Surviving Triple Negative Breast Cancer Hope, Treatment,
and Recovery
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Surviving
Triple-Negative
Breast Cancer
Hope, Treatment, and Recovery
Patricia Prijatel
1
1
Oxford University Press is a department of the University of Oxford.
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Oxford is a registered trademark of Oxford University Press in the UK
and certain other countries.
Published in the United States of America by
Oxford University Press
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© Patricia Prijatel 2013
All rights reserved. No part of this publication may be reproduced,stored in a retrieval
system, or transmitted, in any form or by any means,without the prior permission in
writing of Oxford UniversityPress, or as expressly permitted by law, by license, or under
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Oxford University Press, at the address above.
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and you must impose this same condition on any acquirer.
Library of Congress Cataloging-in-Publication Data
Prijatel, Patricia, 1945–
Surviving triple negative breast cancer : hope, treatment, and recovery / Patricia Prijatel.
p. cm.
Includes bibliographical references and index.
ISBN 978–0–19–538762–9 (hardback : alk. paper)
1. Prijatel, Patricia, 1945—Health. 2. Breast—Cancer—Patients—
United States—Biography. 3. Breast—Cancer—Treatment—Popular works.
I. Title.
RC280.B8P727 2013
616.99’449—dc23
2012012425
9 8 7 6 5 4 3 2 1
Printed in the United States of America
on acid-free paper
To all those who have embarked on the triple-negative breast
cancer journey, their caregivers, families, and friends. Nobody
wants to walk this road, but we can make it easier by helping one
another. I hope these pages calm, clarify, and encourage.
This page intentionally left blank
Contents
List of Tables xi
List of Boxes xiii
Foreword xv
Acknowledgments xvii
one The Sun Shines on My Bald Head 1
Educating Myself 17
How to Use This Book 19
The Language of TNBC 21
I Am, Literally, a Friend 21
two What Is This Disease? 23
Sorting Out the Negatives and Positives 26
Recurrence and Metastases 29
Race and Triple-Negative 31
The Age Factor 34
BRCA Mutations 35
Yeah, But … 37
Additional Resources 39
viii | Contents
three Understanding Your Diagnosis 45
Testing, Testing 48
Breast Cancer Types: Where
Hormone-Negative Fits In 53
Translating Your Pathology Report 56
four The Biology of Triple-Negative 67
Risks, Correlations, and Exceptions 69
The Implications of a Weakened Immune
System 70
Our Genetic Code 72
The Interplay of Hormones and Receptors 76
Inflammation and the Insulin Connection 78
Reproductive Factors 81
How and Why Is Race a Risk Factor? 82
Men and Breast Cancer 85
five Treatment: Your Options 95
Facing Treatment 96
Surgery: Lumpectomy Versus Mastectomy 98
Chemotherapy and TNBC 102
Chemotherapy Drugs 108
Biologic Therapies 115
Radiation 117
Tamoxifen and Arimidex 118
Herceptin 119
Combined Therapy for Hormone-Negative 120
Which Regimen Works Best? 121
On the Horizon 124
The Rest of You 127
Alternative Treatments 131
Follow-Up Care After Hormone-Negative Breast
Cancer 133
six The Positives of Healthy Living 145
Exercise and Physical Activity 147
Contents | ix
Weight Control 152
Diet: Healthy In, Healthy Out 153
Putting It All Together 172
seven My Life Right Now 185
What Cancer Means to Me Now 195
TNBC Women 196
appendix Annotated Pathology Report:
Pat’s Case 199
Glossary 207
Index 215
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List of Tables
2–1 The Many Faces of Hormone-Negative 26
2–2 Comparative Risks 27
2–3 TNBC by the Numbers 30
2–4 Hormone Receptor Status Based on Race 33
3–1 Basal Cancer by the Numbers 55
3–2 Tests of Tumor Aggressiveness 58
3–3 Stages of Breast Cancer 60
4–1 Progesterone and Breast Cancer 77
This page intentionally left blank
List of Boxes
2–1 Common Breast Cancer Drugs 28
2–2 The Impact of Race on Breast Cancer 31
2–3 Age and TNBC 34
2–4 Trying Race and Age Together 35
2–5 Cancer-Prone Families and the BRCA Gene 36
2–6 Encouraging Survival Rates 39
4–1 Inherited Genes 73
4–2 Can BRCA Mutation Be a Good Thing? 74
4–3 Genes and Basal-like Breast Cancers 75
4–4 Life After Cancer Epidemiology (LACE) Study 81
4–5 Toxins in Our Environment 83
5–1 Relative Risk 100
5–2 TNBC Response to Neoadjuvant Chemotherapy 104
5–3 First-Line Versus Second-Line Drugs 108
5–4 Who Benefits from Taxanes? 114
5–5 Aspirin May Reduce Risk of Recurrence 128
6–1 Determining Your Body Mass Index 148
6–2 Menopausal Status and Exercise 150
6–3 Fat Intake and Relative Risk of Recurrence 154
6–4 Can You Take Too Many Vitamins? 158
xiv | List of Boxes
6–5 Understanding Research 161
6–6 The Skinny on Fats 163
6–7 Sources of Vitamin D 167
6–8 Smoking and Hormone-Negative 169
Foreword
I have been a surgeon for three decades. When I began my training,
the accepted surgical treatment for breast cancer was mastectomy.
Classical radical mastectomy had been “modified” several ways and
a less radical operation, the modified radical mastectomy—complete
removal of the breast (including the nipple and areola) and the
lymph nodes under the arm, usually with division of one of the pec-
toral muscles to improve access—had just gained acceptance. We now
offer patients a variety of surgical options ranging from lumpectomy
(with radiation treatment) through modified radical mastectomy.
I can now count at least eleven different surgical procedures that
I currently perform for breast cancer: eight on the breast (not count-
ing reconstructive options) and three on the axillary lymph nodes.
Surgical treatment is now individualized.
Surgery and radiation treatment treat the disease only in the
breast and underarm region. They do not affect any malignant cells
that may be circulating outside of this local area. For that, some kind
of systemic treatment, such as chemotherapy, is required. Modern
treatment of breast cancer is thus termed multimodality—most
women will get some form of surgery, and some kind of systemic
therapy. Many women also get radiation treatment (I will use the
term woman throughout—men do get breast cancer, and their
