Triple Negative Breast Cancer
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What is triple negative breast cancer (TNBC)?
Triple negative breast cancer (TNBC) is:
- Estrogen receptor-negative (ER-negative)
- Progesterone receptor-negative (PR-negative)
- HER2-negative
Most triple negative tumors are basal-like (see figure below). Basal-like tumors have cells that look similar to those of the outer (basal) cells surrounding the mammary ducts.
Triple negative/basal-like tumors are a molecular subtype of breast cancer.
How common is TNBC?
About 15-20 percent of all breast cancers are TNBC or basal-like tumors [46-48,52-54].
TNBC tends to occur more often in [51-55,59-61,114]:
- Younger women
- People with an BRCA1 inherited gene mutation (if you’re diagnosed with TNBC at age 60 or younger, the National Comprehensive Cancer Network recommends you get genetic testing)
- Black, non-Hispanic Black and African American women (more on race/ethnicity and subtypes of breast cancer)
TNBC may also be more common among Hispanic women compared to non-Hispanic white women [54,57-58].
BRCA1 inherited gene mutations and TNBC
Most breast cancers related to a BRCA1 inherited gene mutation are both triple negative and basal-like [59-61].
The National Comprehensive Cancer Network recommends people diagnosed with TNBC at age 60 or younger get genetic testing [66].
Learn more about genetic testing.
TNBC and breast cancer recurrence
TNBC is often aggressive.
Early TNBC is more likely than early ER-positive breast cancer to recur, at least within the first 5 years after diagnosis [46,50,53].
After about 5 years, this difference begins to decrease and over time, goes away [46,50,53].
Treatment of early TNBC
Early TNBC is aggressive, but it can be treated effectively. It’s usually treated with some combination of surgery, radiation therapy, chemotherapy and immunotherapy.
TNBC isn’t treated with hormone therapy or HER2-targeted therapy because it’s ER-negative and HER2-negative.
Learn about emerging areas in drug therapies for early breast cancer.
Chemotherapy for early TNBC
Early TNBC is treated with chemotherapy. People with TNBC tend to get more treatment benefit from chemotherapy than people with hormone receptor-positive breast cancers do [53].
Some people get chemotherapy before breast surgery. This is called neoadjuvant chemotherapy.
For people with TNBC who have cancer remaining in their breast after neoadjuvant chemotherapy, treatment with the chemotherapy drug capecitabine may lower the risk of recurrence and improve survival [14,67].
Learn more about chemotherapy.
Immunotherapy for early TNBC
Pembrolizumab (Keytruda) is an immunotherapy drug used to treat early TNBC at high risk of recurrence. It’s given before surgery, as part of neoadjuvant therapy.
Learn more about pembrolizumab in the treatment of early TNBC.
Treatment of metastatic TNBC
Treatment for metastatic TNBC includes chemotherapy. It may also include other drug therapies.
TNBC isn’t treated with hormone therapy or HER2-targeted therapy because it’s ER-negative and HER2-negative.
Learn about chemotherapy in the treatment of metastatic breast cancer.
Learn about emerging areas in the treatment of metastatic breast cancer.
Immunotherapy for metastatic TNBC
The immunotherapy drug pembrolizumab (Keytruda) is used to treat some metastatic TNBC.
Learn more about pembrolizumab in the treatment of metastatic TNBC.
Trop-2 antibody-drug conjugates for metastatic TNBC
Sacituzumab govitecan (Trodelvy) is a Trop-2 antibody-drug conjugate used to treat metastatic TNBC.
Learn about sacituzumab govitecan in the treatment of metastatic breast cancer.
Clinical trials for people with TNBC
Clinical trials are studying treatment for early and metastatic TNBC.
After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.
Susan G. Komen® Breast Care Helpline |
If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org. Se habla español. |
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service to help find clinical trials for people with early TNBC and clinical trials for people with metastatic TNBC.
Learn more about clinical trials.
Learn more about what Komen is doing to help people with breast cancer find and participate in clinical trials.
Race, ethnicity and TNBC
Read our blog, Inequities in Care and Treatment of Triple Negative Breast Cancer.
Prevalence
Prevalence shows the proportion of people who have a breast cancer (or other health condition) at a given point in time. The prevalence of TNBC differs by race and ethnicity.
Triple negative tumors appear to be more common among non-Hispanic Black and African American women (especially before menopause) compared to women of other ethnicities [51-55,114].
For example, from 2014-2018 (most recent data available), about 23 Black women per 100,000 women were diagnosed with TNBC compared to about 12 white women per 100,000 women [68].
TNBC may also be more common among Hispanic women compared to non-Hispanic white women [54,57-58].
However, most cases of TNBC cases are in white women. This is because the total number of white women diagnosed with breast cancer is much higher than the total number of women of other races and ethnicities diagnosed with breast cancer.
Learn more about numbers versus rates when looking at breast cancer statistics.
Risk factors
Although the reasons for racial and ethnic differences in rates of TNBC are not clear, some lifestyle factors may play a role [58-61].
Compared to white and non-Hispanic white women, Black and African American women tend to have lower rates of breastfeeding and tend to carry excess weight in the abdomen area [63,69-73]. Each of these factors may increase the chances of getting TNBC [53,69-73].
Certain reproductive and lifestyle factors may be linked to a lower risk of ER-positive breast cancers, but not ER-negative breast cancers, including TNBC.
For example, non-Hispanic Black, African American, Hispanic and Latina women are more likely than white women to [58,63,70-74]:
- Have more children
- Have a younger age at first birth
- Be overweight or obese (before menopause)
Although these factors are linked to a lower risk of breast cancer overall, this benefit may be limited to ER-positive breast cancers [58,69,70-71,75-77 ]. So, even though Black and Hispanic women may have these protective factors, the factors may not be linked to a lower risk of TNBC.
There’s even some evidence these factors may increase the risk of TNBC [53,58,69,72,75-76].
These topics are under study.
Prognosis
Higher rates of TNBC may explain, to some degree, the poor prognosis (chances for survival) of breast cancers diagnosed in younger Black, non-Hispanic Black and African American women [54,63-65,78-79,112].
Even among women with TNBC, African American women may have poorer survival than white women [81].
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Susan G. Komen® partnered with Charles River Associates to publish the report, Inequities in Care and Treatment for Triple Negative Breast Cancer Patients, on the barriers to the care and treatment of TNBC. Read the full report. |
Financial assistance
Costs related to breast cancer care can quickly become a financial burden. Dealing with finances and insurance can be overwhelming.
Learn more about insurance plans and prescription drug assistance programs.
Learn more about other financial assistance programs.
Susan G. Komen® Support Resources |
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Updated 07/21/22
