Screening For Breast Cancer
- Australian author and journalist Cassandra Thorburn, 55, was diagnosed with triple-negative breast cancer after experiencing only mild underarm pain during exercise, with her routine mammogram initially showing no masses in her breasts.
- Now cancer-free and finishing radiation, Thorburn is sharing her experience to encourage women to stay on top of routine mammograms after a screening reminder prompted her to get hers.
- Self-breast exams can help women better understand what is normal for their breasts, making it easier to notice any unusual changes. While experts recommend performing regular self-exams, they should not be used as a substitute for routine mammograms.
- The U.S. Preventive Services Task Force (USPSTF) recommends women get mammograms every other year at the age of 40.
The American Cancer Society recommends getting a mammogram every other year for women 55 and older. - To further help you on your cancer journey, explore SurvivorNet’s proprietary AI tool, “My Health Questions.” This powerful resource, embedded across the SurvivorNet website, was built to bridge that gap by offering on-demand explanations of treatment options, clinical trials, side effects, insurance concerns, and more.
In a recent conversation with nine.com.au, Thorburn expressed being confused when she was told she had cancer, as the only symptom she experienced was pain during an intense martial arts class, which she likened to nothing serious.
Read MoreA Surprising Diagnosis
Just one week after her mammogram, following an ultrasound and a biopsy, Thorburn learned she had cancer.
Thorburn—who is now cancer-free after undergoing surgeries (which she has not specified), chemotherapy, and radiation treatments—is now finishing up radiation treatment for TNBC, one of the most challenging types of breast cancer to treat, which makes up approximately 15% of all breast cancers.
RELATED: Treating Triple-Negative Breast Cancer
The American Cancer Society (ACS) describes TNBC as an invasive type of breast cancer in which cancer cells do not have estrogen receptors, progesterone receptors, or high levels of the HER2 protein.
Since the cancer cells lack all three of these markers, the disease is known as “triple-negative” breast cancer. This type of breast cancer often grows and spreads faster while having fewer targeted treatment options.
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It’s important to note that TNBC treatment depends on the size and stage of the cancer. As per the National Cancer Institute (NCI), surgery is often the initial treatment for stage I–III triple-negative breast cancer when the tumor is operable. Surgery options can include a lumpectomy, which removes the cancerous area and a margin of nearby healthy tissue, or a mastectomy, which involves removing the entire affected breast.
For larger triple-negative breast cancer tumors, doctors may recommend chemotherapy before surgery to help shrink the cancer and make removal easier. This pre-surgery approach, called neoadjuvant therapy, may be combined with immunotherapy medications such as pembrolizumab.
RELATED: You Should Be Aware of These Signs of Breast Cancer
Following surgery, additional treatments like chemotherapy, immunotherapy, targeted therapy for patients with certain BRCA mutations, or radiation may be used to help destroy any remaining cancer cells.
Immunotherapy for breast cancer uses drugs such as pembrolizumab (Keytruda) to help activate the body’s immune system, allowing it to better recognize and attack cancer cells.
Immunotherapy and Triple-Negative Breast Cancer
Thorburn chose to go public with her diagnosis on social media in February of this year, telling her followers in an Instagram video, “For my adult children and for myself, I’m not interested in hiding, and that’s because I’m not alone. I’m not walking a path that is not well traveled by many women before me, and I will not be the last.”
She’s now hoping to encourage other women to get checked and get their routine mammograms, as she almost missed hers if it weren’t for a reminder she received from BreastScreen NSW, the official New South Wales Government breast cancer screening program in Australia.
Thorburn, who has since become an ambassador for the Australian Cancer Research Foundation (ACRF) Brave Shave campaign, offered additional insight into why she’s become an advocate for the disease.
“It’s about getting things early. Because we all know the earlier you catch a cancer, the less aggressive the treatment and the higher the chance of survival,” she said.
Understanding Triple-Negative Breast Cancer
Triple-negative breast cancer is one of the most aggressive forms of the disease. The treatment approach varies from patient to patient and may include a combination of different treatments.
Early-stage triple-negative breast cancer treatments may use a combination of chemotherapy drugs.
Understanding Triple-Negative Breast Cancer
For example, a CMF regimen combines the chemotherapy drugs cyclophosphamide, methotrexate, and fluorouracil. AC stands for doxorubicin (Adriamycin) with cyclophosphamide, and ACT indicates that a taxane drug is added to the regimen. Likewise, TC is a regimen of Taxotere and cyclophosphamide.
RELATED: In Triple Negative Breast Cancer, Drug Trodelvy Extends Life
Pembrolizumab and Early-Stage TNBC
In 2021, the FDA approved the immunotherapy drug pembrolizumab (Keytruda) for the treatment of early-stage triple-negative breast cancer, based on the KEYNOTE-522 trial. Pembrolizumab was already used to treat other cancers, including melanoma and non-small cell lung cancer. Doctors heralded the FDA’s approval as a potentially paradigm-shifting advancement in breast cancer treatment.
For patients with stage 2 or 3 TNBC, adding pembrolizumab to combination chemotherapy before surgery increases the chances of living free of breast cancer, oncologist Dr. Sylvia Adams, director of the Breast Cancer Center at NYU Langone’s Perlmutter Cancer Center, has explained to SurvivorNet.
She was one of several researchers involved with the pembrolizumab trials. “It changes the standard of care and should be discussed with all patients diagnosed with stage 2-3 TNBC,” she said. “Yes, it’s a game-changer, though there is much more to be learned.”
Expert Breast Cancer Resources
- Getting to Know Your Breasts with Self-Exams
- Bi-Annual Mammograms At Age 40 Now Recommended For Most Women, What The New Breast Cancer Screening Guidelines Mean For You
- Advances in Metastatic Breast Cancer Treatments Over the Last Year Offer New Hope for Those Fighting
- What Happens During a Double Mastectomy?
- Recovering from a Lumpectomy
- Should I Have a Lumpectomy or Mastectomy?
Immunotherapy for Metastatic TNBC: An Updated Picture
Earlier reporting on this topic pointed to the IMpassion130 trial, which in 2019 led to accelerated FDA approval of atezolizumab (Tecentriq) plus nab-paclitaxel for PD-L1-positive metastatic triple-negative breast cancer — the first immunotherapy combination approved for this disease. However, that approval is no longer in effect.
The First Immunotherapy Approved For Breast Cancer Hope For Triple-Negative Breast Cancer
The confirmatory trial, IMpassion131, failed to show a progression-free survival benefit when atezolizumab was added to paclitaxel, in either the PD-L1-positive population or the overall study population. Following an FDA review, the drug’s manufacturer voluntarily withdrew the accelerated approval for this indication in August 2021. The withdrawal was not attributed to any new safety concerns, but rather to the confirmatory trial not replicating the original results.
Instead, pembrolizumab plus chemotherapy is now the standard of care for patients with previously untreated metastatic TNBC whose tumors have a PD-L1 combined positive score of 10 or higher, since it has been shown to improve overall survival compared with chemotherapy alone.
Dr. Adams’ broader point about biomarkers still holds. She explained, “The question now becomes, is it only triple-negative breast cancer that can benefit from immunotherapy, or are there other subtypes as well?
“If a tumor has the PD-L1 protein in it, that means there’s already an inflammatory response, that the patient’s immune system already recognized the tumor and was starting to work against it. The benefit of identifying such a strong biomarker in the triple negative subset will allow us to actually test for the presence and responsiveness to immunotherapy in other subtypes of breast cancer.”
Is Your Cancer Really Triple Negative?
Dr. Heather McArthur, Clinical Director of the Breast Cancer Program at Simmons Cancer Center at UT Southwestern Medical Center, has spoken with SurvivorNet on this relevant topic.
You might be told you have triple-negative breast cancer, meaning your cancer is not being fueled by any of the three main receptors: estrogen, progesterone, or the HER2 protein. But you could now also be categorized as HER2-low rather than simply HER2-negative.
RELATED: What to Know About CDK4/6 Inhibitors as Breast Cancer Treatment: Weighing the Risks vs Benefits
Breast cancer cells with higher-than-normal levels of HER2 are called HER2-positive; those with low levels of HER2 were traditionally called HER2-negative.
More recently, researchers have expanded this definition to include patients with minimal HER2 expression who do not meet the classic criteria for HER2-positive tumors. This group is called HER2 “low” and represents close to half of all breast cancer patients.
Treatment for Early-Stage Triple Negative Breast Cancer
This distinction matters because HER2-low breast cancers are targetable with the FDA-approved drug Enhertu (fam-trastuzumab deruxtecan-nxki). Enhertu has shown strong efficacy in eligible patients and can meaningfully improve quality of life and survival.
It is therefore worth discussing your HER2 status—including whether you fall into the HER2-low category—with your doctor.
When to Screen for Breast Cancer
Guidance on mammograms varies slightly by organization, which can cause confusion among patients, but we’re here to help.
In April 2024, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation, advising all women at average risk to get a mammogram every other year starting at age 40 and continuing through age 74 — a change from its 2016 guidance, which set the starting age at 50.
The USPSTF said moving the starting age to 40 could save roughly 19% more lives, and noted that Black women face a 40% higher breast cancer mortality risk than white women, a disparity the earlier guidelines didn’t address.
The American Cancer Society’s guidance is close but not identical: annual mammograms starting at 45, moving to every other year (or annual, if preferred) starting at 55.
Women with a strong family history of breast cancer, a BRCA mutation, chest radiation before age 30, early menstruation (before 12), or dense breast tissue are considered higher risk and may need to start screening earlier—however, that conversation should happen with a doctor rather than by following a general guideline.
Questions To Ask Your Doctor
If you have a breast cancer screening coming up or have recently had one, you may have questions you want answered. SurvivorNet’s proprietary AI tool “My Health Questions” is designed specifically for patients and caregivers.
WATCH: How One Cancer Survivor and Her Sister Used ‘My Health Questions’ to Navigate Care
This powerful resource is embedded throughout the SurvivorNet website and delivers structured responses grounded in clinical guidelines and peer-reviewed research to help people better understand their treatment options and feel more confident navigating their care.
My Health Questions can also help patients prepare useful questions ahead of their next appointment.
Contributing: SurvivorNet Staff
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