapies are a group of drugs that block the growth and spread of cancer. They target and interfere with processes in the cells that help cancer grow.
PARP inhibitors are a type of targeted therapy that work in cancer cells that have a change in the BRCA gene.
If you have triple negative breast cancer with an altered BRCA gene, your treatment team may talk to you about a PARP inhibitor called olaparib.
Immunotherapies are a type of targeted therapy that help the immune system recognise and attack cancer cells.
Immunotherapies are currently only available on the NHS for certain triple negative breast cancers.
This may depend on the stage and features of your breast cancer, as well as any previous treatment you’ve had.
Immunotherapies you may be offered include:
Speak to your treatment team to see if they’re suitable for you.
6. Clinical trials
Clinical trials are trying to find out if different treatments will be helpful in treating triple negative breast cancer. Cancer Research UK has a list of current trials for triple negative breast cancer. There’s information about trials for secondary breast cancer on the Make 2nds Count website.
You can also ask your treatment team about any trials that may be suitable for you.
7. Further support
Coping with breast cancer emotionally
Being diagnosed with breast cancer can make you feel lonely and isolated. Many people find it helps to talk to someone who has been through the same experience as them. Our Someone Like Me service can put you in touch with someone who has had a diagnosis of primary triple negative breast cancer, so you can talk through your worries and share experiences. See below to get in touch.
We also have an online forum where you can post messages and receive support.