TNBC

I've been promising you this entry for a while, so I thought I'd finally tackle it and explain what exactly triple negative breast cancer is, and why I chose to go through the toughest chemo treatment in town even though my breast cancer was caught at an early stage. Please note that the below is my personal understanding of the medical background/situation. I am not a medical doctor, nor should any of this entry (or this blog, for that matter) be taken as medical advice.

With the disclaimers out of the way, let me start at the beginning, then. Back in the olden days, scientists and clinicians only distinguished cancers based upon where they originated. In other words, back then doctors treated breast cancer patients as one monolithic group. Women would be treated with surgery, perhaps radiation and chemotherapy. The first of these treatments are known as localized therapies, as they affect cancer cells only the body part at which they are directed (in this case, presumably, the breast). Chemo is different in that it affects all rapidly dividing cells within the body, including cancer cells wherever they may be hiding in the body, which is why it is known as a systemic therapy. But systemic therapy is tough to go through, has potentially toxic side effects, and for most early stage cancer patients does not provide terribly much of a survival benefit (I'll explain why below), so chemotherapy was not (and in many cases is not) a terribly common treatment for early stage breast cancer.

Over time, however, doctors came to realize that not all breast cancers were alike, nor responded equally well to treatments. This was the beginning of a sea change in oncology where doctors tried to identify specific characteristics of a cancer and tailor treatments that attack the cancer cells only -- without the many drawbacks of chemo. Thus began the era of "targeted therapies" where women are treated with medicines specific to their subtype of cancer. Developing such medicines, however, naturally depends upon understanding what makes a particular subtype of breast cancer grow. From what we know today, most kinds of breast cancer are susceptible to female hormones, which is where medicines such as Tamoxifen and aromatase inhibitors come in. 

Triple negative breast cancer, on the other hand, gets its name from the fact that it is a kind of breast cancer that is not fueled by one of the three factors that are known to promote tumor growth: estrogen, progesterone, and human epidermal growth factor/Her2neu. Actually, nobody is quite sure what makes those cancers grow. As a consequence, there are none of those fancy and effective new medicines (including Herceptin for Her2neu positive breast cancer) that can help women with TNBC. 

So in a way, women with TNBC have not been able to benefit as much from medical progress as women with more common kinds of breast cancer have. To make matters worse, TNBC tumors tend to grow much more aggressively than hormone-dependent lesions, which can take a decade or more to grow to a palpable size (Her2neu dependent tumors also grow aggressively, but Herceptin has become an effective tool against them). This is why many women with TNBC are in a more advanced stage of breast cancer when they are diagnosed and their tumors tend to be larger (mine, for instance, was 3.1 cm, which is huge compared to other breast cancers). TNBC also tends to hit younger women rather than older ones, and in those it is particularly aggressive. Oddly, it is also more prevalent amongst African American and Hispanic rather than Caucasian women, and it tends to be even more aggressive in these groups.

Finally, TNBC not only grows faster than other forms of breast cancer, it also has a higher likelihood of coming back and metastasizing -- which it likes to in the brain and other soft tissues. Once that happens, there isn't terribly much that modern medicine can do -- as a rule metastatic TNBC is a terminal diagnosis. This helps explain why the prognosis for TNBC patients is considerably worse than for other breast cancer patients. In one study, for instance, 94% of hormone dependent breast cancer patients were still alive after five years, but only 80% of their TNBC counterparts. 

TNBC thus is a formidable foe -- and in fighting it there are no second chances to win the war. Winning the battle and winning the war are essentially the same thing.  This means that once you have TNBC, it is  even more vital than for other kinds of breast cancer that the every last cancer cell be eradicated so the disease cannot recur and metastasize.

Although TNBC has a poorer prognosis than other cancers, its aggressive growth pattern also makes it a more promising target for chemotherapy than other, more slowly growing breast cancers. After all, chemotherapy kills any and all fast growing cells (this is why many chemotherapies lead to hair loss). More slowly growing cells, on the other hand, are less affected by chemo. Thus the aggressively growing TNBC responds better to chemotherapy than other breast cancers, especially in young women where the cancer is particularly virulent. 

The upshot of all of this is that I have a rare kind of breast cancer that carries a poorer prognosis than other kinds. Given that I caught this disease when I was only 38 years old, and given that this cancer is particularly aggressive and lethal when allowed to metastasize, it needs to be treated as aggressively as possible. Even in cases such as mine where the cancer was caught relatively early (stage IIa) and where it had not spread to the lymph nodes, the prognosis is poorer than for hormone-dependent breast cancers. I do, however, have this one opportunity to evict TNBC from my body for good -- and aggressive chemotherapy is the only way to do it.

So my odds are pretty good if I manage to get the cancer now -- and not so good should I fail to evict all of the cancer from my body. Thus it would be unwise to opt for anything but the toughest, most aggressive chemotherapy around. There really was no other option that made sense, which is why I told my poison man to give it to me as good as a my body can take it. He offered me different choices, but each 'easier' chemo option comes with a lesser survival benefit. And I really, really want to live, which is I selected what has been shown to be most effective against TNBC: dose dense ACT chemotherapy. 

Yes, it is a tough regimen. It puts my body through the paces. But see, I've got plans: Among other things, I have been wanting to have a family and raise kids (well, ok, at this point I'd be very happy with just one kid). But generally, being alive and reasonably healthy is a precondition for having kids in the first place. So I have to do everything I possibly can to fulfil that dream of having a  baby -- and then I need to do all I can to actually hang around and raise the kid.

As you can see, there really was no alternative. I simply had to choose the path that gives the me the best chance of survival and realizing my dreams.  At the end of the day, it's as simple as that.