Triple-Negative Breast Cancer
What is triple-negative breast cancer?
Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer. About 15% of newly diagnosed breast cancer cases are triple-negative, making it one of the more common forms of the disease.
What does triple-negative mean?
“Triple-negative” refers to the lack of three specific molecules, called receptors, produced by the breast cancer cells.
A cell’s receptors interact or bind with specific proteins and hormones in the body. This is called recognition. Recognition sets many biological processes in motion.
Most breast cancers have at least one of three receptors that fuel the growth and spread of the disease through recognition. These are the HER2 protein and receptors for the hormones estrogen and progesterone.
Doctors treat breast cancers with these receptors with drugs that interrupt recognition. TNBC does not have any of the three receptors. As a result, drugs targeting these receptors do not work on TNBC. Different drugs need to be used.
Triple-negative breast cancer also grows quickly and has a high rate of recurrence, making it one of the most aggressive types of breast cancer.
Triple-negative breast cancer survival rate
Each individual with triple-negative breast cancer is unique and survival rates depend on several factors, including how far the cancer has spread at the time it is found and how the tumor responds to treatment. Overall, the five-year survival rate for patients with TNBC is about 77%. This number does not include women diagnosed in the last few years, who may have received new treatments. The survival rate for current patients may be higher.
Diagnosis, symptoms and risk factors
Triple-negative breast cancer may display similar symptoms as other types of breast cancer. Like other breast cancers, TNBC is diagnosed with imaging exams and a biopsy of the cancer tissue.
Once doctors confirm cancer, they test the biopsy tissue for molecular receptors. If the cancer has no receptors for estrogen and progesterone and does not have high levels of HER2, it is considered triple-negative.
TNBC has many of the same risk factors as other types of breast cancer. One difference is age. Compared to other types of breast cancer, TNBC is more common in women under age 50. Black women are also at an increased risk for the disease.
Triple-negative breast cancer treatment
When triple-negative breast cancer is caught before it has spread to distant parts of the body, it is usually treated with chemotherapy, sometimes in combination with immune checkpoint inhibitors, followed by surgery. Patients may receive radiation therapy after surgery.
Patients may also receive additional chemotherapy or immunotherapy after surgery to kill any remaining cancer cells and reduce the risk of recurrence.
If the disease has spread to distant parts of the body, it can be treated with a variety of cancer drugs. These include immune checkpoint inhibitors, chemotherapy and targeted therapy. In some cases, these patients will receive radiation therapy.
Why Choose MD Anderson for your triple-negative breast cancer treatment?
Choosing the right hospital may be the most important decision you make as a triple-negative breast cancer patient. At MD Anderson, you’ll get treatment from one of the nation’s top-ranked cancer centers.
The surgeons, radiation oncologists and medical oncologists with the Nellie B. Connally Breast Center focus exclusively on curing breast cancer, extending the life of breast cancer patients and maximizing their quality of life.
Among them are many physicians who specialize in treating TNBC. Each doctor brings their skills to our multidisciplinary teams, where they work together to develop treatment plans that address the unique nature of each TNBC case and patient.
If a patient receives both chemotherapy and immunotherapy before surgery, the tumor’s response must be monitored closely. At MD Anderson, our dedicated breast imaging team tracks these tumors with state-of-the-art imaging that provides accurate pictures of the tumor throughout treatment.
As a top-ranked cancer center, we also have one of country’s the largest clinical trials program for triple-negative breast cancer. This includes studies of new treatments and treatment combinations, including clinical trials that are not available anywhere else.
In May 2021, Najaah Murray noticed a lump on her left breast. At 39, she was younger than the recommended age for breast cancer screening, but she made an appointment to get a mammogram at a local health care center. After a biopsy, staff from the center called Najaah with her diagnosis: stage IIIB triple-negative breast cancer.
She was referred to a local oncologist but was having difficulty scheduling an appointment.
“A friend asked me why I didn’t just go to MD Anderson,” says Najaah. “It clicked. MD Anderson is right here, and it’s the best cancer hospital. I filled out a form online, and they called me right away.”
She had an appointment the next day.
“I felt like they took my breast cancer diagnosis as seriously as I did,” she recalls. “From there, MD Anderson was the obvious choice for my cancer treatment.”
Instant connection with her MD Anderson care team
Najaah received her care at MD Anderson West Houston, which was close to her home in Cypress, Texas. She felt an immediate connection to her care team and everyone she met – from the greeters to the staff checking in patients.
Najaah and breast medical oncologist Ajit Bisen, M.D., shared similar interests, like kickboxing, and she liked his high energy.
Najaah says her breast radiation oncologist Melissa Joyner, M.D., was very down to earth.
“I used to train Dr. Joyner’s nurse, Essence, at my gym years ago,” says Najaah. “Since I already knew Essence, I felt very comfortable in her care.”
Najaah appreciated what she calls occupational therapist Camiella Esaklul’s “super high-energy.”
“Every visit to the West Houston campus was a pleasant one,” says Najaah. “The fact that I felt comfortable with everyone let me know I was in the right place.”
Treatment for triple-negative breast cancer
Najaah enrolled in the ARTEMIS clinical trial in which doctors monitored her response to chemotherapy treatment to see if it would decrease the size of her tumor. If not, she would receive targeted therapy based on her tumor profile. Najaah began four rounds of the chemotherapy drugs doxorubicin cyclophosphamide. When this combination didn’t shrink the tumor enough, Dr. Bisen added paclitaxel and panitumumab to her chemotherapy regimen. In total, she completed 20 rounds of treatment.
After discussing her options with breast surgical oncologist Catherine Akay, M.D., Najaah decided to have a double mastectomy.
“I didn’t want to risk the chance of cancer developing on the other side later in life,” she says.
Najaah was advised by her breast surgery team to get surgery on one breast at a time. In November 2021, Akay performed a total mastectomy with a sentinel lymph node biopsy.
Najaah also enrolled in the SAPHIRe clinical trial, in which she was randomized to receive the standard six weeks of radiation therapy and monitored for side effects and recurrence.
In October 2022, Akay performed a prophylactic skin-sparing mastectomy on the other breast while plastic surgeon Margaret Roubaud, M.D., completed a DIEP flap reconstruction of both breasts. Roubaud used tissue from Najaah’s stomach to recreate her breasts.
“The symmetry, shape and form of my breast is wonderful,” says Najaah. “I’m very pleased.”
Managing side effects from breast cancer treatment
During chemotherapy, Najaah experienced nausea, fatigue and weight loss.
She knew she’d lose her hair. So, to get ahead of things, Najaah got a tattooed powder eyebrow treatment, learned how to apply eyelashes and visited a barber to get all of her hair cut off.
“When I looked in the mirror, I wanted to be able to hype myself up,” she says. “I still wanted to be cute and dress up.”
After receiving so many compliments on her haircut, Najaah decided to use her diagnosis as an inspiration to others.
“I wanted to go through this being as positive and joyful as possible, just in case somebody I knew or came across was in a similar situation,” she says.
Najaah had always lived an active lifestyle, and she continued walking five miles each day during treatment. To manage her fatigue, she took several breaks to rest and walked at a slower pace.
“The worst side effect I experienced was super dry skin – on my hands, face, everywhere,” she says. “I made sure to use plenty of vitamin E and shea butter.”
Creating the life she wants – now
Najaah’s cancer diagnosis helped her realize she needed to create the life she wanted now.
“I’d always put off travel, but now I travel all the time,” she says. “I even helped my cousins expand their travel agency by opening an office in Texas.”
Everything she does now is intentional.
“I’m more connected with my family, and we have family game night every weekend,” she says. “I teach my son things he’ll need throughout his life. I don’t take anything for granted.”
For Najaah, it’s all about perspective.
“I was always a positive person, but cancer made me realize how bright my light really is,” she says. “You have to live your life with purpose and keep it moving.”
Encouraging Black women to take control of their health
Najaah knows that Black women face a higher risk of getting triple-negative breast cancer, so she encourages Black women to advocate for themselves and make their health a priority.
“I know so many Black women who are afraid to get a mammogram. Maybe they’ve had pain or felt a lump in their breast, but they’re afraid to make an appointment,” she says. “You never want to hear from a doctor, ‘We could have helped you, but now we can’t because x, y or z has happened.’ Have the courage to get checked out, follow up on those appointments and speak up for yourself.”
Today, Najaah is cancer-free, and says she feels amazing. She comes to MD Anderson for checkups every six months.
“I feel light, refreshed and stress-free,” she says. “But I pay attention to my body, so if I feel or see anything abnormal, I’m the first to jump on it.”
Najaah has been volunteering with MD Anderson’s Patient and Family Advisor Program for almost a year.
“I want to connect with and help patients because MD Anderson has done so much to help me,” she says. “I want to be a resource for people who are ready to take on this journey.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
By late 2021, Jennifer Connaly and her husband, Trey, completed five rounds of IVF in the hopes of becoming pregnant with a second child. The process had been unsuccessful, but when she felt a lump in her left breast, she thought it could be a side effect of the medication she had been taking. At an exam with her gynecologist, she asked for a mammogram just to be sure. Jennifer was only 36 years old at the time.
When the mammogram showed a suspicious spot, she underwent a biopsy and ultrasound. Jennifer remembers receiving the call that she had stage II triple-negative breast cancer.
“I was in shock,” Jennifer recalls. “No one in my immediate family had dealt with cancer.”
Jennifer, her husband and her parents gathered and prayed together while they processed the news. She also shared the diagnosis immediately with her 10-year-old son and her niece. One of Jennifer’s family members was an MD Anderson employee and suggested she come to MD Anderson before making any treatment decisions.
“I didn’t know what to expect,” recalls Jennifer. “After my first appointment at MD Anderson, I felt much more confident.”
Navigating breast cancer treatment, complications and work
When Jennifer met with Abenaa Brewster, M.D., she explained that the cancer was aggressive and the treatment would need to be, too. The plan was to start 24 weeks of chemotherapy with concurrent immunotherapy treatments every three weeks.
Unfortunately, Jennifer had a severe reaction to the immunotherapy. She was hospitalized with hemolysis, which is a breakdown of red blood cells. Despite the complications, scans revealed that the treatment was working. The tumor was shrinking.
Jennifer had started a new job near Pasadena, Texas at the time of her diagnosis, so she scheduled her chemotherapy treatments at MD Anderson League City on a Thursday, went to work on Friday, and used the weekend to recover from any side effects she was feeling.
“Chemotherapy was actually the easiest part of treatment for me,” she says. “It’s important to stay on top of medications, especially if you’re dealing with nausea. I had some fatigue, but it was manageable.”
In May 2022, Jennifer underwent a lumpectomy to remove the remaining tumor.
But her complications weren’t over. She had an acute liver injury and developed diabetes as a result of the steroid treatment for the liver injury, which required receiving insulin injections. Jennifer was treated by hepatologist Lan Wang, M.D., and was eventually able to discontinue taking insulin.
The final step in Jennifer’s treatment plan was radiation therapy. But due to previous complications and medications, she was experiencing poor wound healing after surgery. She wasn’t able to start radiation until her wounds were completely healed, which took about four months.
She underwent 30 rounds of daily radiation under the care of Kevin Nead, M.D. Jennifer says the treatment “went rather well” and was able to continue working.
“The staff was amazing. They told me what to expect, played music for me and made me feel so comfortable,” says Jennifer. “I knew at that point that my cancer was gone, and we were just killing any remaining cells, so that helped ease my mind.”
When she finished radiation treatment at the end of November 2022, Jennifer rang the bell at MD Anderson League City to mark the end of her treatment.
Gratitude for family, friends and MD Anderson’s expertise
Jennifer now returns to MD Anderson for follow-up visits every four months. She appreciates being able to ask her care team questions through MyChart between appointments.
“I still have my moments where I get a little scared, but I have to keep my faith,” says Jennifer. “Now, I know what to expect if my cancer ever came back. MD Anderson really cares about their patients, and I know they’re on top of it.”
She also tells the women in her life to get their mammograms and advocate for themselves.
“Don’t be scared to advocate for your health,” says advises. “I saw two doctors who brushed me off before I found one who listened to me and got me a mammogram.”
Jennifer says the strength of her husband, family, God and friends helped her get through the ups and downs of treatment.
“Cancer not only affects the patient; it affects the entire family,” says Jennifer. “My journey was far from easy, but I knew I was in the right place at MD Anderson.”
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Michelene Holmes was diagnosed with stage IIIA triple-negative breast cancer in January 2014 at 45 years old after she noticed a tightening in her left breast.
“When I heard the news that it was cancer, I felt terribly sad and embarrassed,” says Holmes, who is a program manager in Infectious Diseases at MD Anderson.
Thanks to the support of her family and friends, as well as her MD Anderson colleagues and care team, she came to realize that there was no need to feel embarrassed.
“At first I thought this was a punishment, but then I decided to focus on how we all have our own journey in life and that I had the opportunity to use my cancer journey to make a positive impact,” Holmes says.
Now out of treatment, Holmes participates in research studies to help others facing her same diagnosis and to give back to the institution that she feels saved her life. She’s participated in 13 breast cancer research studies in and outside of MD Anderson.
“I want to give back because I feel that so many people at MD Anderson gave so much of themselves to help me while I was in treatment,” Holmes says. “I want to be an example to other women and especially those in my Black/African American community that when we participate in research, we can help other women and hopefully eradicate breast cancer altogether.”
Overcoming a fear of the unknown after BRCA2 mutation found
After her initial diagnosis, she was diagnosed with the genetic mutation called BRCA2 – giving her a higher chance of developing breast and ovarian cancer in her lifetime. This news combined with the need to have a port for her chemotherapy treatment scared her and she contemplated not pursuing treatment. Her team members and teenage daughter provided her with support as she processed her diagnosis and managed anxiety about treatment and the future.
“The fear of the unknown can get a hold on you like no other,” she says.
She began the first of 16 rounds of chemotherapy in February 2014, followed by a bilateral mastectomy that same year in July and then two months after her surgery began 30 days of radiation.
She credits her ability to get through treatment to her care team. In particular her breast medical oncologist Daniel Booser, M.D., as well as the faculty member she supports in her program manager role – Victor Mulanovich, M.D., chair ad interim for Infectious Diseases.
“They all let me cry, process my emotions and calmed my fearful questions,” she says.
Life after treatment has been an ongoing adjustment.
“So much has changed – my body and my outlook on life,” Holmes says. “But it also has helped me to seize each day and make the most of it. I know now that your entire life can change in a matter of hours.”
The importance of connections
Over the course of her 16 years at MD Anderson, Holmes has made countless connections across the institution and beyond. Aside from supporting faculty and physician assistants in Infectious Diseases, Holmes provides one-on-one support to cancer patients and caregivers through our myCancerConnection cancer support community.
Since completing treatment, she’s been an active myCancerConnection volunteer for six years.
“I’ve spoken to women all over the world,” she says. “After coming through something so personally and emotionally challenging, I’m glad that I can be a source of comfort for others. I’m here for anyone who has been touched by cancer – no matter the diagnosis.”
She also co-chairs MD Anderson’s Cancer in the Workplace Employee Network.
“When I share my experience with people who are newly diagnosed, survivors or caregivers, I couldn’t ask for a more meaningful connection,” Holmes says.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.