Black Women and Triple Negative Breast Cancer

Triple Negative Breast Cancer is rare, aggressive and difficult to treat version of breast cancer.

15 percent of the estimated 180,000 women who will learned that they have invasive breast cancer this year in the United States will also have triple negative. The majority of triple negative patients will be young African-American women.

Triple negative cancers do tend to be aggressive in their natural histories, so they have a very high rate of recurrence or relapsing. They usually recurred and spread to the liver, lungs and chest wall.

Several breast cancer experts around the country are trying to learn more about what causes triple negative and how to treat it more effectively.

Dr. Funmi Olopade, a professor of medicine at the University of Chicago, is at the forefront of identifying triple negative and the trend among African-American women. She says what makes it different from other types of breast cancer is that women with the disease lack three hormone receptors known to fuel most breast cancer tumors: estrogen, progesterone and HER2.

“When you have triple negative, it means that we cannot use hormone therapy. … The only way we can treat that type of breast cancer is to use chemotherapy,” Dr. Olopade said.

Tamoxifen and Herceptin, two of the most effective medications for treating breast cancer, don’t work for triple negative breast cancer patients.

But if a patient responds well to chemotherapy, Olopade said, there’s a very good chance of curing the disease.

“The challenge we have is when the cancer comes back,” she added. “Right now, we don’t have any effective way to treat it, and that’s why when it comes back, it tends to be deadly.” Dr. Olopade is hoping better drugs will be available in the next two to five years that will help eradicate triple negative cancer cells.

In the meantime, she stressed, early detection is the key to recovery, especially for women at highest risk.

“In this country, what we have found was young African-American women have a rate that is higher than young white women, and we don’t know if that is because of a gene or other risk factors,” Dr. Olopade said.

“We know that women with a family history of breast cancer who have a BRCA1 mutation are most at risk,” she said.

BRCA1 is a major breast cancer-causing gene that was identified 14 years ago. Dr. Olopade said women born with the defective gene have a higher chance of getting breast cancer and at a younger age.

Olopade also wants to explore further whether triple negative rates are higher among women who do not breastfeed their children. “It’s that first pregnancy and first breastfeeding that really allows the breast to become fully mature,” she said.

She worried that in general, “African-Americans are not likely to breastfeed, as they are getting in the work force and returning to work soon after childbirth.”

Even with several clues, Dr. Olopade acknowledged that researchers still don’t know a lot about triple negative breast cancer and more study is needed.

She encouraged all young women, no matter what their race, to talk to their doctor about doing a risk assessment for the BRCA1 gene. If there is a family history of the gene mutation, some physicians may tell a woman not wait until she turns 40 to get her first mammogram.

“We begin screening as early at 25,” Dr. Olopade said. “Many of the women are surviving. They are beating the odds of dying because they know they can do preventive approaches to reduce their risk of dying.”

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