Q. I’ve been diagnosed with triple negative breast cancer. Is this a type of breast cancer like IDC or inflammatory breast cancer, or…?

A. No, it’s not a type of breast cancer like those you mentioned. You can have IDC and a triple negative diagnosis; or invasive lobular cancer, and be triple negative, too.

So, while IDC and ILC and DCIS are breast cancer sub-types, triple negative is a phenotype – that is, “triple negative” refers not to what the cancer is, but how it behaves.

And how does triple negative breast cancer behave? Well, it’s not cooperative, that’s for sure. “Triple negative” refers to the fact that your cancer cells are negative for estrogen and progesterone receptivity; and also negative for HER2-neu over-expression. Most women’s cancers are positive for at least one of those, giving them more treatment options.

Q. So this is a less-common type of breast cancer, then?

A. Actually, about 17% of women with breast cancer have triple negative cancer. It’s generally considered more aggressive; and it’s more common in younger women; in African–American women, and in women with BRCA1 or BRCA2 gene abnormalities.

Q. How will this diagnosis impact my treatment? Will I have surgery and radiation and chemo and all of that?

A. Yes, you’ll have the usual treatment (surgery, perhaps radiation, and definitely chemo). If the cancer has spread to your lymph nodes, you’ll probably have chemo prior to surgery, to track how effectively it shrinks the tumor.

What you won’t have is long-term drug treatment. Unfortunately, your cancer doesn’t depend on estrogen or progesterone to grow, as most breast cancers do. So denying your cancer access to those female sex hormones, via tamoxifen or an aromatase inhibitor, won’t stop it from growing.

Likewise, it doesn’t “over-express” the HER2-neu protein. And while this over-expression in and of itself isn’t a plus (HER2-neu over-expression signals a more aggressive cancer), it does mean women with this type of cancer can be successfully treated with the drug Herceptin.

Bottom line: Most women have ER/PR-receptive breast cancer, and receive long-term hormone-repression therapy to reduce their risk of recurrence. Women with HER2-neu positive breast cancer take Herceptin for a year, to reduce their risk of recurrence. For women with triple negative breast cancer, there’s no therapy beyond chemo that will help you keep the cancer at bay.

Q. Well, that doesn’t sound good….

A. Luckily, chemotherapy is generally quite effective for women with triple negative breast cancer – in fact, more effective than it is for most other diagnoses. You’ll receive chemo for sure, since you need to attack this cancer with everything available – which is chemo.

Most women with a triple-negative diagnosis receive ACT: Adriamycin (an anthracycline), Cytoxan (a cyclophosphamide), and Taxol (a taxane). Hopefully that’ll knock the cancer out for good. Two newer drugs in the pipeline, carboplatin and cisplatin, are showing promise as perhaps being more effective than ACT. Currently, they’re only being used to treat metastatic TNBC.