Health awareness

Triple-negative breast cancer: risks, signs and symptoms, and diagnosis

Learn about this aggressive type of breast cancer, including risk factors, signs and symptoms

October 12, 2023

Breast cancer is the most commonly diagnosed cancer in the world. There are many different types and subtypes of breast cancer that are defined by where in the breast they begin, how much they have grown or spread and how they behave. One of the more aggressive types is triple-negative breast cancer (TNBC).

What’s triple-negative breast cancer?

The tumors of patients with breast cancer may be tested for three receptors, or proteins, that make cancer grow. If the tumor tests negative for estrogen and progesterone receptors and does not over express HER2, then that patient is diagnosed with TNBC.

Worldwide, there were more than 2.3 million patients diagnosed with breast cancer in 2020:

~10-15%

of people with breast cancer are diagnosed with TNBC

TNBC characteristically has a high recurrence rate within the first five years after diagnosis.

Who’s at risk for triple-negative breast cancer?

Primary risk factors for TNBC include:

Sex: People assigned female at birth are at higher risk for TNBC compared to people assigned male at birth.
Race /ethnicity: Non-Hispanic Black women are nearly two times as likely to have TNBC as non-Hispanic white women.
Age: TNBC is more common in women younger than 40.
Genetic mutations: Mutations in genes such as BRCA1 and BRCA2 are strongly associated with TNBC.

What are the signs and symptoms of breast cancer?

TNBC can have the same signs and symptoms as other common types of breast cancer.

Most breast cancers are detected before any symptoms appear through regular breast cancer screenings. The signs and symptoms of breast cancer differ from person to person, and some will never show symptoms.

However, some signs of breast cancer to watch out for include:

Swelling of all or part of a breast
Skin dimpling
Breast or nipple pain
Nipple retraction
Nipple or breast skin that’s red, dry, flaking or thickened
Nipple discharge
Swollen lymph nodes, under the arm or near the collar bone

How is triple-negative breast cancer diagnosed?

If you’re experiencing symptoms, speak with your doctor, especially if you have a higher risk of having TNBC. Some screening tests include:

Mammogram: An X-ray of the breast that allows doctors to look for changes in breast tissue. Mammograms can often find breast cancer early when it’s easiest to treat.
Magnetic resonance imaging (MRI): An MRI uses radio waves and strong magnets to make detailed pictures of the inside of the breast. Doctors use MRIs along with mammograms to screen people who are considered at high risk for breast cancer.
Ultrasound: An ultrasound uses sound waves and their echoes to make computer pictures of the inside of the breast. While not typically used as a routine screening test for breast cancer, an ultrasound can be useful for looking at some breast changes such as lumps – especially when they can be felt but not seen on a mammogram.
Biopsy: After a breast cancer diagnosis is made with a biopsy, a health care provider may determine whether a patient has TNBC with an assessment of cells from that biopsy, which are checked for estrogen, progesterone and HER2 receptors, to determine the cancer subtype.

How is triple-negative breast cancer staged?

Doctors use five stages to classify triple-negative breast cancer and inform next steps in your care plan:

Stage 0

Cancers diagnosed at stage 0 are confined to the milk ducts or lobules of the breast.

Stage 1

Cancers diagnosed at stage 1 are small, localized and have not spread beyond one nearby lymph node. Stage 1 TNBC is still considered early stage, so 91% of people diagnosed with this stage of cancer are alive five years after their diagnosis. Stage 1 cancer can be classified as either stage 1A or stage 1B dependent on the size of the tumor and whether there is evidence of cancer on the nearby lymph nodes.

Stage 2

Stage 2 TNBC may have spread regionally (beyond the initial site), but not beyond the lymph nodes in the underarm area. Stage 2 cancer can be classified as either stage 2A or stage 2B dependent on the size of the tumor and whether the breast cancer has spread to the lymph nodes. For patients whose cancer has spread to regional lymph nodes, 66% of people diagnosed are still alive five years after their diagnosis.

Stage 3

Stage 3 TNBC has extended beyond the immediate region of the tumor and may have invaded nearby lymph nodes and muscles but has not spread to distant organs. At this stage, TNBC can be classified as stage 3A, 3B or 3C, depending on the size of the tumor and how far it has spread. Stage 3 TNBC is considered to have spread regionally, and 66% of patients who are diagnosed at this stage are still alive five years after diagnosis.

Stage 4

Stage 4 TNBC, also known as metastatic breast cancer, has spread distantly to other areas or organs of the body, such as the brain, bones, lung or liver. This stage is not curable but is usually treatable, and current advances in research and medical technology mean that more people are living longer by managing the disease as a chronic illness. Twelve percent of patients diagnosed at this stage survive five years post-diagnosis.