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Triple-Negative Breast Cancer - Symptoms, Survival Rate, Diet, Treatment

What is triple-negative breast cancer?

Triple-negative breast cancer (TNBC) is a type of invasive malignancy that tends to grow and spread faster. It tests negative for the three receptors commonly found in breast cancer. These include the hormones oestrogen and progesterone and the protein called human epidermal growth factor receptor 2 (HER2).  

Subtypes of Triple-Negative Breast Cancer

There are six distinct subtypes of TNBC based on the gene expression patterns of the tumour. These are as follows: 

  1. Basal-like 1 (BL1) tumours have high activity in genes that control cell growth and DNA repair.

  2. Basal-like 2 (BL2) tumours are linked to growth signals and myoepithelial markers, making them more complex.

  3. Immunomodulatory (IM) tumours have a strong immune response involving immune cells and signalling pathways.

  4. Mesenchymal (M) tumours are associated with processes that allow cancer cells to spread, such as the epithelial-mesenchymal transition (EMT). 

  5. Mesenchymal stem-like (MSL) tumours also show EMT activity but with fewer actively dividing cells. 

  6. Luminal androgen receptor (LAR) tumours have genes that act like those in hormone-sensitive breast cancers and are driven by androgen receptors.

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Stages of Triple-Negative Breast Cancer

Doctors generally use the TNM (tumour size, cancer in lymph nodes, metastasis) staging system to determine the stage of the disease. These stages are as follows: 

  1. Stage 0: This is a non-invasive stage in which the cancer has not spread beyond the milk ducts. 

  2. Stage I: In this stage, the malignant cells spread to the nearby breast tissue. 

  3. Stage II: It is characterised by one of the following: 

    1. A tumour smaller than 2 centimetres across that has spread to armpit lymph nodes.

    2. A tumour larger than 5 centimetres across that has not spread to armpit lymph nodes. 

  4. Stage III: The cancer spreads beyond the point of origin, invading nearby tissue and lymph nodes. However, it has not spread to distant organs like the bones, liver, lungs, and brain. 

  5. Stage IV: In stage IV triple-negative breast cancer, also called metastatic breast cancer, the malignancy spreads to distant organs.

Symptoms of Triple-Negative Breast Cancer

Triple-negative breast cancer symptoms are similar to those of other types of breast cancers. These may include the following: 

  1. A new lump in the breast or underarm area 

  2. Unexplained changes in the breast size or shape, including swelling or shrinkage on one side 

  3. Dimpling or puckering of breast skin 

  4. An inverted nipple 

  5. Nipple discharge, especially clear or bloody fluid 

  6. Changes in skin texture, discolouration, or enlarged pores resembling an orange peel 

  7. Red, scaly, or swollen skin on the breast, nipple, or areola 

Consult a doctor if you experience any of the symptoms mentioned above.

Causes and Risk Factors of Triple-Negative Breast Cancer

The exact cause of triple-negative breast cancer is not known. However, various factors can increase the risk of the condition. These include: 

  1. Age: The risk of TNBC is higher in premenopausal women and those under 50 years of age. 

  2. BRCA Mutations: These are inherited genetic mutations linked to a greater cancer risk. Approximately 10% to 15% of women with this type of cancer test positive for BRCA1 mutations. BRCA2 mutations can also cause TNBC, though less commonly than BRCA1.

  3. Personal or Family History: A personal history of breast cancer or having a family member with any breast cancer raises the risk of developing TNBC.

There are also various modifiable risk factors of TNBC that you can manage to lower your risk. These are mentioned below: 

  1. Sedentary lifestyle 

  2. Obesity 

  3. Alcohol consumption 

  4. Smoking

How to diagnose triple-negative breast cancer?

Performing a mammogram is the first step in diagnosing triple-negative breast cancer. It helps detect a lump or abnormalities in the breast tissue. 

Based on test results, the doctor may take a small sample of the breast tissue (biopsy) and examine it under a microscope. Pathologists check for the presence of oestrogen receptors, progesterone receptors, and HER2 proteins. TNBC is confirmed if all three are absent. 

The doctor may also order other evaluations, including the following: 

  1. Magnetic Resonance Imaging (MRI): Provides detailed images of the breast to determine the exact size and location of cancer

  2. Ultrasound: Uses sound waves to create images that detect cancer in different places such as the other breast, under the arms, and liver

  3. Computed Tomography (CT) Scan: Usually used to check if cancer has spread to other organs like the lungs or liver 

  4. Positron Emission Tomography (PET) Scan: Involves injecting radioactive sugar into the blood to see if cancer has spread to other body parts

Treatment for Triple-Negative Breast Cancer

Triple-negative breast cancer treatment depends on the location, size, and grade of cancer. Due to the absence of receptors that generally fuel breast growth, TNBC cannot be treated with hormone therapies or other drugs. However, other options can be used to manage the condition, such as: 

  1. Surgery: It is a common treatment for TNBC and may include the following two options: 

    1. Mastectomy: It is the surgical removal of one or both breasts. Mastectomy is recommended if the tumour is large or has spread to the lymph nodes. 

    2. Lumpectomy: This procedure removes only the breast tissue with a cancerous tumour to leave clear margins around it. It is ideal for smaller tumours that have not spread to the lymph nodes. Radiation therapy usually follows to reduce the risk of recurrence. 

  2. Chemotherapy: It is the most effective TNBC treatment. Depending on the size and spread of the malignant tumours, patients may receive either one of the following: 

    1. Neoadjuvant Chemotherapy: Before surgery to shrink the tumour 

    2. Adjuvant Chemotherapy: After surgery to reduce the chances of recurrence 

  3. Biologic Targeted Therapy: Drugs called poly ADP ribose polymerase (PARP) block the growth of cancer cells. 

  4. Immunotherapy: It is a type of triple-negative breast cancer therapy that stimulates the immune system of the body to fight cancer. 

When to visit a doctor?

Depending on your situation, you will have regular physical examinations with your doctor every three to six months for the first three years after treatment. These visits will be reduced to every six months in the fourth and fifth months post-treatment. 

However, if you develop triple-negative breast cancer chemotherapy side effects, you may need to consult your doctor immediately. These symptoms include: 

  1. Fever above 100.5 F

  2. Chills 

  3. Wet cough 

  4. Stomach ache 

  5. Constant nausea and vomiting 

  6. Diarrhoea

Recurrence Rate of Triple-Negative Breast Cancer

A study by Stewart et al., 2019, found that triple-negative breast cancer recurrence after mastectomy or other treatments occurs in about 40% of patients with stage 1 to stage 3 cancer. The remaining 60% achieve long-term disease-free survival. This type of cancer may return in about 19-40 months, compared to 35-67 months for other forms of breast cancer. 

The most common areas of recurrence include: 

  1. Local (cancer remains in the breast)

  2. Regional (cancer spreads to lymph nodes and nearby structures)

  3. Distant (cancerous cells spread to organs like the liver and lungs)

Survival Rates of Triple-Negative Breast Cancer

According to the American Cancer Society, the overall five-year triple-negative breast cancer survival rate is 77%. This means that about 77% of patients with cancer are likely to live at least five years after diagnosis. The estimated survival rate for different stages is as follows: 

SEER Stages 

TNM Stages 

Triple-Negative Breast Cancer Survival 

Localised 

0 and I

99%

Regional 

II and III

61%

Distant 

IV

12%

*SEER (Surveillance, Epidemiology, and End Results) is a summary staging system used by the National Cancer Institute for cancer statistics. 

*The TNM staging system classifies cancer based on three factors: tumour size (T), extent of lymph node involvement (N), and evidence of metastasis (M). 

What is an appropriate diet for triple-negative breast cancer?

Proper nutrition is essential before, during, and after cancer treatment. A balanced triple-negative breast cancer diet helps manage weight, preserve strength, and support overall health. It also decreases treatment-related side effects like nausea, fatigue, and mouth sores. 

Foods that one should include in their diet are as follows: 

  1. Nutrient-Dense Options: Eat colourful fruits, vegetables, and whole grains to get the vitamins and minerals needed for your overall health. 

  2. Phytochemicals: Add plant-based compounds with cancer-fighting properties to your diet. These may include the following: 

    1. Folate (found in leafy greens)

    2. Resveratrol (in grapes and berries)

    3. Curcumin (from turmeric)

    4. Sulforaphane (in broccoli)

    5. Genistein (found in grains, soybeans, and legumes)

It is also important to avoid certain foods as they can increase the risk of developing TNBC. These include: 

  1. Red and processed meats 

  2. Sugar-sweetened beverages and refined grain products 

  3. Highly processed foods and alcohol 

Takeaway

Triple-negative breast cancer (TNBC) is a challenging type of breast cancer to treat. Despite its challenges, several effective treatments, including chemotherapy, surgery, radiation, and immunotherapy, are available. Ongoing research continues to enhance treatment options, offering patients renewed hope for better outcomes.

If you have questions or concerns about your diagnosis, it is important to speak with your doctor. At HexaHealth, we offer personalised support and access to expert care for patients with TNBC. Connect with our experienced healthcare professionals to better understand triple-negative breast cancer symptoms, causes, and treatment.

Frequently Asked Questions

Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer that lacks oestrogen, progesterone, and HER2 receptors. This makes it unresponsive to common hormonal therapies.

Triple-negative in this name means that malignant cells lack the three receptors often found in breast cancer. These include oestrogen, progesterone, and HER2 receptors.

Triple-negative breast cancer symptoms are similar to those experienced in other forms of breast cancer. These include: 

  1. A lump or thickening in the breast 

  2. Changes in breast size or shape 

  3. Nipple discharge 

  4. Skin dimpling 

  5. Redness

TNBC grows and spreads faster than other forms of breast cancer. According to Cleveland Clinic, it grows by 1% each day between the time of diagnosis and surgery. 

Yes, TNBC can cause pain in the breast or nipple. Pain management is often an important part of the treatment plan. 

A multidisciplinary team treats TNBC. This may include the following specialists: 

  1. Oncologists 

  2. Surgeons

  3. Medical oncologists 

  4. Radiation therapists 

  5. Plastic surgeons and breast reconstruction experts 

  6. Genetic counsellors

The cost of surgery in breast cancer treatment varies depending on the cancer stage. The estimated price of lumpectomy in India ranges between ₹ 30,000 to ₹ 1,00,000. The expense of mastectomy is about ₹ 45,000 to ₹ 1,10,000. Please consult HexaHealth experts for accurate pricing.

Triple-negative breast cancer survival rates depend on the stage of cancer at diagnosis. The five-year survival rate for localised tumours is about 99%, which decreases to about 12% for distant cancer. 

Grade 3 triple-negative breast cancer life expectancy depends on various factors, including cancer stage and treatment response. More than 60% of people with TNBC at this stage live for at least five years after diagnosis. 

Triple-negative breast cancer treatment is personalised based on the patient’s needs and the stage of cancer. It generally includes the following: 

  1. Surgery (lumpectomy or mastectomy)

  2. Chemotherapy 

  3. Radiation therapy 

  4. Immunotherapy 

  5. Biologic targeted therapy

Treatment for stage IV triple-negative breast cancer involves a combination of therapies such as chemotherapy, immunotherapy, and targeted therapy. Palliative care may also help manage symptoms and improve quality of life.

The best treatment for triple-negative breast cancer involves a combination of chemotherapy, surgery, and radiation. Immunotherapy and targeted therapy are also effective, depending on the cancer stage and progression.

Triple-negative breast cancer recurrence after mastectomy happens in 40% of individuals with stage 1 to stage 3 cancer. It generally comes back 19-40 months after treatment. Therefore, doctors recommend radiation or chemotherapy following mastectomy.

Eribulin is a chemotherapy drug that treats some types of breast cancer. According to a study by Pizzuti et al., 2019, eribulin for triple-negative breast cancer is highly effective. It reduced the mortality risk by 29% compared to other treatments. 

Triple-negative breast cancer chemotherapy side effects are common and can cause discomfort. These may include: 

  1. Fatigue 

  2. Nausea 

  3. Hair loss

  4. Mouth sores 

  5. Increased infection risk

A triple-negative breast cancer diet rich in nutrients can support overall health and manage the side effects of the treatment. Foods high in phytochemicals and antioxidants can also help aid recovery. However, diet alone cannot treat the disease.

Yes, triple-negative breast cancer is considered aggressive due to its faster growth and higher chances of metastasis. It also has fewer treatment options compared to hormone receptor-positive breast cancers. 

Effective triple-negative breast cancer therapy includes chemotherapy, surgery, radiation, and immunotherapy. Targeted therapies like PARP inhibitors may also be used for patients with specific gene mutations.

Immunotherapy involves drugs that help the immune system recognise and fight cancer cells. When combined with chemotherapy, it offers improved outcomes, especially in advanced stages of TNBC.

Doctors suggest various ways to improve the quality of life and improve outcomes from triple-negative breast cancer. These are as follows: 

  1. Pain management 

  2. Lifestyle changes (healthy diet, regular exercise, and enough rest)

  3. Psychological support 

  4. Physical therapy

Yes, triple-negative breast cancer can return. About 40% of people with stage I to III TNBC experience a recurrence, especially within the first three years after treatment. Aggressive treatment and regular follow-ups can help manage and reduce the risk. 

New treatments for TNBC include immunotherapies like checkpoint inhibitors and targeted therapies such as PARP inhibitors. Ongoing clinical trials are also exploring innovative approaches, including: 

  1. Antibody-drug conjugates (ADCs)

  2. Talimogene laherparepvec (a virus that kills cancer cells is combined with neoadjuvant chemotherapy)

  3. cSNX1.3 (a drug that specifically targets TNBC)

References

All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.


  1. Thakur KK, Bordoloi D, Kunnumakkara AB. Alarming burden of triple-negative breast cancer in India. Clin Breast Cancer [Internet]. 2018;18(3):e393–9. link
  2. Triple-negative breast cancer (TNBC) [Internet]. WebMD. [cited 2024 Dec 24]. link
  3. Lehmann BD, Pietenpol JA, Tan AR. Triple-negative breast cancer: Molecular subtypes and new targets for therapy. Am Soc Clin Oncol Educ Book [Internet]. 2015;(35):e31–9. link
  4. Triple-negative breast cancer [Internet]. Cleveland Clinic. [cited 2024 Dec 24]. link
  5. Triple-negative breast cancer [Internet]. Cleveland Clinic. [cited 2024 Dec 24]. link
  6. Aacrjournals.org. [cited 2024 Dec 24].link
  7. Triple-negative breast cancer [Internet]. Cancer.org. [cited 2024 Dec 24].link
  8. Richards L. Triple negative breast cancer and diet: Foods to eat and avoid [Internet]. Medicalnewstoday.com. 2021 [cited 2024 Dec 24]. link
  9. Hopkinsmedicine.org. [cited 2024 Dec 24]. link
  10. Fletcher J. Triple-negative breast cancer: New treatments [Internet]. Medicalnewstoday.com. 2021 [cited 2024 Dec 24]link

Last Updated on: 24 December 2024

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.

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