What Is Hormone Negative Breast Cancer

How Is Triple Negative Breast Cancer Different From Other Diagnoses

No one could blame you for having a mountain of questions after receiving a breast cancer diagnosis. That list might be even longer if you receive a diagnosis of triple negative breast cancer: What exactly does that mean? How is triple negative breast cancer different from other diagnoses? And how can you make life easier on yourself if you have this illness? Here, breast cancer experts answer these and other questions.

Diagnosis Of Hormone Receptor

In most cases, Dignity Health doctors diagnose hormone receptor-negative breast cancer with a biopsy. This sample of cells can tell them about the HER-2 status, hormone receptor status, grade, and specific tumor subtype. This information helps guide your doctor when developing your personalized treatment plan.

Questions To Ask Your Doctor

To learn more about estrogen and progesterone receptor testing for breast cancer, consider asking your doctor the following questions:

• What are the results of the ER and PR tests on my tumor sample? What do they mean?

• Does this laboratory meet the standard guidelines like those from ASCO and the CAP?

• Has a board-certified pathologist diagnosed my cancer?

• Do you know if this is an experienced lab and if my tissue was quickly given to the pathologist after my biopsy or surgery, as recommended by guidelines?

• Can I obtain a copy of my pathology report ?

• Is my ER and PR status indicated on the pathology report? Was the ASCO-CAP guideline recommendation used to define the status?

• Based on these test results, what treatments do you recommend and why?

• What are the possible side effects of these treatments?

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Issues With Current Treatments

According to Dr. Crystal Fancher, the lack of receptors to target mean that some treatments for other forms of breast cancer are not effective for triple-negative breast cancer.

Dr. Fancher is a surgical breast oncologist at the Margie Petersen Breast Center at Providence Saint Johns Health Center and an assistant professor of surgery at Saint Johns Cancer Institute, both in Santa Monica, CA.

Unlike other breast cancers that have hormone receptors, like HER2, triple-negative is harder to treat, she told MNT.

Dr. Jacoub explained that peoples outcomes tend to improve when they use chemotherapy in combination with other treatments. A course of treatment now typically includes immunotherapeutics, which we use before and after surgery as well as during a recurrence, he added.

Platinum chemotherapy, or chemotherapy using platinum-based drugs, is common in the treatment of triple-negative breast cancer due to its effectiveness. However, research has shown that severe side effects can limit its use.

One found around 40 specific side effects, including a decrease in bone marrow production, problems with kidney function, headaches, and other negative effects on the nervous system. There are some treatments available to address these side effects.

Dr. Nan estimated that about 40% of people can use a combination of immunotherapy and chemotherapy.

Why Is Knowing Hormone Receptor Status Important

Knowing the hormone receptor status of your cancer helps doctors decide how to treat it. If your cancer has one or both of these hormone receptors, hormone therapy drugs can be used to either lower estrogen levels or stop estrogen from acting on breast cancer cells. This kind of treatment is helpful for hormone receptor-positive breast cancers, but it doesnt work on tumors that are hormone receptor-negative .

All invasive breast cancers should be tested for both of these hormone receptors either on the biopsy sample or when the tumor is removed with surgery. About 2 of 3 breast cancers have at least one of these receptors. This percentage is higher in older women than in younger women. DCIS should be checked for hormone receptors, too.

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Can Other Drugs Interfere With Hormone Therapy

Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s;use of tamoxifen;because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.

The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.

Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.

Other medications that inhibit CYP2D6 include the following:

• Quinidine, which is used to treat abnormal heart rhythms

Do I Need Genetic Counseling And Testing

Your doctor may recommend that you see a genetic counselor. Thats someone who talks to you about any history of cancer in your family to find out if you have a higher risk for getting breast cancer. For example, people of Ashkenazi Jewish heritage have a higher risk of inherited genetic changes that may cause breast cancers, including triple-negative breast cancer. The counselor may recommend that you get a genetic test.

If you have a higher risk of getting breast cancer, your doctor may talk about ways to manage your risk. You may also have a higher risk of getting other cancers such as ovarian cancer, and your family may have a higher risk. Thats something you would talk with the genetic counselor about.

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Proteins For Targeted Cancer Drugs

Testing cancer cells for particular proteins can help to show whether targeted drug treatments might work;for your breast cancer.

Targeted cancer drugs are treatments that change the way cells work and help the body to control the growth of cancer.;

Some breast cancers have large amounts of a protein called HER2 receptor . They are called HER2 positive breast cancers. About 15 out of every 100 women; with early breast cancer have HER2 positive cancer.

Targeted cancer drugs such as trastuzumab can work well for this type of breast cancer. These drugs attach;to the HER2 protein and stop;the cells growing and dividing.

• Read about targeted cancer therapy

How Common Is Triple Negative Breast Cancer

15% of all breast cancers over 8,000 cases a year in the UK are triple negative.

Triple negative breast cancer is more common in:

• women who have inherited an altered BRCA gene
• black women
• women who have not yet reached the menopause
• women under 40

Some types of 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 ductal breast cancer as this is the most common type of breast cancer in general.

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Treatment Of Breast Cancer Stages I

The stage of your breast cancer is an important factor in making decisions about your treatment.;

Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of drug therapy. In general, the more the breast cancer has spread, the more treatment you will likely need.;But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:

• If the cancer cells contain hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
• If the cancer cells have large amounts of the HER2 protein
• How fast the cancer is growing
• Your overall health
• If you have gone through menopause or not

Talk with your doctor about how these factors can affect your treatment options.

What Causes Triple Negative Breast Cancer

Many patients wonder what causes triple negative breast cancer. The breast cancer experts at Moffitt Cancer Center are often asked this question, but as of yet, there are no clear answers. As research continues, more is being learned about the causes of breast cancer in general, and triple negative breast cancer specifically.

Triple negative breast cancer differs from other types of breast cancer in that the cancer cells do not have receptors for estrogen, progesterone or HER-2/neu hormones. When these receptors are present and exposed to the corresponding hormones, they can stimulate the cancer to grow. But, this also means that triple negative breast cancer patients do not benefit from hormone-based treatments, such as tamoxifen and Herceptin, which are sometimes effective for treating hormone-receptor-positive cancers.

The current theories on what causes triple negative breast cancer and hormone-receptor-positive cancers also differ. For instance, some breast cancers that grow in response to hormone exposure have been linked to a womans childbearing characteristics, such as the age at which she gave birth for the first time. Triple negative breast cancer does not seem to share this link.

Some researchers believe that one possible cause of triple negative breast cancer is a faulty BRCA1 gene. Here are some of the factors that support this theory:

• BROWSE

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What Is Hormone Therapy

Hormone therapy slows or stops the growth of hormone-sensitive tumors by blocking the bodys ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors;and do not respond to hormone therapy.

Hormone therapy for breast cancer should not be confused with menopausal hormone therapy treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.

Tissue Arrays And Immunohistochemistry

Tumor samples were arrayed as previously described. In brief, tissue cores with a diameter of 0.6 mm were punched from the representative tumor regions of each donor block. Each case was sampled twice from the center and the periphery of the tumor. Cores were precisely arrayed into a new recipient paraffin blocks using a tissue microarrayer . Immunohistochemical staining was performed on 4 m thick sections using the avidinbiotin complex method. Briefly, tissue slides were deparaffinized with xylene and then rehydrated through three changes of alcohol. Endogenous peroxidase activity was blocked by incubation in a 0.3% hydrogen peroxide/methanol buffer. Antigen retrieval was carried out by microwave treatment of the slides in sodium citrate buffer for 20 min. The slides were then rinsed in Tris-buffered saline and incubated with normal swine serum in TBS to block nonspecific staining. The slides were then incubated for 1 h with the primary antibody. After washing with TBS, sections were incubated with the secondary antibody for 30 min then the avidinbiotin complex for a further 45 min. 3-3Diaminobenzidine tetrahydrochloride was used as a chromogen and sections were counterstained with Mayer’s hematoxylin. The negative controls were omission of the primary antibody.

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Estrogen And Progesterone Receptor Testing For Breast Cancer

To help doctors give their patients the best possible care, the American Society of Clinical Oncology and the College of American Pathologists developed evidence-based guidelines to improve the accuracy of testing for estrogen and progesterone receptors for breast cancer. This guide for patients is based on ASCO’s and CAP’s 2020 updated recommendations.

What Are Estrogen And Progesterone Receptors

Receptors are proteins in or on cells that can attach to certain substances in the blood. Normal breast cells and some breast cancer cells have receptors that attach to the hormones estrogen and progesterone, and depend on these hormones to grow.

Breast cancer cells may have one, both, or none of these receptors.

• ER-positive: Breast cancers that have estrogen receptors are called ER-positive cancers.
• PR-positive: Breast cancers with progesterone receptors are called PR-positive cancers.
• Hormone receptor-positive: If the cancer cell has one or both of the receptors above, the term hormone-receptive positive breast cancer may be used.
• Hormone receptor-negative: If the cancer cell has neither the estrogen nor the progesterone receptor, it’s called hormone-receptor negative .

Keeping the hormones estrogen and progesterone from attaching to the receptors can help keep the cancer from growing and spreading. There are drugs that can be used to do this.

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Breast Cancer Hormone Receptor Status

Breast cancer cells taken out during a biopsy or surgery will be tested to see if they have certain proteins that are estrogen or progesterone receptors. When the hormones estrogen and progesterone attach to these receptors, they fuel the cancer growth. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors . Knowing the hormone receptor status is important in deciding treatment options. ;Ask your doctor about your hormone receptor status and what it means for you.

Treating Triple Negative Breast Cancer

Triple negative breast cancer can be treated with a combination of

• bisphosphonates

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 carboplatin or cisplatin.

Some breast cancer treatments, such as hormone therapy and HER2 targeted therapies are of no benefit to people with triple negative breast cancer.

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Determining Your Breast Cancer Type

At Rocky Mountain Cancer Centers , we understand that the diagnosis of cancer can be overwhelming, not only for you, but also for your friends and relatives. Therefore, the sooner we determine your specific breast cancer type, the sooner we can get you on the path to treatment and recovery. To do this, we will perform an in-depth evaluation on the tissue sample collected from your breast biopsy, or on the tumor itself after your breast cancer surgery.;

Starting With Neoadjuvant Therapy

Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.

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What Is The Prognosis For Triple Negative Breast Cancer

Triple negative breast cancer can be more aggressive and difficult to treat. ;Also, the cancer is more likely to spread and recur. ;The;stage;of breast cancer and the;grade of the tumor;will influence your prognosis. Research is being done currently to create drug therapies that are specific for triple negative breast cancer.

Interested in learning more? i3Health is hosting an upcoming webinar Metastatic Triple-Negative Breast Cancer: Applying Treatment Advances to Personalized Care. Learn more here.

Material on this page courtesy of Johns Hopkins Medicine

Neoadjuvant And Adjuvant Systemic Therapy

For women who have a hormone receptor-positive breast cancer, most doctors will recommend hormone therapy as an adjuvant treatment, no matter how small the tumor is. Women with tumors larger than 0.5 cm across may be more likely to benefit from it. Hormone therapy is typically given for at least 5 years.

If the tumor is larger than 1 cm across, chemo after surgery is sometimes recommended. A woman’s age when she is diagnosed;may help in deciding if chemo should be offered or not. Some doctors may suggest chemo for smaller tumors as well, especially if they have any unfavorable features .

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to 1 year.

Many women with HER2-positive cancers will be treated with trastuzumab followed by surgery and more trastuzumab for up to 1 year. If after neoadjuvant therapy, residual cancer is found during surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. If hormone receptor-positive cancer is found in the lymph nodes, your doctor might recommend one year of trastuzumab followed by additional treatment with an oral drug called neratinib for 1 year.

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