Just Diagnosed With Triple-Negative Breast Cancer: Questions to Ask About Your Treatment Options

Triple-negative breast cancer is a subtype of breast cancer that makes up about 10% to 20% of diagnoses. Tumors are called “triple negative” when they do not express estrogen, progesterone receptors or human epidermal growth factor receptor 2 (HER2). When triple-negative breast cancer is found only in the breast, it is called “early stage.” If the cancer has spread to the lymph nodes in the underarm, it is called “locally advanced.” Early-stage and locally advanced breast cancers are called stages 1 to 3.

Early-stage and locally advanced triple-negative breast cancer is generally treated with surgery, radiation therapy, chemotherapy, and/or immunotherapy. In choosing a treatment for stage 1 to 3 breast cancer, the goal is to cure the cancer and reduce the risk of it coming back. Treatment for early-stage and locally advanced breast cancer can last for about a year.

The order in which you may receive surgery, radiation therapy, chemotherapy, and/or immunotherapy depends on several factors, including the size of the tumor. However, in general, you may receive:

• Surgery should be done first if the tumor is small and only limited to the breast. Surgery will then typically be followed by radiation therapy. You may or may not need chemotherapy for a small tumor.
• Chemotherapy and immunotherapy first if the tumor in the breast is larger or the cancer has spread to the lymph nodes. This is to help shrink the tumor before surgery and radiation therapy. Depending on how well the treatment works to shrink the tumor, you may then receive immunotherapy alone after the surgery or immunotherapy with chemotherapy.

After a diagnosis of stage 1 to 3 triple-negative breast cancer, you may feel overwhelmed or anxious about your treatment options. Before treatment begins, you will meet with your health care team to choose a treatment plan. Your health care team may include a surgeon, radiation oncologist, and/or medical oncologist. During these appointments, it is important to ask any questions you may have about your diagnosis and treatment plan. If you are not sure what to ask, the questions below can serve as a guide to help you get started.

Questions to ask about surgery

There are different kinds of surgeries that may be recommended to treat triple-negative breast cancer. Your doctor may recommend a lumpectomy, during which only the tumor in the breast is removed, or a mastectomy, during which the entire breast is removed. Your doctor may also recommend removing lymph nodes during the procedure. When only a few lymph nodes in the underarm are removed, it is called a sentinel lymph node biopsy. When all the lymph nodes in the underarm are removed, it is called an axillary lymph node dissection.

The extent of the surgery will depend on the stage of the tumor. The more advanced the disease is, the more extensive the surgery will be. The goal of surgery is to remove all of the tumor.

Before surgery, your surgeon will discuss the procedure with you. Consider asking the following questions:

Questions about preparing for surgery

• Are you a specialist in treating breast cancer with surgery? How many breast surgeries have you had before?
• What type of surgery is recommended: lumpectomy or mastectomy? If you have a mastectomy, will you be removing only the breast with the tumor or both breasts?

• Do you need to remove any lymph nodes? If so, how many? What are the risks and benefits of removing the lymph nodes?

• Do I need to stop taking any medications or supplements before the surgery?
• Do I need any tests done before this surgery?
• When will the surgery take place?
• What type of anesthesia will I receive for this surgery?
• How long will the surgery last?

Questions about recovering from surgery

• How long will I need to stay in the hospital after the surgery?
• If I am receiving a mastectomy, will there be a plan for breast reconstruction after the breast is removed? Will you coordinate this with the plastic surgeon?
• Will I be able to take a shower after the surgery?
• Will I need any drains placed after the surgery? How long will the drains need to stay in?
• Will I need someone to take care of me after surgery?
• What kind of clothes can I wear after surgery?
• How much pain will I have after surgery? What pain medications will I need, and how long will I need them for?
• Will I experience any swelling in the breast or arm after surgery?
• How long will it take me to recover from the surgery?
• Will I need radiation therapy after surgery?
• What long-term complications can I experience after surgery?
• Do I need physical therapy after surgery? What are the benefits of physical therapy?
• How soon can I return to work after surgery?
• Am I able to do physical activity after surgery? Will I have any activity restrictions?
• When will I receive the results from my surgery? Can you give me a copy of the results?
• If all the cancer is removed, do I still need to receive chemotherapy, immunotherapy, and/or radiation therapy after the surgery?

Questions to ask about radiation therapy

Generally, radiation therapy is given after surgery for triple-negative breast cancer. The goal of radiation therapy is to destroy any remaining cancer cells. Radiation therapy is typically given daily over 3 to 4 weeks. If you will be receiving radiation therapy, consider asking your radiation oncologist these questions:

• Will radiation therapy prevent my cancer from coming back?
• How is the role of radiation therapy different from surgery and chemotherapy?
• What are the side effects of radiation therapy?
• Does radiation therapy cause any pain during or after treatment?
• How should I get ready for the treatment? What kind of clothes should I wear? Should I apply any cream or lotion to my breasts to decrease the risk of radiation burns?
• Will I be able to work during radiation therapy?
• Should I avoid eating certain foods or using certain products during my treatment?
• Will receiving radiation therapy affect my chances of becoming pregnant in the future?
• How long will the treatment last?
• If I need to get breast reconstruction after my surgery, can I still get radiation therapy?
• Are there any long-term risks of radiation therapy, such as heart problems or other cancers?
• Can I get radiation therapy and chemotherapy/immunotherapy at the same time?
• How soon after surgery can I get radiation therapy?
• If I experience any radiation burns, can they be treated?
• Is radiation treatment covered by my insurance?

Questions to ask about treatments using medication

Chemotherapy and immunotherapy are the main medications used to treat triple-negative breast cancer. Chemotherapy works by killing the cancer cells directly. Immunotherapy works by activating the body’s immune system to fight cancer. Both chemotherapy and immunotherapy can cause side effects, but many of these can be treated. For example, your doctor may suggest medication to treat nausea and vomiting before starting chemotherapy. Talk with your doctor about what side effects you can expect from the medication you will be receiving.

It is also important to know that chemotherapy and immunotherapy can affect your chances of getting pregnant in the future. If you are planning a pregnancy or if you are pregnant, talk to your doctor and a fertility specialist about preserving your fertility.

When you meet with your medical oncologist, consider asking these questions:

• Do you recommend I receive chemotherapy, immunotherapy, or both?
• How many cycles of treatment will I need?
• What are the benefits of these treatments?
• When will my treatment start, and how long will it last?
• Do I need an intravenous (IV) line or port to receive this medication, or will I take it by mouth?
• What are the side effects of this treatment, and how will they be managed? Can any of these side effects become permanent or life-threatening?
• What happens if I am unable to complete this treatment because of side effects?
• Will this treatment impact my ability to become pregnant? Should I meet with a fertility specialist before treatment?
• Should I be using contraception during my treatment to avoid pregnancy?
• What happens if I become pregnant during my treatment? Are there any risks to the baby?
• If I would like to become pregnant after treatment, how long should I wait before trying?
• Will I lose my hair from this treatment? What can I do to prevent hair loss?
• Will I have nausea and vomiting during treatment? What can I do to prevent it or treat it?
• Will this treatment affect my relationship with my partner or ability to have sex?
• Should I exercise during treatment? How much exercise should I do?
• Can I take any nutritional supplements during my treatment?

Questions to ask about follow-up care

After you have completed your treatment for triple-negative breast cancer, you will continue to see your health care team on a regular basis. You can expect to receive a mammogram every year and to have a physical examination during regular visits with your doctor to check for any signs of the cancer coming back. Consider asking these questions about the follow-up care you will need after treatment is complete:

• What are the chances of this cancer coming back?
• How often would you like to see me after treatment is completed?
• What tests will you be doing to monitor for signs of the cancer coming back? How often will these tests be needed?

Remember that throughout the course of your treatment and follow-up care for triple-negative breast cancer, your health care team is there to help. Always talk with your doctor if you have any questions or concerns about any part of your care.