This type of breast cancer needs more attention due to its high malignancy and poor prognosis!

Author: Song Guohong, Chief Physician, Peking University Cancer Hospital

Reviewer: Rong Long, Chief Physician, Peking University First Hospital

When we talk about cancer, we usually think of middle-aged and elderly people, but there is a type of breast cancer that is more common in young women.

This type of breast cancer is "triple negative breast cancer"!

1. What is triple-negative breast cancer?

Breast cancer is divided into different molecular types based on pathological immunohistochemistry. Triple-negative breast cancer is one of them. So how is the specific molecular type determined?

Immunohistochemistry examination includes three immunohistochemical indicators: estrogen receptor (ER), progesterone receptor (PR), and epidermal growth factor receptor 2 (HER-2). These three indicators are used to distinguish the molecular typing of breast cancer.

For example, ER and PR are positive, that is, estrogen receptor and progesterone receptor are positive, we call it hormone receptor positive type; HER-2 is positive, that is, epidermal growth factor receptor 2 is positive, we call it HER-2 positive, or HER-2 overexpression type; if the three indicators ER, PR, and HER-2 are all negative, we call it triple-negative breast cancer.

Figure 1 Original copyright image, no permission to reprint

Relevant data show that if middle-aged or elderly women suffer from breast cancer, the hormone receptors are generally positive, while if young women suffer from breast cancer, its type is likely to be triple-negative breast cancer.

Among all breast cancers, triple-negative breast cancer accounts for about 15%. Although the proportion is not very high, patients and the media now pay more attention to this type of breast cancer. Why is that?

Because relatively speaking, triple-negative breast cancer is more malignant and has a poorer prognosis among these types of breast cancer, and lacks more therapeutic targets.

For hormone receptor-positive cancers, endocrine therapy can be chosen; for HER-2-positive cancers, anti-HER-2 targeted therapy can be used; however, triple-negative breast cancer, because it lacks specific targets, has a poorer prognosis and fewer treatment options, with chemotherapy being the more common choice.

2. What are the characteristics of triple-negative breast cancer?

In fact, the clinical manifestations of triple-negative breast cancer are the same as those of ordinary breast cancer, and there is no specific manifestation. Breast cancer is generally a painless mass with unclear boundaries, poor mobility, and a relatively hard texture.

Compared with other types of breast cancer, triple-negative breast cancer is relatively more malignant and develops faster. In a short period of time, the tumor will grow larger and faster.

In addition, because triple-negative breast cancer is highly malignant, it is more likely to metastasize to the axillary lymph nodes, because the axillary lymph nodes are usually the first place where breast cancer metastasizes.

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Because triple-negative breast cancer develops quickly, the axillary lymph nodes may swell at the same time as the breast lumps appear. This is the main reason why we touch the armpits in addition to the breasts during physical examinations.

As for other aspects, in fact, from the clinical manifestations, there is no difference between triple-negative breast cancer and ordinary breast cancer, because it is a pathological difference. Only after a puncture examination and staining under a microscope can it be seen that this one is negative and that one is positive.

So as patients, if we feel a suspicious lump, what we need to do is go to the hospital as soon as possible and let the doctor help us determine its nature.

3. Should surgery be performed as soon as possible after triple-negative breast cancer is diagnosed?

Once triple-negative breast cancer is confirmed, if the tumor is relatively large, such as larger than 2 cm, and the axillary lymph nodes have already metastasized, at this time, we do not recommend that the patient undergo surgery immediately. Instead, we recommend that the patient undergo neoadjuvant therapy before surgery.

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Neoadjuvant therapy includes neoadjuvant chemotherapy and can also be combined with neoadjuvant immunotherapy. Through our neoadjuvant therapy, the lesions can be reduced, and then surgery can be performed. This can not only determine the efficacy of the treatment, but also enable some patients who cannot preserve their breasts to achieve the goal of preserving their breasts. So it does not mean that surgery must be performed immediately after the discovery of triple-negative breast cancer.

Of course, if the lesion is very small when it is discovered, that is, about 1 cm, and there is no lymph node metastasis, then immediate surgery is also possible. Therefore, the decision on whether to perform surgery immediately should be based on the size of the lesion, whether there is lymph node metastasis, and other specific circumstances.

Some patients become very anxious after discovering they have breast cancer and must undergo surgery right away. In fact, this is not the case. When preoperative treatment is needed, it must be done according to the doctor's requirements. If you follow the treatment step by step, it will not delay the disease.