Triple Negative Breast Cancer (Female, age 74) Stage T1C N1 (Sentinel Node 4mm- 1 out of 6)

Hello TheCruiseMermaid,

Thanks for getting in touch. My name is Helen, I’m one of the Cancer Information Nurses on the Macmillan Support Line. Welcome to the online community. 

Just a little note to say I see that you use the American spelling for certain words – this might be because your computer auto-corrects to the US version (or you prefer the spelling, of course!). However, just in case you are contacting us from outside the UK, I should say that Macmillan’s information relates to UK treatment.

You have given a very clear outline of your breast cancer pathology and explained that it is Stage 2, triple negative, invasive ductal cancer (no special type) with additional ductal cancer in situ features. 

You mentioned that the size of the tumour at biopsy differed from the size of the cancer that was removed at surgery. It’s usually the case that the size of a cancer is measured using the diagnostic mammogram and ultrasound data, rather that the biopsy, as this is only a small part of tissue removed from the cancer for diagnostic purposes. The measurement for the biopsy (and the imaging) will differ because the cancer, once removed, has been measured in its entirety.

The Nottingham Criteria is a system used by pathologists to determine the grade of a breast cancer. The Mitotic rate indicates the number of malignant cells that are actively dividing and is reported as a number from 1 to 3. The higher the score, the more quickly the tumour cells are growing.

You have outlined the proposed treatment options as chemotherapy and radiotherapy and wondered about the statistical benefits. You explained that you have imputed your pathology data into the online decision-making tool, PREDICT, a tool devised and used by breast cancer teams across the UK, which has been independently validated by US oncologists. 

You have indicated that the percentage of benefit appears small and wondered if treatment was necessary.

Making a treatment decision is a very personal one. Your consultant will have offered the option of additional treatments having determined the benefits outweigh the risks, given you are fit and deemed able to manage the treatment.

However, while your breast specialist will be an expert in your cancer, you are the expert in you. You may feel the risks outweigh the benefits and that your quality of life will be adversely impacted, for instance.

Some people faced with a treatment decision, would prefer to ‘cover all bases’, even if the statistical benefit is small. Others may feel that the things they currently do and enjoy may not be possible with additional therapies and would prefer to decline the offer.

What you would like for your future is important to articulate to your team, so that the decision is a collaborative one. Your breast care nurse and your clinician will be able to talk through your concerns to help you make an informed decision.

Do establish with them that the PREDICT statistic you have is correct for you and perhaps take a look at our booklet titled, Making Treatment Decisions; it has some excellent tips on how to approach your decision.

Also, our triple negative breast cancer forum is a warm and inclusive group for peer support.

I do hope this information is useful. Please don’t hesitate to get back in contact by email, webchat or phone, if you need further information or support.

The Macmillan Support Line offers practical, clinical, financial and emotional support. You can call us free from landlines and from most mobile phone networks* on 0808 808 00 00, 7 days a week, 8am – 8pm.

Best wishes, Helen

Cancer Information Nurse Specialist 

Ref HM/ AMcG