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.
Jewel Johnson was diagnosed with triple-negative breast cancer in December 2019 at age 57. She’d visited her primary care physician in Houston after feeling a lump in her breast, and the biopsy results confirmed it was cancer.
At the time, Jewel hadn’t heard of triple-negative breast cancer, and she didn’t feel like her physicians were giving her the information she needed.
“I didn’t feel comfortable because I felt rushed and nothing was being explained to me,” she says.
Soon after her diagnosis, Jewel called a friend to discuss her situation. A friend of the friend overhead their conversation.
“I’d never seen or met this woman, but she told my friend to tell me to get off the phone and go online and make an appointment at MD Anderson,” says Jewel. “From there, my story only got better.”
Triple-negative breast cancer treatment
It turns out the woman who advised Jewel to seek treatment at MD Anderson was an employee there and also a breast cancer survivor. She knew Jewel would receive the best cancer care at MD Anderson.
Breast medical oncologist David Ramirez, M.D., breast surgeon Puneet Singh, M.D., plastic surgeon Mark Clemens, M.D., and breast radiation oncologist Melissa Mitchell, M.D., Ph.D., worked together to plan Jewel’s treatment, which included chemotherapy, surgery and radiation.
Jewel started with 16 rounds of chemotherapy to help shrink her tumor. Then Singh and Clemens performed a lumpectomy and breast reconstruction surgery, respectively, on the same day. After that, she had six weeks of radiation therapy, which she completed on Oct. 30, 2020.
Jewel enrolled in a clinical trial that looked at whether it was beneficial to shorten the duration of radiation therapy from six weeks to four weeks, but Jewel was assigned to the control group, which receives the standard six weeks.
“They’re still monitoring my treatment and looking for differences about how the body is affected,” she says. “I just want to be an advocate. Use me for whatever you need so that this disease can have more viable treatments.”
In August 2020, Jewel learned she was in remission.
Exploring Integrative Medicine at MD Anderson
Jewel credits MD Anderson’s Integrative Medicine Center with helping her both during and after breast cancer treatment.
She learned about the Integrative Medicine Center when she first got to MD Anderson and took full advantage of its services.
Jewel experienced neutropenia, neuropathy and weight loss as side effects from treatment, but she says they weren’t bad at all and her care team helped ease the symptoms.
From her psychiatrist Rachel Lynn, M.D., to her massage therapist, to her nutritionist, to her psychologist Aimee Christie, Ph.D., everyone played an integral role in keeping her healthy – both physically and mentally.
Jewel’s massage therapy helped ease her neuropathy symptoms, and her nutritionist guided her on what to eat and how to eat, which helped with her weight loss during treatment.
“After meeting with Dr. Christie several times, she said I’d be a great candidate for the IM Healthy program,” says Jewel. “She was right.”
IM Healthy program helps Jewel make healthy changes
The Integrative Medicine Center’s IM Healthy program helps guide patients and survivors through behavior changes to improve their overall health. The group meets weekly, and meetings are led by a health psychologist.
“This program has been a godsend,” says Jewel. “We have our ups and downs, our cries and our laughs, but we all support one another.”
One aspect of the program is goal setting. Jewel’s goals included drinking more water and increasing her movement.
“With triple-negative breast cancer, there’s no medicine you can take to keep recurrence at bay,” she says. “That’s where integrative medicine comes in. Nutrition. Exercise. Peace of mind. Sleep. That’s been my follow-up medicine for triple-negative breast cancer.”
Participation in the program has helped Jewel stay focused and learn how to deal with her emotions.
“When it’s time for scans, everybody’s rooting for you, praying for you, encouraging you,” she says. “I didn’t realize survivorship can be harder than going through the actual treatment. Without this program, I don’t know where I would have been in my survivorship journey.”
Not slowing down after triple-negative breast cancer treatment
Jewel shares recipes and wellness tips she’s learned with everybody.
“You don’t know who’s going to get cancer, so we want to prevent it upfront,” she says. “During radiation, I finally got the courage to post on social media, so I’d post my recipes and juices. I share with everyone I encounter.”
This includes her own family.
“I’d always been in relatively good health and worked out regularly, so I thought my transition to this healthier lifestyle after cancer would be easy, but it was harder than I expected, especially with other family members in my household,” says Jewel. “If I see my kids with fast food, I’m going to want it. But that’s why I stay in the IM Healthy program, so I always keep my focus.”
Since Jewel joined the program, her husband has also made some lifestyle changes, including eliminating red meat from his diet. He’s also learned how to cook healthy meals for her.
Jewel is thankful for her support system, but she understands all patients don’t have one. She encourages other patients to advocate for themselves.
“After receiving my cancer diagnosis, I asked my previous doctor if they take a holistic approach and treat the whole person,” says Jewel. “He just looked at me like he didn’t know what I was talking about. But MD Anderson does that. They treat the whole person, not just the disease.”
Asking those types of questions helped Jewel identify the type of care she wanted and where to go to get it.
“Figure out what you need and ask questions,” she says. “Even if your oncologist can’t provide it, they will have the resources to help you. If it weren’t for Dr. Ramirez, Dr. Christie and the IM Healthy program, it would have been a lot more difficult to navigate my cancer treatment. They were phenomenal.”
Jewel recently enrolled in the IM Fit program, which focuses on lifestyle changes to promote slow weight loss. She plans on participating in as many programs as possible because she knows survivorship is a lifelong journey.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
In October 2020, Archna Chainani was diagnosed with stage IV triple-negative breast cancer (TNBC), one of the most aggressive forms of breast cancer. After some discouraging internet research on the disease, Archna and her family were determined to seek care at a place that would actively treat the cancer and give her the best shot at a full recovery.
“Everything pointed us to MD Anderson,” Archna says.
At the encouragement of Beatriz Adrada, M.D., a family friend who is also a breast imaging physician and researcher, Archna made an appointment at MD Anderson.
“Her care has been curated by experts,” says Ashley Chainani, Archna’s daughter. “We looked for second opinions outside of MD Anderson, but whenever we told others who her oncologist, surgeon or radiologist at MD Anderson was, their names were immediately recognized as being among the best. They would tell us MD Anderson was the best hospital for her.”
After receiving chemotherapy, immunotherapy, radiation and a radical mastectomy, Archna learned she had no evidence of disease in mid-2021. Her family was ecstatic.
Resilience in the face of a triple-negative breast cancer recurrence
But in late 2021, Archna’s world was turned upside down again. The cancer had returned, metastasized to her bones and was likely non-curable.
“Their current goal is to keep the cancer under control with treatment so that it becomes a condition she lives with, such as diabetes,” Ashley says. “Our hope is that my mom will continue to live many fulfilling years and, eventually, benefit from a cure for breast cancer.”
“There are so many new clinical trials and medications, and that gives me hope,” Archna says. “Of course, I have bad days here and there. But I’ve decided I am going to fight for myself and my family.”
As Archna is now receiving a novel agent, she and her family still believe MD Anderson has been the best choice for her treatment.
“My care has been top-of-the-line. My doctors make me feel very at ease and very loved. They are very passionate about what they do,” Archna says.
“Her doctors constantly follow up,” Ashley says. “They remember not just my mom’s face; they remember all of us. They know our stories. They make you feel like you’re not just a patient — you're a person.”
Fundraising for cancer research through the Boot Walk to End Cancer®
After she was initially declared no evidence of disease, Archna and her family wanted to give back to MD Anderson and support the cancer research efforts that had saved her life. When Ashley learned about MD Anderson's Boot Walk to End Cancer®, she encouraged her family to fundraise for and participate in the 1.2-mile walk supporting prevention, research and care. In 2021, their team raised more than $25,000 through the Boot Walk. They designated these funds for breast cancer research led by Archna’s oncologist, Vincente Valero, M.D.
One of Archna’s first treatments was an immunotherapy and chemotherapy combination that was approved by the FDA that year, thanks to a clinical trial funded by the Boot Walk. “Participating in the Boot Walk was an easy way for us to show our appreciation,” she says.
Ashley agrees, noting that the Boot Walk enables their family to support novel research that benefits patients like her mother.
“When someone you love is diagnosed with cancer, you feel so powerless. The Boot Walk makes me feel like there’s something I can do to help. Whether it’s 10 years, five years or one year from now, the clinical trials we are funding could benefit my mom again,” Ashley says.
Boot Walk provides families with meaningful time together
Despite the return of her cancer, Archna’s determination inspired her family to continue participating in the Boot Walk this year.
“Even now that her cancer has come back and spread, we're still fighting, and MD Anderson is still giving us hope. No matter what, they don't give up,” Ashley said.
The Boot Walk has provided a way for the Chainani family and their friends to spend time doing something meaningful together. This year, the Boot Walk will return to an in-person event for the first time in two years. Archna and her team are looking forward to walking together at MD Anderson’s Texas Medical Center Campus in their favorite pairs of boots.
“We don't take each other for granted anymore. Now, every minute we spend with each other is so precious,” Archna says.
“With a stage IV diagnosis, you’d think we might try to live faster and experience as many things as quickly as possible,” Ashley adds. “But instead of hitting the gas pedal, we slowed down, and we try to appreciate every little moment now. We take things one day at a time and focus on what we know, not what we don’t know.”
Register to join the Boot Walk to End Cancer on Nov. 5 at MD Anderson or wherever you are.
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.