Triple Negative Breast Cancer: Myths and Realities
Triple Negative Breast Cancer (TNBC) is an aggressive form of breast cancer that typically affects younger women and carries a poorer prognosis than other subtypes. In a recent WebMD webinar, Kevin Kalinsky, MD, director of breast medical oncology at Emory University’s Winship Cancer Institute, answered viewers’ questions about TNBC and its treatments. Here are some key takeaways from his responses.
Stress and Cancer Development: What’s the Link?
There is no clear data about how stress affects cancer development or recurrence in any of the subtypes, including TNBC. However, there is some preclinical laboratory data about stress hormones and cancer risk that is being studied. Dr. Kalinsky advises that it is important to think about the impact of stress on general well-being and mindfulness. While there is some link between the mind-body connection and TNBC outcomes, there is no clear data on the links between stress hormones and the risk of recurrence, and whether that can help reduce the risk of the cancer coming back.
Systemic Therapy for TNBC
When people with TNBC are given systemic therapy, it is to lower the chance that the cancer will come back. This includes reducing the risk of metastatic recurrence of triple negative breast cancer (when the cancer has spread to other parts of the body). If people have a genetic predisposition, such as the BRCA gene, there may be a risk of other types of cancer as well.
Supplements During Chemotherapy
There is data showing that taking supplements during chemotherapy can lead to worse outcomes. There is interest in turmeric, but in general, it is important to talk to a doctor before taking any supplements. Taking supplements can be a case-by-case basis, and Dr. Kalinsky advises that people talk to their doctors before taking supplements during chemotherapy.
Nutrition and Exercise after Breast Cancer
There are ongoing studies looking at nutrition and exercise and if this can help with better outcomes, even in triple negative breast cancer. Dr. Kalinsky advises that it is always helpful to talk to a nutritionist even outside of breast cancer recurrence, just to have a healthy lifestyle. In general, everything should be in moderation.
Inequalities and Triple Negative Breast Cancer Outcomes
The social determinants of health are important factors when considering differences in outcomes between different communities. It is important to address issues of access to care, even when people have attention, to ensure that there is not a difference in their level of attention and care. There can also be differences in communities when it comes to the rate of mammograms, and attention should be paid to these differences to help improve health outcomes.
Additional Piece: Myths, Misconceptions and Realities of Triple Negative Breast Cancer
Triple-negative breast cancer (TNBC) accounts for about 10-20% of breast cancers globally, and is one of the most aggressive and difficult subtypes to treat. TNBC is negative for estrogen and progesterone receptors and does not have amplified levels of HER2 (human epidermal growth factor receptor 2) protein. There are several myths and misconceptions about TNBC that need to be dispelled to enable a better understanding of this subtype of breast cancer.
Myth: TNBC only occurs in young women.
Fact: While it is true that TNBC predominantly affects younger women, it can occur in people of all ages. In fact, TNBC is more common in African American and Hispanic women, and typically presents at a higher stage than other subtypes of breast cancer.
Myth: TNBC is always aggressive and incurable.
Fact: While TNBC is generally aggressive and associated with a poorer prognosis than other subtypes of breast cancer, it is not true that it is always incurable. Early detection, proper treatment and lifestyle changes can help improve outcomes for patients.
Myth: TNBC is caused by stress.
Fact: There is no clear data about how stress affects the development of TNBC or its recurrence. While there is some link between the mind-body connection and TNBC outcomes, it is important to manage stress for general well-being and mindfulness.
Myth: Complementary and alternative therapies can help cure TNBC.
Fact: There is no evidence that alternative therapies can cure TNBC. Some alternative therapies can interfere with standard treatments, leading to worse outcomes. It is important to talk to a doctor before using any complementing treatments during chemotherapy.
Myth: Triple-negative breast cancer is not a genetic disease.
Fact: While TNBC isn’t considered inherited, there are genetic mutations that contribute to increased chances of developing TNBC. Mutations in the BRCA1 and BRCA2 genes can increase the risk of TNBC as well as other cancers.
Bottom Line
TNBC is an aggressive subtype of breast cancer that affects people of all ages, and is more common in African American and Hispanic women compared to other subtypes. While there is no clear data about how stress affects the development of TNBC or its recurrence, lifestyle changes can help improve patient outcomes. Management of stress can help improve general well-being and mindfulness; it is always recommended to talk to a doctor before taking any supplements or alternative therapies. Understanding the realities of TNBC is essential to break the myths and misconceptions about this type of breast cancer.
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By Kevin Kalinsky, MD, director of breast medical oncology at Emory University’s Winship Cancer Institute, as told to Alexandra Benisek
On the WebMD webinar “Triple negative breast cancer: how we are learning to treat it more effectively,” Kevin Kalinsky, MD, director of breast medical oncology at Emory University’s Winship Cancer Institute, answered viewers’ questions about TNBC and its treatments.
We do not have clear data from any of the tumor subtypes on stress and how it affects cancer development. There is some preclinical data, that is, data in the laboratory, that is examined stress hormones and cancer risk coming back. But again, those are preclinical data. And that hasn’t necessarily translated into how we can care for people with TNBC.
When I talk to people about stress management, it’s important that we think about the impacts stress can have, period, on our general well-being and mindfulness.
There is data to suggest this link between the mind-body connection and the outcomes of someone with TNBC. However, there has been no clear data on the links between stress hormones and the risk of recurrence, and whether that can help reduce the risk of the cancer coming back.
When we treat people who have triple-negative breast cancer and give them systemic therapy, it’s to lower the chance that the cancer will come back. This includes reducing the risk of metastatic recurrence of triple negative breast cancer (when the cancer has spread to other parts of the body).
We think more about the risk of other cancers occurring if someone has a genetic predisposition like the BRCA gene. With BRCA, there is a risk of breast cancer, even with BRCA1 and the link to triple negative breast cancer and, for example, ovarian cancer.
So if people have a genetic predisposition, depending on what it is, there may be a risk of other types of cancer as well.
There is data looking at people who took supplements during chemotherapy. We saw that the more supplements people take, the worse their outcome. And it may be that these are interfering with some of the treatments that we are giving.
There has certainly been interest in turmeric. But I would say that in general, whenever you are taking supplements, be sure to talk to your doctor.
It all comes down to a case by case basis. For example, there was a study that looked at taking a supplement, L-carnitine, to see if it reduced the risk of neuropathy. In fact, we saw that the risk of neuropathy was increased.
This is the most common question we receive in breast cancer. There are ongoing studies looking at nutrition and exercise and if this can help with better outcomes, even in triple negative breast cancer.
We are waiting for the results to help us answer this question.
I would say it’s always helpful to talk to your nutritionist, even outside of breast cancer recurrence, just to have a healthy lifestyle. And I would say, in general, everything in moderation.
Yeah, This is an excellent question and something that is important that we continue to evaluate.
I think it’s been a consistent finding over the years, and it also emphasizes the importance of people, particularly young women who are non-Hispanic black — keep getting your screening mammogram and stay up to date with those images. Especially if they have a strong family history.
I don’t know if the inequalities are related to prevalence. But for differences in results, this is still an important question in terms of the social determinants of health.
That’s not just for triple-negative breast cancer, and not just for non-Hispanic blacks vs. non-Hispanic whites. Differences can also be seen between urban and rural communities.
This is an extremely important question in terms of access to care. And even when someone has attention, if there is a difference in their level of attention. We know that there can also be differences in communities when it comes to the rate of mammograms.
Watch an online replay of “Triple Negative Breast Cancer: How We’re Learning to Treat It More Effectively”.
see others free WebMD webinars by leading experts on a variety of health topics.
https://www.webmd.com/breast-cancer/features/cm/triple-negative-breast-cancer-qa-kevin-kalinsky?src=RSS_PUBLIC
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