Triple-negative breast cancer: A silent threat to women under 40

KUALA LUMPUR - Breast cancer is the most commonly diagnosed cancer among female patients and is the leading cause of cancer-related death.

Not only in Malaysia but globally, numerous campaigns and initiatives have been launched to raise awareness among women about the dangers of breast cancer and to improve their ability to recognise its early signs for prompt prevention.

Breast cancer is a disease characterised by the formation of abnormal cells in the breast that grow uncontrollably, eventually developing into cancer. If not detected early, these cancer cells can spread to other organs and may become life-threatening.

Today, women are not only concerned about the typical form of breast cancer but also about triple-negative breast cancer (TNBC), which has emerged as another significant threat.

LIKE A NIGHTMARE

Being diagnosed with stage three triple-negative breast cancer at the age of 39 felt like a nightmare for Lim Kim Foong.

Kim, also the Breast Cancer Welfare Association Malaysia (BCWA) president shared that it was incredibly difficult to face the heartbreaking news when her doctor informed her four years ago, during the height of the Covid-19 pandemic, that she had triple-negative breast cancer.

"At that moment, I was deeply saddened and in denial about being diagnosed with triple-negative breast cancer. What made it even harder to accept was that I had no family history of breast cancer, and at 39, I was at the peak of my career. I kept asking myself, 'Why me?'" she shared in a recent interview with Bernama.

Kim said she underwent lumpectomy, chemotherapy, and radiotherapy, a process that took seven months to complete. She has now been in remission for four years.

Fighting cancer, Kim said, requires strength and the determination to rise and battle the disease. Alongside her own struggle with the illness, she also faced immense sorrow when her only brother passed away during her second round of chemotherapy.

"Before I was diagnosed with breast cancer, I lost my job, just like many others, due to the Covid-19 pandemic. Then, in October 2020, my only sibling, my brother, passed away at the age of 43 due to heart failure," she shared.

"My brother left behind our elderly mother and his 10-year-old son. This ordeal was overwhelming, and I nearly gave up as I was coping with my own illness, caring for my mother and becoming the guardian of a young boy without any income.

"However, I am grateful and fortunate to have insurance, as well as the support of my family, friends, and the encouragement from BCWA," said the former general manager of a private company in Kuala Lumpur.

Kim also shared words of encouragement for women battling breast cancer, urging them to stay strong and reminding them that they are not alone in their struggle.

"There are many patient support groups, such as BCWA, that provide emotional support, counselling, rehabilitation activities, and accurate information to help guide you through this journey. Don’t stay in sorrow," she said.

Touching on the level of knowledge and awareness among young women regarding TNBC, Kim noted that people generally only know about breast cancer, but many are unaware that there are different subtypes of breast cancer, such as TNBC.

"Information and awareness about triple-negative breast cancer need to be increased continuously so that more people are aware. This is important because each patient's journey and treatment are different, (even when it comes to side effects)," she said.

At BCWA, the association organises various activities to raise public awareness about the disease. This includes collaborating with different stakeholders to create both online and offline resources that provide accurate information about TNBC. One such initiative is the "I Can, We Will" programme which is available on its website and Facebook.

Additionally, BCWA organises forums with medical professionals, patients, and survivors of breast cancer.

WHAT IS TRIPLE-NEGATIVE BREAST CANCER

Awareness of TNBC must be raised, particularly since this type of cancer often affects young women under the age of 40.

Sharing insights on TNBC, Dr Hafizah Zaharah Ahmad, a Consultant Oncologist at Sunway Medical Centre Velocity (SMCV) explained that triple-negative breast cancer is a type of breast cancer that lacks the three common receptors typically associated with most breast cancers.

She said these three receptors are the estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2).

"Because it lacks these receptors, this type of cancer does not respond to hormone therapies (such as tamoxifen) or HER2-targeted treatments (such as trastuzumab/Herceptin)," she said.

Elaborating on the differences, Dr Hafizah explained that triple-negative breast cancer differs from regular breast cancer in terms of its biological characteristics and its response to treatment.

"Firstly, the difference between the two lies in receptor status, where regular breast cancer usually has receptors for ER, PR, or HER2 protein. Medications can target these receptors, making it easier to treat these types of cancer.

"Triple-negative breast cancer lacks all three types of receptors, meaning it is estrogen receptor-negative (ER-), progesterone receptor-negative (PR-), and HER2 receptor-negative (HER2-). The absence of these receptors makes it more challenging to treat, as drugs targeting hormones (such as tamoxifen or aromatase inhibitors) or therapies targeting HER2 (like Herceptin) are ineffective against TNBC," she explained.

She also noted that triple-negative breast cancer is more common among younger women, especially those with BRCA1 (breast cancer gene 1) genetic mutations.

MORE AGGRESSIVE

Compared to regular breast cancer, TNBC is an aggressive form of cancer. It grows rapidly, is more likely to have spread by the time it is detected, and has a higher risk of recurrence after treatment.

"Additionally, patients with TNBC have limited treatment options. As TNBC lacks ER, PR, and HER2 receptors, it does not respond to targeted therapies that are effective for other types of breast cancer. This makes chemotherapy one of the few standard treatment options available.

"Triple-negative breast cancer is also more prone to metastasize, spreading to other parts of the body, especially to areas like the brain and lungs," she said.

However, the oncologist noted that triple-negative breast cancer can respond to chemotherapy, along with newer treatments such as immunotherapy.

"If detected early, treatment can yield positive results," said Dr Hafizah, who treats between two to four new cases, including follow-up cases of TNBC cancer patients every month.

Citing figures, she said that in Malaysia, approximately 10 to 15 per cent of all breast cancer cases are triple-negative breast cancer.

SYMPTOMS

To recognise the signs and symptoms of TNBC, Dr Hafizah Zaharah advised paying attention to several key indicators, including a hard lump that remains stationary when touched.

"This is the most common sign and may be felt in the breast or under the armpit. A change in the size or shape of one of the breasts is among the signs of breast cancer. Other signs include abnormal discharge from the nipple or an inverted nipple.

"The skin of the breast may appear dimpled, wrinkled, or take on the texture of an orange peel (known as peau d'orange). It may also become reddish or show signs of inflammation, even without pain,” she added.

Dr Hafizah also said that while early-stage breast cancer is usually painless, some women with TNBC may experience discomfort or pain in the breast or armpit area.

In advanced stages, symptoms such as fatigue, weight loss, or pain in other parts of the body may indicate that the cancer has spread to other organs (metastasis), she added.

Regarding treatment for this type of cancer, Dr Hafizah said the procedures typically include chemotherapy, surgery, radiation therapy, immunotherapy, and targeted therapy.

NEED TO BE AWARE

It is crucial for young women to stay vigilant about their health, as TNBC can affect women of any age.

Dr Hafizah emphasised the importance of early detection, suggesting several steps that can be taken, such as observing any changes in the body and immediately consulting a surgeon if a lump in the breast grows.

"Women must understand the risk factors because being young is no guarantee against breast cancer. TNBC is often diagnosed in women under 40.

"Additionally, sudden changes during pregnancy may be misinterpreted as pregnancy side effects, but any abnormal or suspicious changes in the breast should still be evaluated by a doctor, she said.

The oncologist advised all women, regardless of age, to perform self-breast exams every month, especially in the week following menstruation.

"Pay attention to any lumps, changes in shape, skin colour, or unusual nipple retraction. Although TNBC can develop quickly, regular examinations allow for early detection. Never ignore symptoms, as young women often dismiss signs like hard lumps or breast changes, assuming breast cancer only affects older women," she said.

Dr Hafizah also encouraged young women to participate in breast cancer awareness programmes, such as seminars or health campaigns, to increase their understanding of TNBC.

Additionally, she recommended that women adopt a healthy lifestyle by maintaining a balanced diet, exercising regularly, and avoiding harmful habits like smoking or excessive alcohol consumption.

She said TNBC remains an active area of research, with scientists working to find more effective treatments and better understand why it disproportionately affects younger women. - BERNAMA