Living with Triple-Negative Breast Cancer
(#5 in a series)
We arrived at the hospital at the scheduled time to discuss the biopsy results. It was obvious the staff was unaware that we had already heard the results from my general physician. If we hadn’t, the nurse with the American Cancer Society (ACS) badge would have been the first tip-off. She seated us in a private room and went in search of “a doctor” to speak with us.
The doctor quickly introduced himself, his delivery cold and hurried. “Well, you’ve got a malignancy and it’s not good. The smaller tumor is not cancerous, but the larger one is. The first thing you need to do is choose a surgeon,” he said, indicating a list of surgeons taped to the wall.
To our questions about these surgeons he replied that it really didn’t matter which one we chose because “they’re all good.” This particular doctor’s job was to deliver difficult news to a patient he’d never met and would never see again. Clearly, his job was done. How grateful I was that our general physician called yesterday to break the news personally!
The ACS nurse said she had three other patients with the double whammy of multiple sclerosis and breast cancer. As she looked at the biopsy report, she put her hand to her forehead and rubbed. “You don’t see triple-negative very often.” It was the first time I’d heard the phrase “triple-negative,” but still had no idea what it meant.
After much discussion, we ended up with an appointment with a well-respected breast surgeon.We were advised that I would probably need a lumpectomy and my lymph nodes checked, to see if the cancer had spread. Only then could it be “staged.”
We departed the hospital knowing little more than when we went in but, armed with a copy of the biopsy report and several days remaining before our surgeon appointment, we did some research on our own.
The report gave us some important information about the cancerous tumor.
- Grade 3: On a scale of 1-3, the higher the grade, the more abnormal the cells are, and the more likely to recur.
- Infiltrating ductal carcinoma: Invasive. Cancer that spread from where it started into surrounding breast tissue, and may then spread to other parts of the body.
- Moderate-poorly differentiated: Cancer cells that closely resemble normal cells from the organ where they begin are labeled well-differentiated. When they bear little resemblance to the normal cells, they are called poorly differentiated.
- Lymphovascular invasion positive: the cancer has acquired the genetic mutation it needs to create its own blood vessels.
- Negative for progesterone receptors, negative for estrogen receptors, and HER-2 negative: This is where Triple-Negative Breast Cancer gets its name.
The Surgeon Enters the Picture
It was finally time to meet and assess the surgeon. Friendly nurse Jennifer showed us to the examining room, her smile and warmth easing our tensions.
From the moment she walked into the room and greeted us with hugs, we knew we were going to like Dr. M. After a physical exam, she approached the subject slowly and honestly, deliberately repeating the word “cancer,” as if to make certain we soaked it in. She appreciated our queries and made no attempt to whitewash the hard facts — or to discourage us in any way. “You’re already a survivor,” she pointed out.
Placing the biopsy report in front of us, she wrote the words, “triple-negative” and circled them. Pointing out this narrowed our options, she stressed that surgery and chemotherapy were excellent weapons.
The large tumor appeared dangerously close to penetrating the chest wall, a serious situation, so an MRI of the chest would be necessary before attempting surgery. Lumpectomy? Not an option. The large and aggressive cancer, its location, and the second tumor, prompted her to recommend a mastectomy. The large tumor indicated a minimum of stage 2. A tentative surgery date was put on the calendar.
Dr. M strongly suggested that we not concern ourselves with preparing for reconstructive surgery at this time… if ever. She didn’t want anything to get in the way of a clear assessment of my breast area and chest wall for the foreseeable future… My husband and I were already way beyond concerning ourselves with the cosmetics of it all, anyway.
Life over breast became the game plan.
Dr. M would forward the information to a highly-recommended oncologist who would meet with us several weeks after surgery. He would explain the post-surgery options of chemotherapy and radiation.
After giving us a breast cancer guide book on which she had written her home phone number — yes, her home phone number — she ended our session with another round of hugs. From Dr. M to Jennifer to the woman who handled our paperwork, we were pleasantly stunned by the very real human connection we felt with this group. Our cancer team was coming together, aiming for a win.
Triple-Negative Breast Cancer 101
About 10 to 20 percent of breast cancers are triple-negative. Having triple-negative breast cancer means the cells tested negative for hormone receptors and HER2 receptors. This cancer will not respond to hormonal therapies, including tamoxifen, Arimidex, Aromasin, Femara, and Faslodex, or to medications that target HER2, such as Herceptin or Tykerb. Triple-negative breast cancer can be treated with chemotherapy and radiation therapy.
Triple-negative breast cancer tends to be more aggressive than other types, and is more likely to spread beyond the breast and recur after treatment.
Five-year survival rates tend to be lower. A 2007 study of more than 50,000 women with all stages of breast cancer found that 77 percent of women with triple-negative breast cancer survived at least five years, versus 93 percent of women with other types. Another study of more than 1,600 women published in 2007 found that women with triple-negative breast cancer had a higher risk of death within five years of diagnosis, but not after that time period, based on averages for all women with triple-negative breast cancer, although the grade and stage of the breast cancer influence an individual woman’s prognosis.
Triple-negative breast cancer tends to be higher grade than other types. The higher the grade, the less the cancer cells resemble normal, healthy breast cells in their appearance and growth patterns. On a scale of one to three, triple-negative breast cancer often is grade three.
Living with Triple-Negative Breast Cancer Series
#1 The Lump in my Breast: Meeting the Enemy
#2 Most Breast Lumps are Non-Cancerous: Would Mine Be?
#3 The Mammogram, the Ultrasound, and ‘the Look’
#4 The Biopsy and Breast Cancer Confirmation
Access the up-to-date Living with Triple-Negative Breast Cancer Series
Author’s Note: This is article is part of a series chronicling my first-hand patient perspective of life with Triple-Negative Breast Cancer. Without being overly self-indulgent, I hope to convey the raw emotion that comes with such a diagnosis… and the process of living with and beyond it. Entries will appear in Care2 Causes and in Care2 Healthy & Green Living. Follow on Twitter @AnnPietrangelo