Triple-negative breast cancer: what to ask your oncologist

Often referred to as TNBC, triple-negative breast cancer is a type of breast cancer that tests negative for estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2).

There may be fewer treatment options for TNBC compared to other types of breast cancer, but there are treatment options. If you or a loved one has been diagnosed with TNBC, here is an overview of what you’ll want to discuss with your healthcare team.

Questions about the diagnosis

Your healthcare providers will be your best source of information. While this article includes background information about TNBC, it’s important to remember that every cancer diagnosis is different. A cancer diagnosis will take into account many different factors. Some points you will want to cover:

• How is TNBC different from other types of breast cancer?
• Why is TNBC considered aggressive, or more aggressive than other types of breast cancer?
• What type of breast cancer is this? Type refers to the type of cells where the cancer originated.
• What is the stage of the cancer? Staging refers to the amount of cancer, including the size of the tumors and if/where the cancer has spread.
• What is the cancer grade? Cancer grade or tumor grade refers to how abnormal cancer cells look compared to healthy cells.
• What additional diagnostic tests can provide more information? Do you recommend genetic testing?

Again, your healthcare team will be your best source of information. If your providers use a term that you do not understand, ask them to define that term. If there is an aspect of your diagnosis you do not understand, ask for an explanation, or ask them to explain it in a different way.

Treatment options for TNBC

“What are the treatment options?” is often one of the first questions that will come to mind when a person learns that they have cancer.

TNBC is often more challenging to treat than other types of cancer. This is because estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) are targets for cancer treatments. Because TNBC does not have these targets, there are fewer treatment options. This does not mean that there are no treatment options, or that the treatment options that are used are not effective.

The decision of how to treat TNBC will depend on many of the factors described above—the type of cancer, the stage, the size and locations of tumors. It will also depend on a person’s age, overall health, medical history, and treatment preferences.

Chemotherapy is the main treatment for TNBC. For early-stage TNBC, chemotherapy is often combined with surgery, and sometimes used with radiation. Chemotherapy is also often used in the treatment of TNBC that is more advanced.

Treatment options for TNBC have also evolved and continue to evolve, and now include immunotherapy and targeted drugs. Immunotherapy refers to anti-cancer medications that help the immune system identify and destroy cancer cells. Targeted drugs are anti-cancer medications that target specific proteins found on specific cancer cells—in other words, these are drugs that are able to identify and attack cancer cells.

Treatment for TNBC will be somewhat different for everyone—again, every cancer diagnosis is different.

Questions to ask about a cancer treatment

Here are some questions to ask when discussing a treatment option with your healthcare providers:

• Why do you recommend this treatment approach?
• How does this therapy treat TNBC?
• What is the goal of using this treatment?
• How will we know if this treatment is working? Also, what are the next steps if the cancer does not respond to this treatment?
• What will day-to-day life be like during treatment? For example, how long will it take to recover from surgery, what side effects will a medication cause, will you need to take time off work, what activities will need to be limited?
• How long will treatment take? Treatment may involve several steps, such as rounds of chemotherapy or other medications, or one type of therapy followed by another type of therapy.
• What does the therapy cost? Who can I talk to if I have concerns about the cost of treatment?

Remember, your best source of information will be your healthcare team. Use the questions above as a guide or a starting point, but also take time to write down your own questions and concerns before your appointment.