Understanding Triple-Negative Breast Cancer
- Tayla Gardiner, a 32-year-old mom of one from England, was diagnosed with triple-negative breast cancer after finding a lump in her right breast while taking a shower. She credits her breast implants as “life-saving” and is now urging others not to hold off on getting checked when something seems off.
- “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 some common therapies.
- In addition to surgery and radiation, chemotherapy is a mainstay of treatment for early-stage triple-negative breast cancer. Different chemotherapy combinations may be used to treat this aggressive form of cancer. In some cases, immunotherapy — which harnesses the body’s immune system to recognize and attack cancer cells — will be used for triple-negative breast cancer.
- Meanwhile, doctors have detected a possible link between breast implants and cancer; specifically between implants and anaplastic large cell lymphoma (ALCL), a cancer of the immune system. If you do find yourself in a situation where an evaluation of your implants is needed, you will undergo a physical exam and imaging studies “to evaluate the implant shell integrity, determine if there is fluid around the implant and visualize the implant capsule,” according to SurvivorNet experts.
Thankfully, Gardiner, who works as a model and resides in Kent, England, scheduled a doctor’s appointment right after she found a lump in her breast while showering in January of this year.
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Offering more insight into her diagnosis, she explained, “It’s small, it’s only 17cm at the moment but I think because the breast implants I have are quite big, you can notice the implant more because it’s pushing it forward.
‘I think that helped find the lump because they say to check your boobs and you know if you have lumpy boobs that something isn’t right.I can’t put into words how I felt. The first thing I asked was, ‘am I going to die?'”
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Looking back on how she had her breast implants put in back in 2014, she is curious as to if a rupture in her breast led to her cancer diagnosis, adding, “I kept getting kidney and water infections and I went to have a full CT scan, which found my right breast had ruptured.”
Gardiner, who will soon find out what her treatment plan will consist of and admits to only experiencing fatigue as her other symptom, continued, “It’s such a coincidence that [the cancer] happened in my right breast where it ruptured.”
She concluded, “I’m waiting to hear from my consultant to find out if I need to have a lumpectomy, a mastectomy, chemo or radiotherapy. I don’t feel unwell, I feel tired but I wouldn’t know that’s there.
“Apart from the lump I wouldn’t know it’s cancer.”
Gardiner is using her story to encourage others to get their breast checks and not wait to get screened.
She advises, “If you have any little thing, if you feel something isn’t right, go straight to the doctors and get it checked. Don’t wait. Don’t leave it. Even if you feel a bit silly.”
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
- Treating Early Stage Triple-Negative Breast Cancer
- New Study Identifies Genes Linked to Increased Risk for Triple-Negative Breast Cancer
- ‘It’s A Game Changer’: FDA Approves Keytruda, Chemo Combo To Treat Aggressive Triple-Negative Breast Cancer
- Immunotherapy and 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
- Can Statin Use Improve Breast Cancer Survival? New Research Shows ‘Significant Association’ for Triple-Negative Breast Cancer Patients
- How to Treat Triple-Negative Breast Cancer: Keytruda Shows Promising Boost in Survival
- Treatment Sequence for 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.
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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.
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
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.
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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.
Learning About Breast Implants
It’s important to understand that there is a possible link between breast implants and cancer; specifically between implants and anaplastic large cell lymphoma (ALCL), a cancer of the immune system. Researchers don’t know if the implant filling (i.e. saline or silicone) impacts the development of ALCL.
Meanwhile, Breast implant illness (BII) is a condition with symptoms that include fatigue, joint pain, memory and concentration problems, and more, says Breastcancer.org. Experts believe this condition is due to having an autoimmune reaction to the breast implants.
Breastcancer.org notes that BII is a separate condition from the types of cancer, which are rare, that can develop in scar tissue and fluid surrounding a breast implant, including breast implant-associated large cell lymphoma (BIA-ALCL), other forms of lymphoma, and squamous cell carcinoma.
According to the FDA, the lists associated with all FDA-approved implants include:
- Additional surgeries
- Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL)
- Systemic symptoms, Breast Implant Illness (BII)
- Scar tissue that squeezes the implant
- Breast pain
- Rupture (tears or holes in the shell) of saline and silicone gel-filled implants
- Deflation of saline-filled implants
- Silent (no symptoms) rupture of silicone gel-filled implants
- Infection
“The silicone used for breast implants is different than injectable silicone. Injectable silicone is not FDA-approved for breast augmentation, breast reconstruction, or for body contouring,” the FDA explains.
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In an earlier interview, SurvivorNet spoke with Dr. Andrea Pusic, Chief of Plastic Surgery at Brigham and Women’s Hospital, about the safety of implants. She says, “Many years ago there were concerns about silicone implants, and silicone implants were taken out of the U.S. market.”
Dr. Pusic continues, “Subsequent to that there were a number of very large studies that gave us new information about the performance of silicone implants.
“Subsequent also to that, there’s been further improvements in the silicone implants we are able to offer patients. If that implant does leak, the silicone would rarely go anywhere, and it won’t make you sick.”
She says that implants are generally safe, but that they require surveillance, too.
Are Breast Implants Dangerous?
Doctors Weigh In On Breast Implant Concerns
In an earlier interview with SurvivorNet, Dr. Sarah Cate, the lead physician for the Special Surveillance Breast Program at Mount Sinai Beth Israel, and Dr. Jordan Jacobs, a plastic and reconstructive surgeon, discussed breast implant concerns for survivors of breast cancer, following the release of FDA safety communication. The FDA received 10 medical device reports (MDRs) about squamous cell carcinoma and 12 reports about various lymphomas connected to breast implants.
Doctors Cate and Jacobs told SurvivorNet, regarding the FDA safety communication, “personally don’t think there is cause for alarm.”
The doctors believe the data shared by the FDA does not conclusively tie breast cancer to implants. Although, the pair does say, “the fact that the cancers were found in the implant capsules is certainly concerning and requires further investigation.”
Dr. Cate and Dr. Jacobs note how the FDA has required the placement of warnings on breast implant packaging. Additionally, there is newly an implant checklist that patients must sign and review before undergoing implant surgery. The doctors noted how ALCL, a rare form of non-Hodgkin lymphoma, has been associated with implants for years.
The doctors affirmed that textured implants, those linked to ALCL, are not used at Mount Sinai. The doctors also note that implants require monitoring, and that if there are an adverse conditions spotted after the implants, they should be reported to the FDA.
Dr. Cate and Dr. Jacobs tell SurvivorNet, “Patients who have implants placed for either cosmetic or reconstructive purposes should have yearly follow-ups with their surgeons.”
They add that “there are recommendations from the FDA for routine (every 2-3 years) MRIs to evaluate the integrity of the implant and the surrounding capsule.”
If you do find yourself in a situation where an evaluation of your implants is needed, you will undergo a physical exam and imaging studies “to evaluate the implant shell integrity, determine if there is fluid around the implant and visualize the implant capsule.” Most breast radiologists can perform sampling fluid, as well, so that the fluid can be examined to see if there are any abnormal cells present.
“Surgical management includes removal of the implant and the surrounding capsule, which is sent to pathology to rule out atypical cells and/or cancer,” Dr. Cate and Dr. Jacobs added.
Questions to Ask Your Doctor
If you are struggling with body image and mental health, here are some questions you may consider asking your doctor:
- Are there interventions beyond medication for my depressed or anxious feelings?
- How can I go about finding and nourishing positive emotions?
- What can I do if I’m struggling to maintain a sense of positivity?
- What lifestyle factors can I adjust to feel better mentally?
Contributing: SurvivorNet Staff
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