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Medically Approved

What is triple-positive breast cancer?

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TypesDiagnosisOutlookSummary
Triple-positive breast cancer is a type of breast tumor. This type of cancer tests positive for progesterone receptors, estrogen receptors, and increased levels of HER2 protein.
Medically reviewed by Faith Selchick, DNP, AOCNP
Updated on

Triple-positive breast cancer is a type of cancer that tests positive for three different features:

  • estrogen (ER) receptors
  • high levels of human epidermal growth factor receptor-2 (HER2) protein
  • progesterone (PR) receptors

Several treatment options for triple-positive breast cancer are available, such as hormonal therapy, anti-her2-based targeted therapies, and chemotherapy.

If you notice any symptoms of breast cancer, you should speak with a doctor as soon as possible.

Types

Female sitting on a couch and wearing a head wrap, representing getting treatment for triple-positive breast cancer.
1389278061Daniel Llao Calvet/Getty Images

There are several types of breast cancer, and knowing the type of breast cancer you have is critical for planning the most appropriate treatment to improve the outcome of the disease.

Doctors will look for specific types of receptors or proteins in your tests, including triple positive, triple negative, ER/PR positive and HER2 negative, and ER/PR negative and HER2 positive.

Triple-positive breast cancer

Triple-positive breast cancer is a cancer that has positive progesterone receptors, estrogen receptors, and a high number of HER2 receptors on the cell surface. This cancer type typically responds better to hormone therapy treatment and medications.

The symptoms of triple-positive breast cancer are the same as other common types of breast cancer.

This may include:

  • swelling of part or the whole breast
  • breast or nipple pain
  • swollen lymph nodes under the arm or the collarbone
  • skin dimpling, similar to an orange peel
  • breast or nipple skin becoming red, dry, thickened, or flaky
  • nipple retraction
  • nipple discharge

About ductal carcinoma in situ (DCIS)

About 1 in 5 people with breast cancer have DCIS. This is where the cells lining the breasts’ milk ducts turn into cancer cells, but the cancer does not spread further into the breast. DCIS is localized and not invasive. It has a high survival rate of 98% after 10 years of having follow-ups.

DCIS symptoms may include some of the same symptoms as triple-positive breast cancer. However, some people do not experience any symptoms at all.

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Invasive breast cancer

There are several types of invasive breast cancer. The two most common types are invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC).

IDC accounts for about 80% of invasive breast cancers. It begins in the milk duct and grows into the near breast tissue. IDC can also metastasize and spread to other body parts through the bloodstream and lymph nodes.

ILC accounts for about 10% of invasive breast cancer cases. It occurs in the glands that produce milk, called lobules. This type of cancer is more likely to involve both breasts than other breast cancer types. Like IDC, ILC can metastasize and spread to other body parts.

The symptoms of invasive breast cancers are typically similar to those of other common types of breast cancer and can include:

  • breast swelling
  • breast lumps
  • breast or nipple pain
  • nipple discharge

Less common types of breast cancer

Other less common types of breast cancer may include:

  • Angiosarcoma of the breast: This is a rare type of breast cancer that involves the lining of blood and lymph vessels. Generally, this is a complication of previous radiotherapy to the breast. It typically occurs 8-10 years after radiation therapy. Its symptoms include lumps in the breast and skin changes, such as purple-colored nodules.
  • Inflammatory breast cancer (IBC): This type of cancer is rare and affects 1-5% of people with breast cancer. IBC cancer cells block the lymph vessels, causing breast inflammation. People with IBC may experience swelling and redness of the breast.
  • Paget’s disease of the breast: This type of breast cancer involves the skin of the nipple and areola. It typically only affects one breast. The symptoms of Paget’s disease include:
    • dry, flaky, and red or discolored skin on the nipple and areola
    • blood or a yellow nipple discharge
  • Phyllodes tumors of the breast: These are rare tumors that involve the breast’s connective tissue. According to the American Cancer Society, about 50% of these tumors are benign, but about 1 in 4 are cancerous. They can cause firm and generally painless bumps in the breast. The lumps typically grow quickly, which can stretch the breast skin.
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Treatment

Several treatment options are available for triple-positive breast cancer. These may include:

  • Anti-HER2 targeted therapies: Targeted drug therapies stop cancer cells from growing and dividing. If you have too much HER2, the drugs will attach to HER2, stopping their growth. Examples include trastuzumab (Herceptin), pertuzumab (Perjeta), and margetuximab (Margenza).
  • Hormonal therapy: Hormonal drugs can block cancer cells from obtaining those hormones they need to grow, such as estrogen and progesterone. Examples of medications include fulvestrant (Faslodex), aromatase inhibitors like anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara), tamoxifen (Soltamox) and toremifene (Fareston).
  • Chemotherapy: This treatment uses medication that can kill cancer cells or make them shrink. Chemotherapy comes in the form of oral pills or IV infusions. Examples include capecitabine (Xeloda) and cyclophosphamide (Cytoxan).

General treatment for breast may also involve:

  • Biological therapy: This type of treatment helps your immune system recognize and kill cancer cells. Biological therapy can also help control certain side effects that you may experience due to other types of cancer treatment.
  • Surgery: Doctors may recommend surgically removing the part of the breast where the cancer has occurred. Depending on the extent of the disease and other contributing factors, doctors may also recommend a full mastectomy, or breast removal.
  • Radiation therapy: This treatment uses high-energy rays to kill cancer cells.

A healthcare professional will recommend the most appropriate treatment option for breast cancer, depending on its type and stage.

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Diagnosis

There are several tests to diagnose breast cancer. According to the National Health Service (NHS) in the United Kingdom, tests may include:

  • Mammogram and breast ultrasound: These tests can provide an inside image of the breast and highlight any lumps or abnormalities that may have developed in the breast.
  • Biopsy: During this test, doctors collect a sample of cells from your breast for testing. They may also collect a sample from the lymph nodes in your armpit to check if cancer has reached them.
  • Needle aspiration: This procedure can help collect a sample of breast cells for testing and drain any benign cyst that may have developed in the breast.
  • Needle biopsy: This involves taking a sample of cells from a lump in your breast using a large needle. Doctors may use a local anesthetic to numb your breast before the procedure.
  • Imaging tests: Doctors may require additional imaging tests to check whether cancer has spread to other areas of your body. Imaging tests for breast cancer may include:
    • CT scan
    • MRI scan
    • X-ray
    • liver ultrasound
    • bone scan

If you notice any symptoms of breast cancer, you should speak with a doctor as soon as possible.

Outlook

If you have received a triple-positive breast cancer diagnosis, the outlook could depend on many different factors, like:

  • cancer stage, tumor size, and grade
  • how quickly the tumor is growing and whether it’s spread
  • your overall health
  • your age and whether you have been through menopause
  • if the cancer is recurring
  • when you received your diagnosis

While HER2-positive breast cancer can spread and grow faster, targeted therapies are more likely to be the most effective treatment. The National Cancer Institute advises a relative 5-year survival rate of 98.8% in HER2-positive breast cancer that has not spread to other areas of the body.

Summary

Triple-positive breast cancer refers to breast cancer cells testing positive for progesterone and estrogen receptors and high levels of HER2 protein.

Hormone therapy and drugs targeting HER2 may treat triple-positive breast cancer more effectively. Doctors may also recommend undergoing other types of cancer treatment, such as:

  • chemotherapy
  • radiation therapy
  • surgery

The outlook of people with triple-positive breast cancer can vary depending on several factors, including:

  • their cancer stage
  • how they respond to cancer treatment
  • their age
  • other health conditions they may have

If you notice any symptoms of breast cancer, you should speak with a doctor as soon as possible.

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