Understanding Triple-Negative Breast Cancer
- Marissa Sweitzer, 33, found a small lump in her left breast when she was nine-months pregnant—something her doctor likened to her milk developing in her breast. She learned after giving birth that she had stage 2B triple-negative, grade three, invasive, ductal carcinoma in her breast and her lymph nodes, according to People.
- “Triple-negative” means the cancer is not fueled by any of the three main types of receptors: estrogen, progesterone, or the HER2 protein. Because of this, the cancer won’t respond to certain common therapies.
- It’s always a good idea to be familiar with your own breasts, so you can learn what’s normal for you, and how to spot any changes worth mentioning to your doctor. For this reason, SurvivorNet’s experts recommend that you do regular breast self-exams.
- Various cancer treatments, including chemotherapy and radiation, can affect both men’s and women’s fertility. IVF is among several options cancer patients can turn to if they have hopes of parenthood.
- Before undergoing cancer treatment, patients must speak to their doctors about fertility preservation if they wish to have a family in the future. Egg, sperm, and embryo freezing are common approaches to fertility preservation, but other options exist, like adoption.
Once Sweitzer left the hospital, she had an ultrasound, mammogram, and biopsy to determine whether the lump was cancerous. She was ultimately diagnosed with stage 2B triple-negative, grade three, invasive, ductal carcinoma in her breast and her lymph nodes, according to People, who interviewed the resilient mom as she works toward beating the disease.
Read MoreRELATED: What You Need to Know About Breast Cancer
Sweitzer gave birth to her first child in February 2024, but just weeks before her daughter’s birth, the soon-to-be mom felt something unusual in her left breast while putting on lotion to prevent stretch marks.
Speaking to People exclusively, Sweitzer admitted the finding, which was approximately the size of a walnut, “freaked” her out, but her doctor reassured her it was probably just milk developing in her milk ducts. Additionally, she recounted the lump seemingly getting smaller and not causing any discomfort.
However, after giving birth on Feb. 3, getting discharged from the hospital, and undergoing testing, her doctor did suspect the lump to be cancer.
Days later, her doctor delivered her pathology results to her and revealed she had breast cancer, and despite the news, Sweitzer recounted to People, “I was extremely thankful, relieved that it wasn’t anywhere else in my body.”
She began chemotherapy about one month later, but prior to doing so, she and her husband created an embryo through IVF to preserve her fertility and have the option to have another child.
Sweitzer completed chemotherapy in August and had both her breasts surgically removed one month later. Now she’s getting through her final rounds of radiation and remains hopeful as there were no more signs of cancer after her double mastectomy.
She told People, “I feel thankful, grateful. Cancer makes you have a different perspective on life and makes you not get mad at the small things.
“I used to stress the small stuff. Everything had to be perfect, everything had to get done the way it needed to get done. Now it’s like, I’d rather enjoy spending time with my daughter and my dog and my boyfriend… I have more grace for myself — and for everyone around me.”
Sweitzer also praised that being mindfulness has helped her tremendously, saying, she’s “just enjoying what I can enjoy, when I can enjoy it.”
After praising her daughter for being her “angel,” she explained, “If I didn’t get pregnant, my milk wouldn’t have come in and pushed the tumor to the surface. I am only 33, so I’m not getting mammograms. So by the time they found it, who knows what it would’ve looked like.”
Understanding Triple-Negative Breast Cancer
Triple-negative breast cancer is one of the most aggressive forms of the disease and makes up for approximately 20 percent of all breast cancers. The treatment approach varies from patient to patient and may include a combination of different treatments.
Early-stage triple-negative breast cancer (TNBC) treatments may use a combination of chemotherapy drugs.
Expert Resources On Triple-Negative Breast Cancer
- Immunotherapy and Triple Negative Breast Cancer
- ‘It’s A Game Changer’: FDA Approves Keytruda, Chemo Combo To Treat Aggressive Triple-Negative Breast Cancer
- In Triple Negative Breast Cancer, New Drug Trodelvy Extends Life
- Treating Triple Negative Breast Cancer
- New Study Identifies Genes Linked to Increased Risk for Triple-Negative Breast Cancer
- More Than 80% of Women With Early-Stage Triple-Negative Breast Cancer Experienced a Prolonged Event-Free Survival With Keytruda Plus Chemotherapy Regimen
- Chemo Plus Immunotherapy for Metastatic Triple-Negative Breast Cancer
For example, a CMF regimen is an abbreviation for combining chemotherapy drugs cyclophosphamide, methotrexate, and fluorouracil. AC stands for doxorubicin (Adriamycin) with cyclophosphamide, and ACT just indicates that a taxane drug is added to the regimen. Likewise, TC is an abbreviation for a regimen of Taxotere and cyclophosphamide.
RELATED: In Triple Negative Breast Cancer, New Drug Trodelvy Extends Life
In 2021, the FDA approved the immunotherapy drug pembrolizumab for the treatment of early-stage triple-negative breast cancer (TNBC). Pembrolizumab (Keytruda) is already used to treat other cancers, including melanoma and non-small cell lung cancer. Doctors heralded the FDA’s approval of pembrolizumab as a potentially paradigm-shifting advancement in breast cancer treatment.
Understanding Triple Negative Breast Cancer
For patients with stage 2 or 3 TNBC, adding the immune-boosting medication pembrolizumab to combination chemotherapy before surgery increases chances of living free of breast cancer, explains oncologist Dr. Sylvia Adams, director of the Breast Cancer Center at NYU Langone’s Perlmutter Cancer Center.
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 adds. “Yes, it’s a game-changer, though there is much more to be learned.”
The First Immunotherapy Approved For Breast Cancer Hope For Triple Negative Breast Cancer
Until recently, researchers hadn’t had much success using the therapy to fight breast cancer. That’s changing now. The IMpassion130 trial showed for the first time that a combination of immunotherapy and chemotherapy had a significant effect in treating metastatic triple negative breast cancer. Triple negative breast cancer is an extremely aggressive form of the disease, so this discovery is important.
Dr. Sylvia Adams explains, “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, that means that your cancer is not being fueled by any of the three main types of receptors: estrogen, progesterone nor the HER2 protein. But now you could be categorized as HER2 low instead of HER2 negative.
Breast cancer cells with higher-than-normal levels of HER2 are called HER2-positive, those with low levels of HER2 are (or were) called HER2 negative. Recently, however, researchers have looked to further expand this definition to include patients that have a minimal amount of HER2 expression but do not meet the classic definition for HER2-positive tumors. This group has been called HER2 “low” and is very important as it represents almost 50% of all patients with breast cancer.
This excitement stems from the fact that HER2-low breast cancers are targetable with a recently new FDA-approved Enhertu (Fam-trastuzumab deruxtecan-nxki). It appears that Enhertu is extremely effective for appropriate patients and can greatly improve their quality of life and help them live longer.
Therefore, it is exceedingly important to discuss with your physician about your HER2 status.
Treatment for Early-Stage Triple Negative Breast Cancer
Options For Preserving Your Fertility Before Cancer Treatment
Most women who preserve their fertility before cancer treatment do so by freezing their eggs or embryos. After you finish your cancer treatment, a doctor who specializes in reproductive medicine can implant one or more embryos in your uterus or the uterus of a surrogate with the hope that it will result in pregnancy.
If you freeze eggs only before treatment, a fertility specialist can use sperm and your eggs to create embryos in vitro and transfer them to your uterus.
When freezing eggs or embryos is not an option, doctors may try these less common approaches:
- Ovarian tissue freezing, an experimental approach for girls who haven’t yet reached puberty and don’t have mature eggs or for women who must begin treatment right away and don’t have time to harvest eggs.
- Ovarian suppression to prevent the eggs from maturing so that they cannot be damaged during treatment.
- Ovarian transposition, for women getting radiation to the pelvis, to move the ovaries out of the line of treatment.
In addition to preserving eggs or embryos, positive research has shown that women with early-stage hormone-receptor (HR) positive breast cancer were able to safely pause endocrine therapy to try to get pregnant and they did not have worse short-term recurrence rates than people who did not stop ET.
RELATED: Can I Have A Baby After Breast Cancer?
In the study from the Dana-Farber Cancer Institute, most of those people who paused ET were able to conceive and deliver healthy babies.
Of course, your doctor will be able to help you understand your unique circumstances and which path such as pausing endocrine therapy is right for you.
Dr. Terri Woodard discusses your options for preserving fertility after a cancer diagnosis.
Understanding Mindfulness and How It Can Improve Mental Health
If you’re facing a difficult period in life maybe you’ve just been diagnosed with a serious illness, are experiencing a breakup of sorts, or are simply dealing with hopeless feelings mindfulness could be a great help.
Often emotions of fear, anxiety, and confusion arise during difficult times, along with many unanswered questions.
Mindfulness is often suggested for cancer patients to reduce high levels of anxiety and distress associated with diagnosis, treatment, and anticipation of possible disease recurrence. Both the American Society of Clinical Oncology (ASCO) and the Society of Integrative Oncology (SIO) recommend meditation as part of a multidisciplinary approach to reduce stress, depression, and mood disturbance, and to improve the quality of life in cancer patients. That same approach can be beneficial during any hardship.
And the question remains: does it really work? We think it does.
5 tips for practicing mindfulness:
- Choose one daily activity to practice mindfully (e.g. eating your lunch, brushing your teeth or taking a shower). During this activity notice your breath and activity of your mind for a few moments.
- Take a pause throughout your day. During your day, find a moment to stop and take 5 deep breaths with your eyes closed.
- Kindly acknowledge a moment you’re experiencing a difficulty by putting your hand on your heart and saying, “I feel my pain. How can I be kind to myself in this moment?”
- Get curious about your emotions. Experiment with welcoming your emotions as they come, instead of pushing them away.
- Become aware when you’re in a rush. Ask yourself, “Do I really need to hurry?”
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
