Triple-negative breast cancer (TNBC)

Triple-negative breast cancer (TNBC) is a fast-growing type of breast cancer. Like other types of breast cancer, TNBC starts as a growth of cells in the breast. What makes TNBC different from other types is that the cancer cells don't use the hormones estrogen and progesterone to help them grow. The cells also don't make much of a protein called HER2.

TNBC tends to happen at a younger age and is more common in black women. It also happens more often in people who have DNA changes that increase the risk of breast cancer.

This type of breast cancer is called triple negative because the cells test negative for estrogen receptors, progesterone receptors and HER2 protein. Healthcare professionals use the results of these tests to make treatment decisions. Having TNBC limits the treatment options, since the cancer won't respond to estrogen blocker therapy to lower hormone levels or treatments that target the HER2 protein.

Compared with other types of breast cancer, TNBC is more likely to be diagnosed at a later stage. The cancer often has grown large or spread to the lymph nodes by the time it is found. Treatment for TNBC often starts with medicines, such as chemotherapy and immunotherapy. These medicines can shrink the cancer to make it easier to remove with surgery. Other treatments might include radiation therapy and targeted therapy.

Triple-negative breast cancer (TNBC) is not a single condition. TNBC is a broad term for breast cancers that test negative for estrogen receptors, progesterone receptors and HER2. TNBC includes several subtypes. This helps explain why two people with TNBC may have cancers that grow, spread or are affected by treatment differently.

The subtypes include, but are not limited to:

• Basal-like 1 and basal-like 2. Most, but not all, TNBC falls into the basal-like group. These cancers are called basal-like because in lab testing they show some of the same features as healthy basal cells on the outer layer of the breast ducts and lobules. Basal-like TNBC often grows quickly.
• Mesenchymal and mesenchymal stemlike. These subtypes show features linked to cell movement. The stemlike subtype also has features linked to stemlike cells and blood vessel growth.
• Immunomodulatory. This subtype shows signs of immune cells inside and around the cancer cells or tumor.
• Luminal androgen receptor. This subtype may use androgen hormone instructions to help cancer cells grow.
• Metaplastic. This rare subtype has cancer cells that, under a microscope, do not look like usual breast cancer cells.

Triple-negative breast cancer (TNBC) may not cause signs or symptoms at first. As it grows, TNBC symptoms are usually the same as most other common breast cancer symptoms. These include:

• A breast lump or thickened area of skin that feels different from the surrounding tissue.
• A nipple that looks flattened or turns inward.
• Changes in the color of the breast skin. On white skin, the breast skin may look pink or red. In people with brown or black skin, the breast skin may look darker than the other skin on the chest or it may look red or purple.
• Change in the size, shape or appearance of a breast.
• Changes to the skin over the breast, such as skin that looks dimpled or looks like an orange peel.
• Peeling, scaling, crusting or flaking of the skin on the breast.

When to see a doctor

TNBC is often a fast-growing cancer. It may be more likely to appear between routine mammograms than other breast cancer types. Make an appointment with a healthcare professional if you notice a change in your breasts. Changes to look for may include a lump, an area of puckered or otherwise unusual skin, a thickened region under the skin, and nipple discharge. Don't wait for your next mammogram to see if the change you found is breast cancer. Report any changes in your breasts even if a recent mammogram showed there was no breast cancer. A healthcare professional may recommend additional imaging.

The exact cause of triple-negative breast cancer (TNBC) often isn't known. This type of breast cancer is more likely to happen in people who inherit DNA changes that increase the risk of breast cancer, such as BRCA1 and BRCA2. These DNA changes run in families and raise the risk of breast cancer. Not all people with TNBC have these DNA changes. More research is needed to understand what causes this type of breast cancer.

Factors that may increase the risk of triple-negative breast cancer (TNBC) include:

• Age. Compared with other types of breast cancer, TNBC tends to happen at a younger age. It is more common in women under 40. This is different from other types of breast cancer that happen more often in older women.
• Race and ethnicity. Black women have a higher risk of TNBC.
• Inherited DNA changes that increase cancer risk. A family history of changes in the BRCA1 and BRCA2 genes can increase your risk of TNBC and other cancers. However, not everyone with these DNA changes gets cancer.
• Dense breast tissue. Breast tissue is made up of fatty tissue and dense tissue. Dense tissue is made of milk glands, milk ducts and fibrous tissue. If you have dense breasts, you have more dense tissue than fatty tissue in your breasts. Having dense breasts can make it harder to find breast cancer on a mammogram. If a mammogram showed that you have dense breasts, your risk of breast cancer is increased. Talk with your healthcare team about other tests you might have in addition to mammograms to look for breast cancer.
• Oral contraceptive use. Using oral contraceptives for 10 years or more is linked with a higher risk of TNBC.
• Having your first child at a younger age. Having your first child after age 30 may lower the risk of TNBC. This is different from other types of breast cancer in which having a child before age 30 lowers the risk.
• Beginning your period at a younger age. Beginning your period before age 11 increases the risk of TNBC and other types of breast cancer.

Complications that can happen with triple-negative breast cancer (TNBC) include:

• Cancer that comes back. TNBC can come back after treatment. It also might spread to other parts of the body such as the lungs, liver, brain and bones. The risk is highest in the first few years after treatment. When cancer comes back, healthcare professionals sometimes call it recurrent cancer.
• Infertility. TNBC treatment often involves chemotherapy, which can affect the ability to get pregnant after treatment. If you want to have children in the future, talk about this with your healthcare team. Your team may refer you to a fertility specialist who can explain your options. These options might include freezing eggs, freezing embryos and other ways to preserve fertility.

Sometimes people ask if TNBC can cause ovarian cancer. TNBC itself does not cause ovarian cancer. TNBC and ovarian cancer are linked to changes in BRCA genes.

There's no sure way to prevent triple-negative breast cancer (TNBC). But making changes in your daily life may help lower your risk of breast cancer in general. Try to:

• Ask about breast cancer screening. Breast density and family history of breast cancer are linked to TNBC. Talk with your doctor or other healthcare professional about when to begin breast cancer screening. Ask about the benefits and risks of screening. Together, you can decide what breast cancer screening tests are right for you.
• Become familiar with your breasts through breast self-exam for breast awareness. Breast awareness can't prevent breast cancer. But it may help you to better understand the look and feel of your breasts. This might make it more likely that you'll notice if something changes. If there is a new change, a lump or something not typical in your breasts, report it to a healthcare professional right away.
• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit how often you drink. For overall health, do not drink every day. The less you drink, the better. For breast cancer prevention, there is no safe amount of alcohol.
• Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask a healthcare professional for guidance and start slowly.
• Maintain a healthy weight. Work to maintain a healthy weight. If you need to lose weight, ask a healthcare professional about healthy ways to lower your weight. There is no specific diet linked to preventing TNBC.
• Breastfeeding. Consider breastfeeding if you want to and are able to. If you have a baby, breastfeeding might play a role in helping prevent breast cancer. The longer you breastfeed, the greater the protective effect.

People sometimes wonder if there is a vaccine to protect against TNBC. There currently is no vaccine for TNBC.

Triple-negative breast cancer (TNBC) is usually diagnosed in steps, not with a single test. If symptoms or a screening test such as a mammogram suggest breast cancer, the workup starts with a physical exam with a healthcare professional. Other tests typically include imaging, biopsy, testing cells in the lab and tests for biomarkers.

Breast exam

During a breast exam, a healthcare professional looks at the breasts for anything that's not typical. This might include changes in the skin or to the nipple. Then the health professional feels the breasts for lumps. The health professional also feels along the collarbones and around the armpits for lumps.

Mammogram

A mammogram is an X-ray of the breast tissue. Mammograms are commonly used to screen for breast cancer. If a screening mammogram finds something concerning, you might have another mammogram to look at the area more closely. This more-detailed mammogram is called a diagnostic mammogram. It's often used to look closely at both breasts.

Breast ultrasound

Ultrasound uses sound waves to make pictures of structures inside the body. A breast ultrasound may give your healthcare team more information about a breast lump. For example, an ultrasound might show whether the lump is a solid mass or a fluid-filled cyst. The healthcare team uses this information to decide what tests you might need next.

Breast MRI

MRI machines use a magnetic field and radio waves to create pictures of the inside of the body. A breast MRI can make more-detailed pictures of the breast. Sometimes this method is used to look closely for any other areas of cancer in the affected breast. It also might be used to look for cancer in the other breast. Before a breast MRI, you usually receive an injection of dye. The dye helps the tissue show up better in the images.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. To get the sample, a healthcare professional puts a needle through the skin and into the breast tissue. The health professional guides the needle using images created with X-rays, ultrasound or another type of imaging. Once the needle reaches the right place, the health professional uses the needle to draw out tissue from the breast. Often, a marker is placed in the spot where the tissue sample was removed. The small metal marker shows up on imaging tests. The marker helps your healthcare team monitor the area of concern.

Lab testing

The tissue sample from a biopsy goes to a lab for testing. Tests can show whether the cells in the sample are cancerous. Other tests give more details about the cells. Pathologists do the testing. Pathologists are doctors who look for disease in cells, fluids and tissue removed from the body.

Results are often given in a pathology report. The results may show:

• Cell type. The results show whether the cancer cells are ductal cells, lobular cells or other kinds of cells.
• Cell grade. The grade of the breast cancer cells is based on how the cells look under a microscope. The grade tells the healthcare team whether the cancer is likely to grow slowly or quickly.
• Hormone receptor status. Cancer cells that use hormones to help them grow have receptors that help them catch the hormones in the bloodstream. If testing finds receptors for hormones, the cancer is hormone receptor positive. If testing doesn't find receptors, then the cancer is hormone receptor negative. TNBC is hormone receptor negative.
• PD-L1 status. Programmed cell death ligand 1 (PD-L1) is a protein that some breast cancer cells make to help them hide from the immune system. Results of this test can tell your healthcare team whether immunotherapy treatments are likely to work against your cancer cells. This test is used for TNBC that spreads or comes back after treatment.
• The presence of TILs. Tumor infiltrating lymphocytes (TILs) are immune system cells found around the cancer. TILs may be a sign that the immune system is actively fighting the cancer. The healthcare team may test for TILs to better understand your prognosis.
• HER2 status. Some breast cancer cells use a protein called human epidermal growth factor receptor 2 (HER2) to help them grow. Healthy breast cells make some HER2, but the cancer cells can make a lot more. If tests show the cancer cells have extra copies of the HER2 gene or increased levels of the HER2 protein, the cancer is HER2 positive. If testing doesn't find these, the cancer is HER2 negative. TNBC is HER2 negative.
• Ki-67 score. Ki-67 is a protein that marks how fast the cancer cells divide, also called the proliferation rate. The Ki-67 score goes from 0% to 100%. A higher score suggests a higher rate of dividing cells and faster growth.

The healthcare team uses the results from lab tests to decide on the cancer's stage, understand the prognosis and make a treatment plan.

Treatment for triple-negative breast cancer (TNBC) often involves several steps. Treatments typically include surgery and medicines, such as chemotherapy and immunotherapy. Other treatments might include radiation therapy, targeted therapy and antibody-drug conjugates.

If the cancer in the breast is small enough in stages 1 through 3, treatment may start with a lumpectomy or mastectomy.

Sometimes treatment starts with medicine. Healthcare professionals may use chemotherapy and, sometimes, immunotherapy before surgery. The medicines help shrink the cancer and make it easier to remove. Using medicines first also helps the healthcare team see how well the treatment works. This helps the care team make decisions about what treatments to do after the surgery. Treatment before surgery is called neoadjuvant therapy.

After surgery, treatment depends on what is found. Some people may get more chemotherapy, more immunotherapy or radiation therapy.

Breast cancer surgery

Breast cancer surgery typically involves a procedure to remove the breast cancer and a procedure to remove some nearby lymph nodes. Operations used to treat breast cancer include:

• Removing the breast cancer. A lumpectomy is surgery to remove the breast cancer and some of the healthy tissue around it. The rest of the breast tissue isn't removed.

• Removing all of the breast tissue. A mastectomy is surgery to remove all breast tissue from a breast. The most common mastectomy procedure is total mastectomy, also called simple mastectomy. This procedure removes all of the breast, including the lobules, ducts, fatty tissue and some skin, including the nipple and areola.

  Some newer types of mastectomy procedures might not remove the skin or nipple. For instance, a skin-sparing mastectomy leaves some skin. A nipple-sparing mastectomy leaves the nipple and the skin around it, called the areola. These newer operations may not be for everyone.

• Removing a few lymph nodes. A sentinel node biopsy is an operation to take some lymph nodes for testing. When breast cancer spreads, it often goes to the nearby lymph nodes first. To see if the cancer has spread, a surgeon removes some of the lymph nodes near the cancer. If no cancer is found in those lymph nodes, the chance of finding cancer in any of the other lymph nodes is small. No other lymph nodes need to be removed.
• Removing several lymph nodes. Axillary lymph node dissection is an operation to remove many lymph nodes from the armpit. Your breast cancer surgery might include this operation if imaging tests show the cancer has spread to the lymph nodes. It also might be used if cancer is found in a sentinel node biopsy.
• Removing both breasts. Some people who have cancer in one breast may choose to have the other breast removed, even if it doesn't have cancer. This procedure is called a contralateral prophylactic mastectomy. It might be an option if you have a high risk of getting cancer in the other breast. The risk might be high if you have a strong family history of cancer or have DNA changes that increase the risk of cancer.

You may choose to have breast reconstruction after mastectomy surgery. Breast reconstruction is surgery to restore shape to the breast. Options might include reconstruction with a breast implant or reconstruction using your own tissue. Consider asking your healthcare team for a referral to a plastic surgeon before your breast cancer surgery.

Chemotherapy

Chemotherapy treats cancer with strong medicines that kill cancer cells. It can shrink TNBC to make it easier to remove with surgery. There are many types of chemotherapy medicines that damage the cancer cells in different ways. Most chemotherapy medicines are given through a vein. Some come in pill form.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system fight cancer cells. Typically, the immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells recognize and kill the cancer cells.

For TNBC, immunotherapy may be used before surgery to shrink the cancer and make it easier to remove. It also may be used after surgery or when surgery isn't an option.

To see if this treatment is likely to help, your healthcare team may test your cancer cells for a protein called programmed cell death ligand 1 (PD-L1). Immunotherapy medicines only work in cells that have this protein.

Radiation therapy

Radiation therapy treats TNBC with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.

For TNBC, radiation therapy is sometimes used after surgery to kill any cancer cells that might remain.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

One example of targeted therapy is medicines called poly (ADP-ribose) polymerase (PARP) inhibitors. PARP inhibitors target cells with BRCA1 or BRCA2 gene variations. Your healthcare team may do tests to see if these medicines might help fight your cancer.

Many other targeted therapy medicines exist. Some are used only when the cancer comes back or spreads to other parts of the body.

Antibody-drug conjugates

Antibody-drug conjugates are medicines that combine targeted therapy with chemotherapy. These medicines use targeted therapy to target the cancer cells and deliver chemotherapy directly to the cells. Antibody-drug conjugates are typically used alone or with other medicines to treat breast cancer that spreads.

No alternative medicine treatments have been found to cure breast cancer. But complementary and alternative medicine therapies may help you cope with side effects of treatment.

Alternative medicine for fatigue

Many people with breast cancer have fatigue during and after treatment. This feeling of being very tired and worn down can continue for years. When combined with care from your healthcare team, complementary and alternative medicine therapies may help relieve fatigue.

If you are interested in ways to reduce fatigue, talk with your healthcare team about:

• Expressing your feelings. Find an activity that allows you to write about or discuss your emotions. Examples include writing in a journal, participating in a support group or talking to a counselor.
• Doing gentle exercise. If you get the OK from your healthcare team, start with gentle exercise a few times a week. Add more exercise, as you feel up to it. Consider walking, swimming, yoga and tai chi.
• Managing stress. Take control of the stress in your daily life. Try stress-reduction techniques such as muscle relaxation, visualization, and spending time with friends and family.

Some breast cancer survivors say their diagnosis felt overwhelming at first. It can be stressful to feel overwhelmed at the same time that you need to make important decisions about your treatment. In time, you may find ways to cope with your feelings. Until you find what works for you, it might help to:

Learn enough about your TNBC to make decisions about your care

If you'd like to know more about your TNBC, ask your healthcare team for the details of your cancer. Write down the type, stage and hormone receptor status. Ask for reliable sources of information where you can learn more about your treatment options.

Knowing more about your cancer and your options may help you feel more confident when making treatment decisions. Still, some people don't want to know the details of their cancer. If this is how you feel, let your care team know that too.

Talk with breast cancer survivors

You may find it helpful and encouraging to talk with others who have been diagnosed with breast cancer. For support groups, contact the American Cancer Society or ask your healthcare team about local or online groups. Find support online through Mayo Clinic Connect, a community where you can connect with others for support, practical information and answers to everyday questions.

Find someone to talk with

Find a person who has experience helping people with serious illnesses. Ask your healthcare team to suggest a counselor, clergy member or medical social worker you can talk with.

Keep your friends and family close

Your friends and family can provide a crucial support network for you during your cancer treatment.

As you begin telling people about your breast cancer diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with. Examples include listening when you want to talk, helping you with preparing meals, cleaning your home or caring for your pets.

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you or are not going away. If an exam or imaging test shows you might have breast cancer, your healthcare team will likely refer you to a specialist.

Specialists who care for people with breast cancer include:

• Breast health specialists.
• Breast surgeons.
• Doctors who specialize in diagnostic tests, such as mammograms, called radiologists.
• Doctors who specialize in treating cancer, called oncologists.
• Doctors who treat cancer with radiation, called radiation oncologists.
• Genetic counselors.
• Plastic surgeons.

What you can do to prepare

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Write down your family history of cancer. Note any family members who have had cancer. Note how each member is related to you, the type of cancer, the age at diagnosis and whether each person survived.
• Make a list of all medicines, vitamins or supplements that you're taking and the doses.
• Keep all your records that relate to your cancer diagnosis and treatment. Organize your records in a binder or folder that you can take to your appointments.
• Consider taking a family member or friend along. Sometimes it can be hard to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your healthcare professional.

Questions to ask your doctor

Your time with your healthcare professional is limited. Prepare a list of questions so that you can make the most of your time together. List your questions from most important to least important in case time runs out. For breast cancer, some basic questions to ask include:

• What type of TNBC do I have?
• What is the stage of my cancer?
• Can you explain my pathology report to me? Can I have a copy for my records?
• Do I need any more tests?
• What treatment options are available for me?
• What are the benefits from each treatment you recommend?
• What are the side effects of each treatment option?

Other questions to ask may include:

• Will treatment cause menopause?
• Will treatment affect my being able to become pregnant in the future?
• How might each treatment affect my daily life? Can I continue working?
• Is there one treatment you recommend over the others?
• How do you know that these treatments will benefit me?
• What would you recommend to a friend or family member in my situation?

More questions to ask:

• How quickly do I need to make a decision about cancer treatment?
• What happens if I don't want cancer treatment?
• What will cancer treatment cost?
• Does my insurance plan cover the tests and treatment you're recommending?
• Are there any brochures or other printed material that I can take with me? What websites or books do you recommend?
• Are there any clinical trials or newer treatments that I should consider?

In addition to the questions that you've prepared, don't hesitate to ask other questions you think of during your appointment.

What to expect from your doctor

Be prepared to answer some questions about your symptoms and your health, such as:

• When did you first begin having symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Once your healthcare team diagnoses triple-negative breast cancer (TNBC), you may have other tests to figure out the extent of the cancer. This is called the cancer's stage. Your healthcare team uses your cancer's stage to understand your prognosis.

Complete information about the cancer's stage may not be available until after you have breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count and tests to show how well the kidneys and liver are working.
• Bone scan.
• CT scan.
• MRI.
• Positron emission tomography (PET) scan.

Not everyone needs all these tests. Your healthcare team picks the tests for you based on your situation.

First, healthcare professionals typically confirm if the cancer is triple negative by testing for the HER2 protein and the estrogen and progesterone receptors. Then they check to see how big the cancer is, its location and the distance it traveled from where it first started.

Types of staging

The process of breast cancer staging can take place at different times after diagnosis and around treatment. Your stage may change as your care team gets more information about your cancer.

Healthcare professionals use different types of stages at different times.

• Anatomic staging happens after a breast biopsy confirms cancer. It tells your care team about the size of the cancer and whether it has spread. It does not take cancer grade, hormone receptor status or HER2 status into account.
• Clinical prognostic staging happens after all tests on your biopsy sample are complete and your care team knows your cancer grade, hormone receptor status and HER2 status. The prognostic staging process tells your care team more about whether the cancer responds to medical treatment. It helps the team choose the first treatment.
• Pathological prognostic staging is used after surgery once the cancer is removed. This kind of staging looks at factors such as the size of the cancer removed during surgery and the number of lymph nodes removed that contain cancer.
• Postneoadjuvant therapy prognostic staging is used when you receive medicine as your first treatment for breast cancer. This staging process considers the status of the cancer after the medicine is given. It can help your care team decide what to do next. The healthcare team also might consider the residual cancer burden (RCB) score. This score tells the care team how much cancer remains after initial treatments.

Because there are several types of stages that consider different factors, the stages of breast cancer can be confusing and complicated. Ask your healthcare team to explain your stage and what it means for your treatment.

Anatomic stages

Anatomic staging is the simplest form of breast cancer staging. To decide on the anatomic stage, the healthcare team uses the size of the cancer and whether it has spread. Using this type of staging, the stages go from 0 to 4.

• Stage 0. Cancer cells have not grown beyond ducts. This cancer does not spread. Ductal carcinoma in situ is a stage 0 noninvasive cancer.
• Stage 1. The cancer in the breast is less than 1 inch (2.5 centimeters) in diameter. Cancer cells have spread beyond ducts into the breast tissue. There is little or no evidence of cancer in the lymph nodes. Cancer has not spread elsewhere in the body.
• Stage 2. The cancer in the breast is less than 2 inches (5 centimeters) in diameter and has spread to some underarm lymph nodes. Or the cancer is larger than 2 centimeters in diameter and has not spread to the underarm lymph nodes.
• Stage 3. The cancer in the breast is any size and has spread to many underarm lymph nodes. Or the cancer is larger than 2 inches (5 centimeters) in diameter and has spread to some underarm lymph nodes. This stage also includes cancers that spread to the skin, the chest beyond the muscle or the lymph nodes inside the chest wall. Inflammatory breast cancer is considered a stage 3 cancer.
• Stage 4. The cancer in the breast is any size and cancer cells have spread to sites away from the breast and nearby lymph nodes. These sites may include the brain, bones, lungs or liver.

The anatomic stage may be the first stage your healthcare team talks about after your diagnosis.

Triple-negative breast cancer (TNBC) survival rates come from studying many people with this cancer. The rates describe how many people are living five years after diagnosis.

People diagnosed with cancer often want to know the survival rates. The numbers may be helpful to some people because they offer a general sense of what to expect and help put the diagnosis in perspective. Or they may not be helpful. Sometimes the statistics can be confusing, discouraging or overwhelming.

Survival statistics can provide general information about the seriousness of the situation, but they can't predict what will happen to an individual. These statistics include thousands of people with TNBC, including people of different ages, with different health conditions and with different treatment histories.

Keep in mind that your healthcare team uses much more detailed information when talking with you about your individual prognosis and treatment options.

Survival statistics

The National Cancer Institute (NCI) tracks cancer survival rates in the United States based on how far the cancer has spread. Many people expect survival rates by stage, such as stages 1 to 4. But the NCI uses summary staging to report survival rates. It gives rates for cancers that are localized, regional or distant.

• Localized cancer means the cancer is only in the breast. The five-year survival rate is 93%.
• Regional cancer means the cancer has spread to nearby tissues or lymph nodes. The five-year survival rate is 68%.
• Distant cancer means the cancer has spread to other parts of the body, such as the lungs, liver, brain or bones. The five-year survival rate is 15%.

Advances in research continue to improve survival rates. The people included in these numbers were diagnosed more than five years ago, so they may not have had access to the latest treatments.

Your own chances for survival depend greatly on the details of your cancer.

Prognosis

Cancer prognosis describes how likely it is that a cancer can be treated successfully. Healthcare professionals estimate prognosis using information about the cancer and your overall health. To better understand your personal prognosis, talk with your healthcare team. Your care team can explain the factors that affect your situation.

Factors that may affect prognosis for TNBC include:

• The type of triple-negative breast cancer you have.
• The residual cancer burden (RCB) score, which describes how much cancer is left after initial treatment with medicines. If little or no remaining cancer is found during surgery, the RCB score is low and the risk of recurrence also is low. If more remaining cancer is found, the RCB score is higher and so is the risk of recurrence.
• Your overall health.

Your healthcare team can explain how these factors apply to your specific situation and discuss treatments that may offer the best possible outcome.