Breast cancer

Triple Negative Breast Cancer: Diagnosis and Treatments

Triple-negative breast cancer refers to a group of cancerous tumors characterized by the absence of estrogen, progesterone and HER2 protein receptors. Triple negative breast cancer is usually more aggressive than other cancers, as it usually spreads quicker to the rest of the body.

This type of cancer mainly affects women under the age of 40. Screening for triple-negative cancer is based on performing mammograms as well as regular breast checks. Triple-negative cancer is often diagnosed at an advanced stage, which presents a higher risk of axillary lymph nodes or metastasis in other organs such as the lungs or the liver. Although triple-negative cancer is often associated with a poor prognosis, treatments and medical advances now allow a better understanding of this disease.

What is triple negative cancer?

Most cancer cells have estrogen or progesterone hormone receptors, as well as receptors for the protein called HER2. Triple negative cancer is a group of tumors lacking all these 3 receptors. Triple negative breast cancer is, for this reason, considered a separate type of cancer. In most cases, it is an invasive ductal cancer which tends to spread quickly. Because of these specificities, these tumors are generally aggressive and of high grade.

Triple-negative breast cancer is mostly diagnosed in women under the age of 40, who have not gone through menopause yet. Unfortunately, it is often discovered at an advanced stage. In this case, the presence of metastases in the lymph nodes or in other organs is quite common. It also presents a higher risk of recurrence.

The absence of hormone receptors means treatment options specifically adapted to this type of cancer.

The different types of breast cancer

The date of the French “Haute Autorité de Santé” (a local independent public authority) shows that triple negative cancer accounts for 15% of breast cancers. Although it is less common, it is nonetheless one of the most aggressive types of breast cancers.

There are several types of breast cancer, depending on their location and grade.

Adenocarcinoma in situ

In situ or non-invasive adenocarcinoma account for 95% of breast cancers in France. In the case of ductal cancer in situ, the tumor develops without infiltrating the surrounding tissues.

Invasive adenocarcinoma

Cancer cells involved in invasive adenocarcinoma can spread to the lymph nodes or to other organs. This type of cancer is often the cause of metastases.

Inflammatory breast cancer

In case of an inflammatory breast cancer, the skin tissues are affected by the cancerous cells. This type of cancer is much less common than adenocarcinoma. However, inflammatory cancer is aggressive and spreads quickly.

How is triple negative breast cancer diagnosed?

As with any other type of cancer, the diagnosis of triple negative breast cancer lies on several tests.

The doctor starts by performing a palpation of the breasts in search of a possible lump. When breast cancer is suspected, a screening mammogram must be performed. If the results of this test show some abnormalities, additional screening tests are required. They usually include breast ultrasound, biopsy and blood tests.

An analysis of the removed tissues carried out in an anatomopathology laboratory helps identify the nature of the tissues. If there are no hormone receptors and HER2 protein receptors, the diagnosis of triple negative breast cancer is then confirmed.

The risk of cancer cells spreading to the lymph nodes is quite high in this case. Therefore, a sentinel lymph node biopsy must be performed in order to analyze the first lymph nodes. In such situations, axillary curettage is not systematic. It is only carried out in the event of lymph node invasion. Fluobeam® is an innovative technology based on fluorescence imaging that helps locate precisely the lymphatic drainage and the sentinel lymph node after incision.

Triple negative cancer treatment

The therapeutic strategies to manage a triple-negative cancer are defined by the doctors during a multidisciplinary consultation meeting. During this consultation, all the medical staff that follow the patient meet together. The therapeutic protocol that must be followed is adapted to each case. Several treatments for triple negative breast cancer may be offered.

Triple negative cancer surgery

Surgery is quite common in case of a triple negative cancer. The type of surgery is defined according to several parameters such as the size of the tumor, or its spread. The indication for mastectomy or lumpectomy depends on the specifics of the cancer.

Chemotherapy

Chemotherapy is particularly recommended to treat patients with triple negative breast cancer. The protocol as well as the therapeutic combinations are generally identical for any type of breast cancer.

PARP inhibitor: BRAC1 and BRCA2 gene mutation

The BRCA1 and BRCA2 genes repair DNA if it breaks. The mutation of these genes doesn’t allow DNA to be properly restored, which can cause certain cancers. Drug treatment based on a PARP inhibitor can destroy cancer cells by preventing a bad DNA repair. This type of targeted therapy is indicated in the treatment of metastatic triple-negative breast cancer linked to the BRCA gene mutation. 

Good to know: the latest medical advances


The latest medical advances about triple negative cancer include immunotherapy or immuno-oncology that shows encouraging results. Immunotherapy aims to stimulate and restore the ability of the immune system to allow it to fight against cancer cells naturally. On the other hand, the French Haute Autorité de Santé has authorized early access to a new treatment option: Trodelvy. This medication is intended to treat metastatic cancers in patients experiencing treatment failure.