Lumpectomy for Early-Stage Triple-Negative Disease Doesn’t Seem to Increase Risk of Breast Cancer Coming Back in Same Breast

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Triple-negative breast cancer is:

  • estrogen-receptor-negative
  • progesterone-receptor-negative
  • HER2-negative

The hormones estrogen and progesterone don’t fuel the growth of triple-negative breast cancers. Triple-negative disease also doesn’t have an abnormally high level of HER2 receptors. This means that triple-negative breast cancer doesn’t respond to hormonal therapy (such as tamoxifen or the aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin (chemical name: trastuzumab), Tykerb (chemical name: lapatinib), or Perjeta (chemical name: pertuzumab).

About 10-20% of breast cancers – more than one out of every 10 – are triple-negative. Triple-negative breast cancer tends to be more aggressive than other types of breast cancer.

Because triple-negative disease is considered more aggressive than breast cancers that are HER2-positive or hormone-receptor-positive, many doctors believe that it should be removed with mastectomy rather than lumpectomy followed by radiation to reduce the risk of recurrence and improve survival chances. Still, not much research has been done on the type of surgery that’s best for early-stage, triple-negative breast cancer, so no standard recommendations have been developed.

To help women and their doctors make the best decisions about surgery for early-stage, triple-negative breast cancer, researchers decided to see if there were any differences in the risk of recurrence for women who had lumpectomy and radiation and women who had mastectomy.

The research was published in the March 2014 issue of JAMA Surgery. Read the abstract of “Breast-Conserving Therapy for Triple-Negative Breast Cancer.”

The researchers reviewed the records of 1,851 women diagnosed with breast cancer who had lumpectomy at the Cedars-Sinai Medical Center in Los Angeles from January 2000 to May 2012. Women who received chemotherapy before breast cancer surgery were not included in the study.

Of the 1,851 women:

  • 234 (12.6%) were diagnosed with triple-negative breast cancer
  • 1,341 (72.4%) were diagnosed with hormone-receptor-positive, HER2-negative breast cancer (also called luminal A breast cancer)
  • 212 (11.5%) were diagnosed with hormone-receptor-positive, HER2-positive breast cancer (also called luminal B breast cancer)
  • 64 (3.5%) were diagnosed with hormone-receptor-negative, HER2-positive breast cancer (also called HER2 over-expressing breast cancer)

Almost all of the women had stage I or stage II disease:

  • 60.6% of the women were diagnosed with stage I disease
  • 34.6% of the women were diagnosed with stage II disease
  • 4.8% of the women were diagnosed with stage III disease

Women who were diagnosed with triple-negative breast cancer were more likely to:

  • be younger
  • have larger cancers at diagnosis
  • be diagnosed with stage II or stage III cancers

About half the women got chemotherapy after lumpectomy and 91% of the women got radiation after lumpectomy. Women who were diagnosed with triple-negative breast cancer were more likely to get chemotherapy after lumpectomy.

There were 47 local recurrences, which means the breast cancer came back (recurred) in the same breast in the same place or very close to the original cancer, including:

  • 11 women diagnosed with triple-negative breast cancer (4.7% of women with that diagnosis)
  • 8 women diagnosed with HER2-positive, hormone-receptor-negative breast cancer (12.5% of women with that diagnosis)
  • 23 women diagnosed with hormone-receptor-positive, HER2-negative breast cancer (1.7% of women with that diagnosis)
  • 4 women diagnosed with hormone-receptor-positive, HER2-positive breast cancer (1.9% of women with that diagnosis)

There were 21 regional recurrences, which means the breast cancer came back in the lymph nodes next to the breast, including:

  • 3 women diagnosed with triple-negative breast cancer (1.3% of women with that diagnosis)
  • 4 women diagnosed with HER2-positive, hormone-receptor-negative breast cancer (6.3% of women with that diagnosis)
  • 9 women diagnosed with hormone-receptor-positive, HER2-negative breast cancer (0.7% of women with that diagnosis)
  • 5 women diagnosed with hormone-receptor-positive, HER2-positive breast cancer (2.4% of women with that diagnosis)

Distant/metastatic recurrence – the cancer coming back someplace in the body away from the breast, such as the liver or bones – was the most common type of recurrence; 66 women had this type of recurrence, including:

  • 21 women diagnosed with triple-negative breast cancer (9% of women with this diagnosis)
  • 5 women diagnosed with HER2-positive, hormone-receptor-negative breast cancer (7.8% of women with this diagnosis)
  • 31 women diagnosed with hormone-receptor-positive, HER2-negative breast cancer (2.3% of women with this diagnosis)
  • 9 women diagnosed with hormone-receptor-positive, HER2-positive breast cancer (4.2% of women with this diagnosis)

The researchers found that compared to breast cancers that are hormone-receptor-positive and HER2-negative or breast cancers that are hormone-receptor-positive and HER2-positive, triple-negative breast cancers are linked to worse survival and a higher risk of distant recurrence. These results are consistent with results from a number of other studies.

Still, this study also found that women diagnosed with triple-negative breast cancer who have lumpectomy and radiation don’t have a higher risk of local recurrence.

This is good to know. Many women and their doctors may automatically choose mastectomy for triple-negative disease because this type of breast cancer is more aggressive. It’s reassuring to know that women who may prefer to have lumpectomy can make that choice without increasing the risk of local recurrence.

If you’ve been diagnosed with triple-negative breast cancer and are planning your surgery, talk to your doctor about all your options. You and your doctor will consider a number of factors when deciding on the type of surgery that’s best for you, including:

  • the characteristics of the cancer
  • your age
  • any other health problems you have
  • your medical history
  • your preferences
  • the results of any genetic testing you may have had

Together, you and your doctor will come up with a surgical plan that makes the most sense for you and your unique situation.



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