Oncologists want women in their 30s and 40s to know about triple-negative breast cancer, Health News & Top Stories

Breast cancer is the most common cancer among Singaporean women and affects almost 30 percent of Singaporean women diagnosed with cancer. According to the World Health Organization, this year it has overtaken lung cancer to become the most common cancer in the world and the leading cause of death for women.

About 70% of all breast cancers are hormone-positive breast cancers, which means that the cancer cells contain either the estrogen receptor, the progesterone receptor, or both. They are commonly diagnosed among women in their 60s.

There is another type of cancer called Triple Negative Breast Cancer (TNBC). This is a more aggressive form of cancer that is more common in women in their 30s and 40s, said Dr. Khoo Kei Siong, Deputy Medical Director and Senior Consultant at the Parkway Cancer Center.

Other risk factors for breast cancer are:

• Race: African-American women are at greater risk
• Family history: Family history of breast cancer increases the risk of developing breast cancer
• weight: Obese people are at increased risk of developing breast cancer
• pregnancy: A woman who became pregnant for the first time after the age of 30
• Personal education: Women with cancer in one breast are three to four times more likely to develop cancer in the other breast or another part of the same breast

Approximately 10% to 15% of patients diagnosed with TNBC carry the BReast CAncer 1 (BRCA 1) gene mutation, which increases their risk of developing breast cancer.

Doctors may also measure the level of protein (called PD-L1) in cancer cells and the immune cells around them after a biopsy. PD-L1 is made by cancer cells. When it binds to the PD-1 receptor on immune cells, it loses the ability to recognize the bad properties of cancer cells and is unable to attack them. The presence of PD-L1 may help in choosing the right treatment for the patient.

Here are three things you need to know about TNBC:

1. TNBC is a more aggressive form of breast cancer

“Aggressive means that the cancer grows faster and grows faster. If surgery is done, there is a higher chance of recurrence. Patients will also have a shorter survival time,” said Dr. Khoo. Says.

In general, 5-year relative survival rates decline significantly at more advanced stages.

In comparison, hormone-positive breast cancer can be placed under control, and hormone therapy reduces the recurrence rate at all stages. Another type of advanced breast cancer, HER2, can also be managed with targeted drugs.

TNBC cells do not have estrogen and progesterone receptors (ER and PR), nor do they have human epidermal growth factor receptor 2 (HER2). The absence of these receptors, unlike hormone receptor-positive and HER2-positive counterparts, makes TNBC more difficult to cure than other breast cancer subtypes because it has no targets (ER, PR, HER2, etc.). Means. Therefore, chemotherapy remains the center of treatment.

Symptoms of TNBC are similar to those of other types of breast cancer. Common symptoms include lumps and swelling in the breast, pain in the breast and nipples, and nipple discharge.

2. TNBC has treatment options

Women who are currently diagnosed with TNBC may have better prospects than before.

Surgery is an important and essential part of treatment as long as the cancer is localized to the breast and the lymph nodes in the armpit (from stage 0 to part of stage 3). If affected, the tumor should be removed from the breast and the lymph nodes should be removed from the armpits. Stage 0 breast cancer refers to non-invasive breast cancer.

Chemotherapy may be given first before surgery to shrink a large tumor or after surgery to reduce the chance that the cancer will come back. Radiation therapy may also be an option, depending on the characteristics of the tumor.

“If the cancer spreads beyond these areas, surgery on the primary tumor may not make a big difference in the long run,” says Dr. Khoo. “When a patient is found to have stage 4 breast cancer (called metastatic cancer, which has spread beyond the breast), we are no longer in a hurry to have surgery.” This is known as stage 4 TNBC. It is more likely to spread to internal organs such as the lungs, liver and kidneys.

“TNBC is an invasive disease, but there are now better treatments that can provide patients with the potential to control cancer.”

Chemotherapy has been the traditional method for treating TNBC, especially in metastatic cases. The TNBC tumor has responded to chemotherapy, but the cancer may come back.

Over the last 5-8 years, immunotherapy in the form of PD-1 and PD-L1 inhibitors has been shown to be an effective treatment for many cancers, including lung, kidney and melanoma. increase. However, among different types of breast cancer, immunotherapy has so far been shown to be effective only in TNBC. Immunotherapy, used in combination with chemotherapy, may help improve the response to treatment. This combination can help keep cancer away for nearly 10 months. With chemotherapy alone, regrowth can occur after 6 months.

Patients whose tumors express PD-L1 are eligible for this option. The higher the proportion of immune cells and cancer cells found to have PD-L1, the more likely the reaction is and the better the patient’s outcome. Therefore, high levels of PD-L1 indicate to the doctor that the patient is more likely to respond well to immunotherapy and has better results for the patient.

In addition, patients with mutated BRCA1 or BRCA2 genes respond well to a class of drugs known as PARP inhibitors. In some selected cases, this means a much better quality of life and a longer chance of survival, “says Dr. Kuu. Another option to consider is the antibody drug conjugate (ADC).

Advances in innovative treatments have allowed many to lead a relatively normal life, and he has seen some patients return to work as well.

As treatment with TNBC progresses, Dr. Kuu is “carefully optimistic” and believes that there may be better treatment options for patients. However, he emphasizes that early detection of cancer is still the best treatment.

3. The importance of healthy living and early detection

Although cancer cannot be prevented, some habits, such as maintaining a healthy weight, maintaining physical activity, eating fruits and vegetables, and limiting alcohol intake, can help reduce risk.

Many women with breast cancer may not show symptoms until the early stages of stage 4. Therefore, Dr. Kuu recommends that women take regular mammograms every year when they reach the age of 40, and women over the age of 50 take mammograms every two years. Follow the recommendations of the Health Promotion Committee (HPB). Screening is the key to early detection because mammograms are x-rays that allow qualified professionals to examine suspicious areas of breast tissue and can detect tumors before they are felt.

Mammograms are not recommended for children under the age of 40. However, we recommend that you do a breast self-examination at least once a month. It is very important to establish regular breast self-examinations, as 40% of diagnosed breast cancers are detected by women who feel lumps.

Early detection also helps detect cancer early before it spreads to other organs.

Dr. Kuu advises: “No matter how effective the treatment is, the earlier you diagnose it, the more likely you are to get rid of it. Be aware of the symptoms of breast cancer and seek treatment early. Go to screening. , Find it on stage 0. “

Many women with breast cancer are asymptomatic. This is why regular breast self-examination and breast cancer screening are important for early detection.

Talk to your healthcare provider for more information.