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Although much is said and written about breast cancer, which is the most common cancer in women in Poland and in the world, you rarely hear about triple-negative breast cancer. It accounts for 10 to 15 percent. of all breast cancers, most often affects young women and is characterized by a very aggressive course. What is the prognosis of patients diagnosed with triple negative breast cancer and is there any hope for effective drugs? Explains Dr. Joanna Streb from the Clinical Oncology Department of the University Hospital in Krakow, Provincial Consultant in the field of Clinical Oncology.
- Breast cancer is the most common cancer in the world
- Last year, about 20 thousand. Polish women heard the diagnosis: breast cancer.
- Triple negative breast cancer is recognized as one of the aggressive breast cancer subtypes
- What is the treatment for this cancer and what is the prognosis?
- More information can be found on the TvoiLokony home page
Breast cancer – the number of cases in Poland is growing
Let’s start with the basics. How common is breast cancer in women?
Dr Joanna Streb, family medicine specialist, oncologist: When it comes to cancer in women, breast cancer ranks first in Poland and in the world. In Poland, we have about twenty thousand cases a year and, unfortunately, this number is growing every year. Due to the fact that the possibilities of treating this disease, even in its disseminated stage, are increasing, we treat it in a sense as a chronic disease. However, the prognosis really depends on what type of breast cancer we are dealing with.
What is the average age of the patient at diagnosis?
Statistically, it is about sixty years old. That is why the program of early breast cancer detection through mammography as part of screening is addressed to women over 50 years of age.
How did the pandemic affect this situation?
Unfortunately, fewer women reported for testing during the pandemic. I understand this was due to the fear of infection, but as a result there are more diagnoses of the disease at a more advanced stage. And yet we have been repeating for years that breast cancer diagnosed early gives us the possibility of a complete cure.
Breast cancer – risk factors
What are the primary risk factors for developing breast cancer?
Of course, the main factor in breast cancer incidence is gender, although it must be remembered that men also suffer from it. Age is another factor: with increasing life expectancy, the risk of cancer appears more frequently. We must also mention the presence of breast cancer in the family and the burden of mutation in the BRCA1 and BRCA2 genes, and recently also about obesity, physical inactivity and alcohol abuse. Of course, we cannot forget about the early onset of menstruation and late menopause – these are also important risk factors.
How is breast cancer diagnosed?
The first method is self-examination or examination by a specialist doctor – a gynecologist. In younger women, we deal with a more glandular structure of the breast, so we perform MRI and ultrasound. Another option is a mammogram. If, on the other hand, there is any change, the first thing to remember is that it may be a benign mastopathic lesion or fibroadenoma. In order to confirm the diagnosis, we perform a biopsy, which in a histopathological examination gives us an answer to the question about the type, subtype and receptor status of the cancer.
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Cancer is unequal to cancer. There are several types and sub-types of breast cancer …
Taking into account pathomorphological examinations, we can talk about pre-invasive, non-invasive and invasive, infiltrating tumors. The former occur in the ducts or lobules of the breast and are precancerous lesions. The latter, i.e. invasive and infiltrating changes, most often occur in the ducts and account for 70 to 80 percent. all crayfish. Much less, 10-15 percent. are changes in the lobules of the breast. The remaining cancers are different subtypes, e.g. mucous, ethmoid or tubular.
If, on the other hand, we are talking about the molecular division, i.e. depending on the status of the receptors, we evaluate estrogen and progesterone receptors in the neoplastic tumor, and HER-2 receptors in the cell membrane. We also test the Ki-67 proliferation index, which measures how quickly cells divide.
The prognosis and treatment of neoplasms depend on whether the cancer is lobular or ductal, and what the cancer subtype is, e.g. luminal or HER-2 – positive or triple negative.
Triple Negative Breast Cancer – What Is It?
This is where triple negative breast cancer occurs. What is it characterized by and what percentage of patients does it affect?
As the name suggests, triple negative cancer has neither estrogen, progesterone nor HER receptors. It mostly affects younger women, develops faster, and is mostly associated with the BRCA1 and BRCA2 mutations. It accounts for 10 to 15 percent. of all breast cancers, so it is uncommon but has a worse prognosis. Patients come to us with disease in the second or third stage of advancement, and in triple-negative cancer we cannot, unfortunately, use hormone treatment, so we are left with chemotherapy. Statistics show that as much as 18 percent. women diagnosed with triple-negative breast cancer are referred to doctors with disseminated disease.
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From what you say, women with triple negative breast cancer simply have less treatment options …
Indeed, it is so, because in this case there are no predictive factors for uptake for a given treatment. In triple negative cancer, the only treatment option is chemotherapy. Besides, it is a cancer that grows rapidly, so subsequent attacks of chemical treatment with cytostatics cause a number of side effects and tolerance decreases with each cycle.
How do you rate the role of BRCA1 and BRCA2 mutation testing as the main risk factors for triple negative cancer? Would the introduction of wider access to this diagnostics increase the detection rate at an earlier stage of the disease?
Indeed, having the BRCA1 and 2 mutations increases your risk, but it doesn’t mean you will definitely get the disease. However, if the patient’s family has a history of breast or ovarian cancer, it is worth doing genetic tests. They will show whether we are dealing with a burden and, consequently, with an increased risk of cancer.
Triple negative breast cancer – therapy
Speaking about the effects of therapy, i.e. what is most important to patients, we evaluate it in a five-year experience. What does it look like in breast cancer?
Five-year survival is an oncological term. In the case of cancers, it all depends on the stage of advancement: the earlier we detect the disease, the better the chances of a cure. When we are dealing with early luminal carcinomas, we can use hormone therapy and even 99 percent. We manage to cure such cancers. These chances decrease depending on the tumor subtype, tumor size, and whether lymph nodes are involved. Five-year survival is much lower in triple negative cancer than in hormone-dependent cancers. The main reason is their late detection and rapid development.
Once again, you underline the importance of early diagnosis, also in the case of triple negative cancer.
Of course! We emphasize this on every occasion, especially in October, Breast Cancer Awareness Month, which also celebrates the European Breast Cancer Day. When the disease is detected early, we have a chance to cure the cancer completely and additionally, we can apply a sparing procedure that is extremely important for women.
Unfortunately, women are still reluctant to submit to preventive examinations. In order for these studies to have an effect in the form of lowering the mortality rate, more than 70 percent should be tested. healthy women. It is still a long way to go, because before the pandemic it was 40% in Poland, and now it is even less.
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So let me repeat it again: breast cancer diagnosed early is fully curable. We can treat disseminated cancer, but unfortunately it cannot be cured.
Can we expect effective therapy for women with triple negative breast cancer in the future?
Breast cancer is one of the best-known types of cancer and new treatments are being registered all the time. We have a double anti-HER-2 blockade or a therapy that breaks hormone resistance. In the case of triple negative cancer, numerous studies are also conducted on immunochemotherapy, i.e. a combination of monoclonal antibodies with cytostatics. We also place great hopes on the treatment with PARP inhibitors, which have proved successful in the treatment of ovarian cancer. Finally, immunotherapy must of course be mentioned, as some drugs have already been approved in the US and Europe.
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I constantly believe that there will be a breakthrough therapy at last, because the progress in cancer treatment has been huge in recent years. However, the most important thing is to detect these cases as soon as possible – I will repeat that ad nauseam!
Also read:
- How to detect breast cancer at the earliest stage?
- Cancer doesn’t have to mean breast loss
- Breast cancer – what can I do to reduce my risk?