Understanding Triple-Negative Breast Cancer
- Joan Lunden, who beat triple-negative breast cancer 10 years ago, is commemorating Breast Cancer Awareness month by spreading awareness on the importance of mammograms, dense breasts, and being your own advocate. She spoke with news reporter and three-time cancer survivor Stacey Sager in a recent interview about how having an ultrasound, while writing a story on mammograms in 2014, saved her life.
- “Triple-negative” means the cancer is not fueled by any of the three main types of receptors: estrogen, progesterone, or the HER2 protein. Because of this, the cancer won’t respond to certain common therapies.
- In addition to surgery and radiation, chemotherapy is a mainstay of treatment for early-stage triple-negative breast cancer. Different chemotherapy combinations may be used to treat this aggressive form of cancer.
- In some cases, immunotherapy — which harnesses the body’s immune system to recognize and attack cancer cells — will be used for triple-negative breast cancer.
- Additionally, the Food and Drug Administration (FDA) now requires mammogram reports to include a section that informs women about their breast density, like Lunden has.
In honor of Breast Cancer Awareness month, the 74-year-old, who previously worked as a co-host of ABC’s Good Morning America for 17 years, spoke with fellow news reporter and three-time cancer survivor Stacey Sager about new mammogram regulations in the U.S., along with dense breasts and what that means for cancer risk.
Read MoreLooking back on her 2014 diagnosis, Lunden told WABC 7’s Stacey Sager in a recent interview, “Well, triple negative is extremely fast-growing and aggressive. I might not be sitting here talking to you if I hadn’t had that ultrasound that day.View this post on Instagram
“I had a clean 3D mammogram. I wouldn’t have even known to ask for that ultrasound, had I not just happened to have been sent on that story.”
Lunden credits working on a story with a doctor about mammograms as what led her to her diagnosis. Since then she’s worked hard to spread awareness and lobby for other women with dense breasts.
Having dense breasts means Lunden has more fibroglandular tissue and less fatty breast tissue. During mammograms, the tissue difference can make locating signs of cancer more difficult in women with dense breasts.
Since September 2024, the Food and Drug Administration (FDA) is requiring women undergoing mammograms, which screen for breast cancer, to be notified of their breast density.
Lunden urged for anyone hearing her story, “If you don’t know, call your radiology lab, and say, ‘what is my breast density?'”
Sager shared some behind-the-scenes photos of the interview on her Instagram page, with the caption reading, “Talking to one of the greatest advocates around.
“Joan Lunden is 10 years out from triple negative breast cancer now, and her story still resonates. So grateful for her message to women with dense breasts, and for the knowledge gained after interviewing doctors at @basserbrca and @mountsinainyc for our coverage.”
Lunden also took to her social media to share the news of her recent interview, as well as a photo of her bald head amid cancer treatment.
She captioned the post, “I took this picture on Oct 1 2014 – first day of Breast Cancer Awareness Month. I was half way through my year long cancer battle.
“As a survivor, I became an advocate for others battling cancer and today at 10am I join WABC 7’s Stacey Sager to discuss the new regulations for mandatory mammogram reporting for women everywhere. #breast #cancer #breastcancerawareness.”
WATCH: Joan Lunden Throws It All Out There
Joan Lunden’s Breast Cancer Journey
In 2014, Lunden was diagnosed with stage 2 triple-negative breast cancer, which means Lunden’s cancer was not being fueled by any of the three main types of receptors: estrogen, progesterone, or the HER2 protein.
Since triple-negative breast cancer is constantly unresponsive to certain targeted therapies, including hormone therapy or HER2-targeted agents like Herceptin, chemotherapy is typically the treatment and there are several options.
“Any triple-negative cancer that’s over half a centimeter or has lymph node involvement needs chemotherapy,” Dr. Julie Nangia, medical oncologist at Baylor College of Medicine said.
Triple-negative breast cancer is an aggressive form of the disease and if the cancer is advanced, your doctor may also recommend participation in a clinical trial that involves immunotherapy or targeted therapies.
“She went through chemo and if I couldn’t be at a session, Joan’s girls would be there. It’s all about the support, it’s about the family, it’s about the community, it’s about loved ones,” her supportive husband Jeff Konigsberg previously said, while detailing Lunden’s breast cancer treatment.
Meanwhile, in an earlier interview with SurvivorNet, Lunden shared that she knew little about breast cancer before she was diagnosed with it.
WATCH: Joan Lunden Ages With Candor
“Candidly,” Lunden said. “I never thought I would be one of the women who would get breast cancer.”
“The fact that I didn’t understand the significance of dense breast tissue kind of just lit a fire in me and sent me on this mission to say, ‘Here I am a journalist, and how could I have been so uneducated about something so incredibly important,” she explained.
WATCH: Joan Lunden Helps Best-selling author Laura Mortons Through Cancer
Understanding Triple-Negative Breast Cancer
Triple-negative breast cancer is one of the most aggressive forms of the disease and makes up for approximately 20 percent of all breast cancers. The treatment approach varies from patient to patient and may include a combination of different treatments.
Early-stage triple-negative breast cancer (TNBC) treatments may use a combination of chemotherapy drugs.
Understanding Triple Negative Breast Cancer
For example, a CMF regimen is an abbreviation for combining chemotherapy drugs cyclophosphamide, methotrexate, and fluorouracil. AC stands for doxorubicin (Adriamycin) with cyclophosphamide, and ACT just indicates that a taxane drug is added to the regimen. Likewise, TC is an abbreviation for a regimen of Taxotere and cyclophosphamide.
RELATED: In Triple Negative Breast Cancer, New Drug Trodelvy Extends Life
In 2021, the FDA approved the immunotherapy drug pembrolizumab for the treatment of early-stage triple-negative breast cancer (TNBC). Pembrolizumab (Keytruda) is already used to treat other cancers, including melanoma and non-small cell lung cancer. Doctors heralded the FDA’s approval of pembrolizumab as a potentially paradigm-shifting advancement in breast cancer treatment.
Expert Resources On Triple-Negative Breast Cancer
- ‘It’s A Game Changer’: FDA Approves Keytruda, Chemo Combo To Treat Aggressive Triple-Negative Breast Cancer
- Chemo Plus Immunotherapy for Metastatic Triple-Negative Breast Cancer
- More Than 80% of Women With Early-Stage Triple-Negative Breast Cancer Experienced a Prolonged Event-Free Survival With Keytruda Plus Chemotherapy Regimen
- New Study Identifies Genes Linked to Increased Risk for Triple-Negative Breast Cancer
- Metastatic Triple-Negative Breast Cancer Treatments To Consider
- Treating Early Stage Triple-Negative Breast Cancer
- Chemo for Triple Negative Breast Cancer
For patients with stage 2 or 3 TNBC, adding the immune-boosting medication pembrolizumab to combination chemotherapy before surgery increases chances of living free of breast cancer, explains oncologist Dr. Sylvia Adams, director of the Breast Cancer Center at NYU Langone’s Perlmutter Cancer Center.
She was one of several researchers involved with the pembrolizumab trials. “It changes the standard of care and should be discussed with all patients diagnosed with stage 2-3 TNBC,” she adds. “Yes, it’s a game-changer, though there is much more to be learned.”
The First Immunotherapy Approved For Breast Cancer Hope For Triple Negative Breast Cancer
Until recently, researchers hadn’t had much success using the therapy to fight breast cancer. That’s changing now. The IMpassion130 trial showed for the first time that a combination of immunotherapy and chemotherapy had a significant effect in treating metastatic triple negative breast cancer. Triple negative breast cancer is an extremely aggressive form of the disease, so this discovery is important.
Dr. Sylvia Adams explains, “The question now becomes, is it only triple negative breast cancer that can benefit from immunotherapy, or are there other subtypes as well?
“If a tumor has the PD-L1 protein in it, that means there’s already an inflammatory response, that the patient’s immune system already recognized the tumor and was starting to work against it. The benefit of identifying such a strong biomarker in the triple negative subset will allow us to actually test for the presence and responsiveness to immunotherapy in other subtypes of breast cancer.”
Is Your Cancer Really Triple-Negative?
Dr. Heather McArthur, Clinical Director of the Breast Cancer Program at Simmons Cancer Center at UT Southwestern Medical Center, has spoken with SurvivorNet on this relevant topic.
You might be told you have triple-negative breast cancer, that means that your cancer is not being fueled by any of the three main types of receptors: estrogen, progesterone nor the HER2 protein. But now you could be categorized as HER2 low instead of HER2 negative.
Breast cancer cells with higher-than-normal levels of HER2 are called HER2-positive, those with low levels of HER2 are (or were) called HER2 negative. Recently, however, researchers have looked to further expand this definition to include patients that have a minimal amount of HER2 expression but do not meet the classic definition for HER2-positive tumors. This group has been called HER2 “low” and is very important as it represents almost 50% of all patients with breast cancer.
This excitement stems from the fact that HER2-low breast cancers are targetable with a recently new FDA-approved Enhertu (Fam-trastuzumab deruxtecan-nxki). It appears that Enhertu is extremely effective for appropriate patients and can greatly improve their quality of life and help them live longer.
Therefore, it is exceedingly important to discuss with your physician about your HER2 status.
Treatment for Early-Stage Triple Negative Breast Cancer
Enhanced Screening for Dense Breasts
Women with dense breasts may not know they have it based on feeling alone. Breast density is determined by its appearance on a mammogram. Dr. Connie Lehman, the chief of the Breast Imaging Division at Massachusetts General Hospital, explains to SurvivorNet that fatty breast tissue appears gray on an X-ray. Conversely, dense breast structures appear white during an X-ray. Cancers also appear white on an X-ray, meaning the dense breast structures can mask the possibility of cancer. Luckily, advanced mammograms exist to help doctors navigate this obstacle.
WATCH: 3D Mammograms explained.
“Digital mammography, it turns out, significantly improves the quality of the mammogram…It’s 3D or tomosynthesis mammography,” Dr. Lehman explains.
“This allows us to find more cancers and to significantly reduce our false-positive rate. With digital mammography 3D tomosynthesis, we’re taking thin slices through that breast tissue, like slices of a loaf of bread. We can look at each slice independently rather than trying to see through the entire thickness of the entire loaf of bread. So those thin slices help us find things that were hidden in all the multiple layers,” Dr. Lehman adds.
Additional testing can be considered for dense breasts, depending on a woman’s personal history, preferences, and her physician’s guidance. These tests include:
- 3-D Mammogram (Breast Tomosynthesis): This technology acquires breast imaging from multiple angles and digitally combines them into a 3D representation of the breast tissue. This allows physicians to see breast tissue architecture better, even in dense breasts. 3D mammograms are fast becoming the standard way of performing mammography.
- Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnets to create highly detailed, intricate images of the breast. These are mostly reserved for women with an extremely high breast cancer risk. Dense breasts alone may not be a valid reason to obtain a breast MRI. However, dense breasts in women with genetic mutations, like BRCA1 and BRCA2, or a strong family history of breast cancer could justify obtaining breast MRIs.
- Molecular Breast Imaging (MBI): MBI is a newer imaging technique that uses a radioactive tracer to detect breast cancer. It is beneficial for women with dense breasts. However, MBI is not as widely available as other screening methods.
A new rule from the Food and Drug Administration (FDA) says that facilities offering mammograms must notify patients about their breast tissue density and recommend they speak with a doctor to determine if further screening is necessary. There will be “uniform guidance” on what language to use and what details to share with the patient to make the communication clear and understandable.
Contributing: SurvivorNet Staff
Learn more about SurvivorNet's rigorous medical review process.
