Researchers are studying how molecular subtypes of breast cancer may be useful in planning treatment and developing new therapies. Most studies divide breast cancer into four major molecular subtypes:
- Luminal A
- Luminal B
- Triple negative/basal-like
- HER2 type
These same subtypes also appear in ductal carcinoma in situ [38-39].
Other less common molecular subtypes have also been described including normal breast-like, apocrine molecular type and claudin-low type. Breast cancers that do not fall into any of these subtypes are often listed as unclassified.
Learn more about luminal A, luminal B and HER2 type molecular subtypes.
Triple negative/basal-like breast cancer
Triple negative breast cancers are:
- Estrogen receptor-negative (ER-)
- Progesterone receptor-negative (PR-)
- HER2/neu-negative (HER2-)
There are several subsets of triple negative breast cancer. One subset is referred to as basal-like because the tumors have cells with features similar to those of the outer (basal) cells surrounding the mammary ducts. Most basal-like tumors contain p53 mutations [30,40,45].
Most triple negative tumors are basal-like and most basal-like tumors are triple negative. However, not all triple negative tumors are basal-like and not all basal-like tumors are triple negative (as shown in the figure below).
About 15 to 20 percent of breast cancers are triple negative or basal-like [30,40-45]. These tumors tend to occur more often in younger women and African American women (more on race/ethnicity and subtypes of breast cancer) [30,44,48,50-54]. And, most BRCA1 breast cancers are both triple negative and basal-like [44,50,55-56].
Triple negative/basal-like tumors are often aggressive and have a poorer prognosis (at least within the first five years after diagnosis) compared to the estrogen receptor-positive subtypes (luminal A and luminal B tumors) [30,40,43-44,57].
Learn more about BRCA1 mutations.
Treatment of triple negative/basal-like breast cancer
Triple negative/basal-like tumors are usually treated with some combination of surgery, radiation therapy and chemotherapy. These tumors cannot be treated with hormone therapies or trastuzumab (Herceptin) because they are ER- and HER2-.
Learn more about breast cancer treatment.
Learn more about breast cancer surgery.
Learn more about radiation therapy.
Learn more about chemotherapy.
Emerging areas in treating triple negative/basal-like breast cancer
The genes linked to basal-like tumors are not well understood at this time and thus, targeted therapies do not yet exist. However, potential targets for future therapies include the EGF receptor, aB-crystallin and cyclin E .
Learn about our work with the Triple Negative Breast Cancer Foundation (TNBC) and research we are funding to study triple negative breast cancer.
Clinical trials for people with triple negative/basal-like breast cancers
Clinical trials studying treatment options for triple negative/basal-like tumors are underway. After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service that can help you find a clinical trial that fits your health needs. Learn more about this program or search BreastCancerTrials.org for clinical trials on triple negative breast cancer.
Learn more about clinical trials.
Race/ethnicity and triple negative/basal-like breast cancer
The prevalence rates of the four subtypes of breast cancer appear to differ by race.
In studies of U.S. and British women, triple negative/basal-like tumors appear to be more common among black women, especially those who are premenopausal, compared to white women [30,44,52-54,61-63]. Although the reasons for this are not clear, some studies suggest lifestyle factors might play a role. Some findings show African American women tend to have lower rates of breastfeeding and to carry excess weight in the abdomen area compared to other women, all of which may increase the chances of having triple negative/basal-like tumors [52,60,64-68].
It may also be that certain reproductive and lifestyle factors protect more against ER+ breast cancers than ER- breast cancers, including triple negative breast cancers. So, although African American may be more likely than white women to have these protective factors, they may not lower the risk of triple negative breast cancers as much as they lower the risk of ER+ cancers. For example, African American women are more likely than white women to [52,65,68-70]:
- Have more children
- Have a younger age at first birth
- Be overweight or obese (before menopause)
Although these factors lower the risk of breast cancer, this benefit may be limited to ER+ breast cancers [60,65,69-70]. There is even some evidence that these factors may increase the risk of triple negative breast cancers [60,65,68-72]. However, data are limited. These topics are under active study.
Higher rates of triple negative/basal-like tumors may explain, to some degree, the poor prognosis of breast cancers diagnosed in younger black women. Further, luminal A tumors, which have the best prognosis of the subtypes, occur less often among premenopausal African American women compared to postmenopausal African American women and compared to white women of either menopausal status .
Komen Support Resources
- Our breast care helpline 1-877 GO KOMEN (1-877-465-6636) provides free, professional support services and help finding local support groups. Our trained and caring staff are available to you and your family Monday through Friday from 9:00 a.m. to 10:00 p.m. EST and from 6:00 a.m. to 7:00 p.m. PST.
- Our Message Boards offer online forums to share your thoughts or feelings about subjects related to breast cancer. Our Survivors of Less Common Cancers (Triple Neg / HER2+ / IBC) forum within the Message Boards offers triple negative breast cancer survivors a place to share their own unique experiences and challenges.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.