Triple-Neg Breast Cancer Stirs Screening Debate

By Diane Loupe

WeNews correspondent

Tuesday, June 22, 2010

Doctors debate the screening implications of triple-negative breast cancer, a particularly deadly form of breast cancer that strikes earlier, produces larger tumors, resists common treatment and is prevalent among women of West African descent.

Breast cancer awareness event in New Jersey. (WOMENSENEWS)--After Laurie Stewart's boss died of breast cancer five years ago, she and five other women at the funeral each vowed to do what they could to prevent the disease.

That night, Stewart--who has asked that her first name be changed--found a lump in her breast.

A week later, she learned that she had a particularly nasty type of breast cancer. Hers was "triple negative," meaning it's not traced to any of three common culprits: estrogen, progesterone or human epidermal growth factor receptor 2 (HER2).

Among black women in the United States with breast cancer, the incidence of triple-negative breast cancer is higher and the disease strikes at even earlier ages, spurring some doctors to urge earlier breast cancer screenings. In particular, women of West African descent are more likely to develop triple-negative breast cancer at younger ages with larger tumors.

The median age at diagnosis for triple-negative breast cancer is 53, compared with 58 for other types of cancer, said Dr. Lisa A. Newman, professor of surgery and director of the Breast Care Center at the University of Michigan in Ann Arbor.

At the time she was diagnosed, Stewart said very little was known about the disease and for many it was basically a death sentence. "Just pack your bags, because you're going quick, sister," she said.

Luck was with her, as last November Stewart finished radiation treatment and early this year she got a clean bill of health from her oncologist.

"As far as I know, I'm okay," said Stewart, who is active in online discussion groups sponsored by the Triple Negative Breast Cancer Foundation, based in Norwood, N.J. A central figure on the foundation's board is Malaak Compton-Rock, the model and spouse of comedian Chris Rock and a Women's eNews 21 Leader 2009.

Stewart joins an estimated 30,000 women each year who are diagnosed with this form of breast cancer, according to experts.

Understanding Somewhat Limited

Doctors have considered triple-negative breast cancer as a separate subtype for approximately the last decade, said Kathryn J. Ruddy, an oncologist at the Dana-Farber Cancer Institute in Boston.

"Our understanding of the underlying biology of triple-negative disease is somewhat more limited, and some of our triple-negative breast cancer treatments are less well tested," said Ruddy, who is also an instructor at Harvard Medical School.

"Most of us know the words breast cancer, but it's not until the doctor hands us the first pathology report that we hear about triple-negative breast cancer," said Stewart, a kitchen designer in eastern Washington state. "What does this mean?"

One thing it means is a higher rate of mortality.

While most breast cancers develop from the milk ducts, which are lined with epithelial cells, triple-negative cancers seem to arise from basal cells, which lie under the epithelial cells. Basal-cell cancers appear to be more aggressive.

Although only 10 to 20 percent of all breast cancer cases are diagnosed as triple negative, they account for as many as 25 percent of all breast cancer deaths, according to a variety of studies, including one published in 2009 in the Journal of the National Cancer Institute.

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