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Risk factors and treatment options

There are many types and sub-types of breast cancer, and understanding which type you have can help you and your doctor determine treatment options.

Most of the time, breast cancer growth is fueled by “receptors,” which are found inside cells. In these instances, breast cancers are estrogen receptor positive, progesterone receptor positive and/or human epidermal growth factor receptor 2 (HER2) positive.

About 70 percent of breast cancers test positive for Estrogen and Progesterone. Roughly 20 percent of breast cancers include HER2 receptors.

In some cases, none of these factors is responsible for breast cancer. When a breast cancer can’t be classified as any of these three types fueled by receptors, it’s called triple-negative breast cancer.

“We have targeted therapies to treat estrogen/progesterone-receptor positive and HER2- positive breast cancers,” explained Dr. Numan Fateh, a hematologist/oncologist at Geisinger Community Medical Center. “But when a patient tests negative for these receptors, the cancer generally does not respond to hormonal therapies, which can make it more difficult to treat.”

In addition, triple-negative breast cancer is often more aggressive than other breast cancers.

How triple-negative breast cancer is diagnosed
If you discover a lump or a breast abnormality, your doctor will conduct a biopsy, a procedure where cells are removed and examined. Then, a pathologist will look at the cells to determine if they’re cancerous, pre-cancerous or if there is no cancer present at all.

If the cells are cancerous, a pathologist will conduct more tests to determine the type of cancer. If the cells test negative for each of the three receptors, the cancer will be deemed triple-negative.

During this stage, your care team will also determine which stage—one through four—your cancer is.

Who’s at risk for triple-negative breast cancer?
Doctors continue to learn more about triple-negative breast cancer, but there are some risk factors they’ve identified so far.

• Obesity and inactivity: People who are obese and don’t exercise regularly typically have a higher body mass index (BMI) and may be at increased risk.
• Genetics: People with the BRCA1 gene mutation are at greater risk for triple-negative breast cancer.  People with the BRCA2 genetic mutation tend to be estrogen receptor positive.
• Age: Triple-negative breast cancer affects more premenopausal women than postmenopausal women.
• Race or ethnicity: Studies show that more African American women have been diagnosed with triple-negative breast cancer than other races and ethnicities.

“Understanding the risk factors for triple-negative breast cancer can help both patients and doctors get ahead of this aggressive cancer and become more vigilant in screening and surveillance,” said Dr. Fateh.

Triple-negative breast cancer treatment options
Though triple-negative breast cancer does not typically respond to medicines that target estrogen, progesterone or HER2, it may respond to chemotherapy and radiation. In addition, your doctor may recommend surgery to remove just the lump, called a lumpectomy usually followed by radiation therapy. Or your doctor may recommend a partial or full mastectomy, where part or all of one or both breasts are removed.

The combination of surgery, chemotherapy and radiation may shrink or eliminate cancer cells in the breast; however, triple-negative breast cancer is more likely to spread beyond the breast or return after treatment than other types of breast cancer. The risk is greater in the three years following treatment.

“If you’ve been treated for triple-negative breast cancer, it’s essential to work closely with your doctor for follow-up care and treatment in the years following,” suggested Dr. Fateh. “If you notice a lump in your breast or another abnormality in your body, you should see your doctor immediately.”

Fellowship-trained hematologist/oncologist Numan Fateh, DO, sees patients at Geisinger Community Medical Center in Scranton. To schedule an appointment with Dr. Fateh or another Geisinger hematologist/oncologist, please call 800-275-6401 or visit




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