Triple negative

Posted November 25th, 2008 by Jane

Breast cancer isn’t one disaese, its many, though no one who hasn’t got breast cancer is much interested in this fact.

There was a mass of publicity three years ago about the breast cancer drug herceptin, hailed, and rightly so, as a major breakthrough, so important that oncologists stood and cheered when the trial results were announced at one of the big US cancer conferences. Breast cancer cells have receptors on them which prompt the cancer to grow. A while back scientists discovered a growth factor called HER2 and herceptin is a drug tailored to stop her2 growing.

I think herceptin is probably the most major breakthrough in breast cancer treatment since tamoxifen. Most breast cancers are fuelled by the hormones oestrogen and progesterone and tamoxifen is a drug which stops the hormones stimulating the cancer. There’s another class of drugs too called aromatase inhibitors…arimidex and femara are two of the drugs..which do the same thing, sometimes better than tamoxifen.

Cancers which produce oestrogen and progesterone are called in the jargon. er+ and pr+. Cancers which have the her2 growth factor are her2+.

Women with breast cancer chat about their er, pr, and her2 status. Labelling is important in breastcancerworld.

About 15% of breast cancers are er-, pr- and her2-….that’s ‘triple negative’ . The term was barely used five years ago when I was first diagnosed but it has now entered breastcancerworld lexicon.

Younger women, black women and women who carry the known cancer genes (BRCA1 and BRCA2) are more likely to have triple negative breast cancer. Of course there are many exceptions. I’m white and was 54 at diagnosis and my cancer is triple negative.

Actually it’s more complicated than this. ‘Triple negative’ breast cancer is itself a shorthand for probably several different kinds of breast cancer which share the feature of not being fuelled by oestrogen, progesterone or her2. Some triple negative breast cancers are more aggressive than others, particularly basal type ones…my own (the indolent kind?) is likely not to be basal…or so the man at the Marsden said.

What is the same for all triple negative breast cancers is that there are no specifically designed targetted treatments. Tamoxifen is no good, arimidex is no good, herceptin is no good. The only treatments to try are surgery, radiotherapy and chemotherapy.

Research on triple negative breast cancer has been scanty..with a burst of interest in parts of the scientific community in the past 18 months. There are many reasons for this lack of interest, though I think one is that the white middle aged middle class breast cancer lobby (particularly in the States) has not until recently been much concerned in shouting about a kind of breast cancer more likely to affect African Americans. Those dying, and die quickly many do, of triple negative disaese have often been invisible.