Triple negative breast cancer

I am 42, recently diagnosed with left breast infiltrating ductal carcinoma. Sonogram and MRI showed tumor size 1.6 cmx 0.6cm. Right breast atypical ductal hyperplasia.  Had bilateral mastectomy in July 2010. Pathology result triple negative breast cancer - grade 111 and the tumor was only 3.5mm with no lymph node invasion. I will be doing the BRCA test soon. My question is what is the right treatment for me at this time? Do I need chemotherapy? If yes what med and what is the dose? If my gene study reveal negative for BRCA, do I benefit from oopherectomy? My aunt died of ovarian CA at 53. What else I can do to prevent recurrence? What monitoring tools I can use? Is there any test that will alarm me about the recurrence? I am devastated and hope to find a cure for this type of cancer.

[bluebutterfly2222]

These are all questions that you should be discussing with your oncologist, who has highly specialized training in regard to all these issues, and would have full access to all of the details of your case as well as your medical history, rather than with volunteers on  the Internet, don't you think?.

One comment though: TNBC Grade 3 is a very aggressive type of cancer and should therefore receive very aggressive tx. I am providing a link to a research report dealing with this topic, as well as a brief quote from that report:
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http://www.sciencedaily.com/releases/2007/12/071216104305.htm

Even Tiny Breast Tumors Can Be Aggressive And May Require Maximum Therapy
ScienceDaily (Dec. 19, 2007) — Breast tumors that are 1 centimeter in size or smaller — no more than 0.4 inch in length — can still be very aggressive and may require more intensive therapy than is routinely offered today, say researchers at Mayo Clinic in Jacksonville, Fla.

The study, which is being presented at the San Antonio Breast Cancer Symposium, is one of the few that has looked at outcomes of women who have tiny tumors that have not spread to the lymph nodes. The findings suggest that outcome of two types of breast cancer — those classified as HER2 positive (HER2+) and triple negative — may not depend on size alone.
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Although only small numbers of women have the rarer cancer subtypes included in this study, the findings suggest that women with HER2+ and triple negative tumors should receive as much treatment as possible in order to prevent cancer relapse, Dr. Amar says. Researchers found that only 35 percent of women with triple negative cancer were treated with adjuvant chemotherapy (chemotherapy after surgery) despite the higher grade of the tumors. "Chemotherapy may not work as well as we would like in these tumors, but, still, physicians who treat patients with triple negative cancer should be aware of the higher risk of relapse, even if tumors are quite small," she says.
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Best wishes....

[SueYoung55]

I'm glad you're going to have the BRCA testing done. In addition to breast cancer in men and women, mutations in BRCA2 also lead to an increased risk of ovarian, Fallopian tube, prostate, and pancreatic cancers, as well as malignant melanoma. In some studies, mutations in the central part of the gene have been associated with a higher risk of ovarian cancer and a lower risk of prostate cancer than mutations in other parts of the gene. Several other types of cancer have also been seen in certain families with BRCA2 mutations.

But the best answers you can get to your questions will come from a genetic counselor and if you haven't spoken with one to assess ALL your risks then I really recommend you do so, not just for you but for your siblings and children. They will also help you determine what your risks are for OC if you find out you're BRCA negative.

The chemo decision is up to you but honestly, triple negative cancers are very aggressive and you need to go into this battle with as much ammunition as you can carry.

We can't answer all of your questions but we can certainly support you in any way you need. Please keep in touch with us. Also, I recommend you visit www.facingourrisk.org if you haven't been there already to find out more specifically about BRCA mutations and clinical trials.

[Cheerpul]

You have many well-thought out questions that your oncologist can help you resolve.  Last October, after a mastectomy for extensive DCIS,  I was diagnosed with a 5 mm tumor that was Her2 positive and ER+/PR+.  For me, the Her2 positive made me choose to take chemo (I took TCH - taxotere, carboplatin and herceptin.)  
It  lessened my statistics from over 30 % chance of recurrance to less than 10%.

I have done most all that I can and it was rough, but I would make the same decision if I had to.  I had 4 months of chemo and am still taking Herceptin, Zometa and Tamoxifen.  From my experience, I recommend doing all you can.  Getting the BRACA test will further your understanding of your unique situation and help your family as well.

Keep in touch and we will support you as you work out your treatment plan.  Thinking of you.

[sweety914]

To bluebutterfly2222
Thanks for your response. The link is great. It is scary. My oncologist did not believe that I need to be treated because the size of the tumor is so small. I checked some info from triple negative breast cancer foundation also and many of them had trials with advance stages. Not much trials done for stage 1, grade 3 triple negative.
Keep in touch

[sweety914]

To Sue Young55
Thank you for responding. I raised all concerns with my oncologist and she did not believe that I need to be treated because the size of the tumor is so small. I checked some info from triple negative breast cancer foundation also and many of them had trials with advance stages. Not much trials done for stage 1, grade 3 triple negative.

[sweety914]

To Cheerpul
Although cancer itself is scary, now that I am comparing the different types, It is much better to have a positive cancer. I want to do everything I can and insist my oncologist to treat me with the chemo but the size of my tumor again put me in a position were the team do not think I needed.
Thank you for the response. Good luck to you.

[bluebutterfly2222]

One possibility would be to have a second opinion consultation with another oncologist, and take with you a copy of the article that was presented at the San Antonio Breast Cancer Symposium to discuss with him/her.

If that oncologist also dismisses the need for chemo, or if you decide just to follow the advice of your current oncologist, I wish you well re remaining NED (no evidence of disease) due to your bilateral mastectomy and lack of lymph node involvement.

Warm regards,
bluebutterfly