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  • author Siddharth Burman
  • person February 26, 2019

Triple-negative breast cancer: Managing the fear of recurrence

  • Triple-negative breast cancer is characterized by the absence of progesterone receptors, estrogen receptors, and excess HER2 protein. Almost 10 to 20 per cent of

Triple-negative breast cancer: Managing the fear of recurrence

Triple-negative breast cancer is characterized by the absence of progesterone receptors, estrogen receptors, and excess HER2 protein. Almost 10 to 20 per cent of all breast cancer cases is triple-negative breast cancers. This means that the growth of the cancer cells in the breast is not fuelled by the estrogen or progesterone hormone or the HER2 proteins.

This finding is important to know if hormonal therapy would be effective in the treatment for triple negative breast cancer but not hormone therapy.

Does triple-negative breast cancer have different symptoms than other subtypes of breast cancer?

The signs and symptoms of triple negative breast cancer are often the same as those of other subtypes, including the following:

  • A lump or mass in either of the breast
  • Breast pain
  • Breast redness
  • Inward turned nipple
  • Discharge from nipple

If the triple negative breast cancer spreads to other parts of the body, it shows similar metastatic breast cancer symptoms like any other subtype, which may include the following:

  • Constant pain in back, bone, or joint
  • Urinary incontinence or not being able to urinate
  • Weakness or numbness in any part of the body
  • Constant dry cough
  • Breathing difficulty
  • Shortness of breath
  • Pain in chest
  • Loss of appetite

Here are some facts about triple negative breast cancer that are alarming:

  • Triple-negative breast cancer is associated with a poor prognosis as there are no targeted medicines to treat it in comparison to other forms of breast cancer
  • It is considered to be more aggressive and is more likely to spread (metastasize) beyond the breast and more likely to recur even after successful treatment
  • It tends to be a higher grade than other types of breast cancer
  • It is more likely to be diagnosed in younger people less than age 50 as compared to other breast cancers that are usually diagnosed after 50 years of age
  • It grows quickly and is often discovered between screening mammograms
  • It is usually diagnosed in about 70 per cent of people who have an inherited BRCA mutation, particularly BRCA1


Fear of Recurrence

Recurrence or relapse is the return of breast cancer that can be local in the breast or in scar tissue or distally in other parts of the body. Distantly spread cancer is termed as metastatic cancer and is difficult to stop or treat.
Even though there are many treatment options available for triple-negative breast cancer, still the fear for recurrence is more than any other breast cancer as it is a more aggressive form. Its possibility of recurrence is greater in the first five years than other forms of the disease. However, it drops down sharply after five years.

If you are diagnosed with triple-negative breast cancer

It is quite upsetting and scary to know that you have triple negative breast cancer, which is a more aggressive form and is not even a candidate for target hormone therapy. But it is also important to remember that there are other triple negative breast cancer treatment options available that can manage it. It can be treated with a combination of surgery, radiation therapy, and chemotherapy. Most importantly, triple negative breast cancer has a much better response to conventional chemotherapy than other breast cancer subtypes.

Also, neoadjuvant chemotherapy, that is chemotherapy before surgery, has been found to be very effective with complete pathologic response and disease-free survival. The overall survival is also better for neoadjuvant chemotherapy in triple negative breast cancer.

One more category of drugs called PARP inhibitors are approved for the treatment of advanced-stage HER2-negative breast cancer in patients who have a BRCA1 or BRCA2 mutation.

In addition to these, research has proven that immunotherapy drug (Tecentriq), that boosts the immune system to work harder or smarter to attack cancer cells, along with chemotherapy can improve outcomes in advanced-stage triple negative breast cancer.

So there are numerous treatment options available even for triple-negative breast cancer but no long post-therapy regimens. Though there is a fear for recurrence, there is a hidden benefit too. The treatment course is short as compared to another early stage, slow-growing breast cancers whose treatment last for 10 years or more.

Survival after triple negative breast cancer treatment

Triple-negative breast cancer is a higher grade cancer, grows very rapidly, and tends to metastasize. It has been observed that the five-year survival rate of this cancer is lower than other breast cancer types. According to BreastCancer.org, the five-year survival rate for other subtypes of breast cancer is 93 per cent while the 5-year survival rate for triple negative breast cancer is around 77 per cent.

This means that in the case of cancer recurrence, there’s a higher risk of death. Although the survival of a cancer patient depends upon various factors such as the stage and grade of cancer as well as the response to treatment but still triple negative breast cancer has a lower chance of survival if recurred.

Triple negative breast cancer also has a high recurrence rate and recurrence is specifically greatest within the first three years. But after 5 years, the recurrence rate drops down sharply. This means that if a patient is disease free for 5 years after treatment of triple negative breast cancer, there are higher chances that cancer won’t reoccur later. But follow-up is very important in every case.

Recovery from Triple Negative Breast Cancer

Patients with triple-negative breast cancer should not lose hope and stay on the road to positivity by focusing on things like healthy eating, regular exercise, mindful meditation to cope stress, and periodic tests and regular medical follow-up with cancer specialists.

Also, as chemotherapy causes many cognitive difficulties, occupational therapy should be chosen to learn strategies to cope with all the cognitive deficits.

Psychosocial oncology team can provide support to cope with both bodily and mental depression. Support from friends, family, and neighbours also play a crucial role in giving strength to the patient to fight this deadly disease.

All in all, it is very important to work on mindfulness and live in the present moment, rather than dwelling on the past or fearing the future recurrence of cancer.

References:

https://www.lbbc.org/learn/types-breast-cancer/triple-negative-breast-cancer/living-triple-negative-breast-cancer/risks

https://www.cbcn.ca/en/blog/our-stories/Kelina-tnbc-story

https://www.healthline.com/health/triple-negative-breast-cancer-recurrence

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