Basal-like and Triple-negative Breast Cancers

A Critical Review With an Emphasis on The Implications for Pathologists and Oncologists

Sunil Badve; David J Dabbs; Stuart J Schnitt; Frederick L Baehner; Thomas Decker; Vincenzo Eusebi; Stephen B Fox; Shu Ichihara; Jocelyne Jacquemier; Sunil R Lakhani; José Palacios; Emad A Rakha; Andrea L Richardson; Fernando C Schmitt; Puay-Hoon Tan; Gary M Tse; Britta Weigelt; Ian O Ellis; Jorge S Reis-Filho

Disclosures

Mod Pathol. 2011;24(2):157-167. 

In This Article

What is a Triple-negative Breast Cancer?

In contrast to the controversy regarding the definition of basal-like breast cancers, there is uniform agreement that triple-negative cancers are defined as tumors that lack ER, PR, and HER2 expression. These tumors account for 10–17% of all breast carcinomas,[1,24,28,59–65] depending on the thresholds used to define ER and PR positivity and the methods used for HER2 assessment. Future studies are likely to produce slightly different prevalence rates for triple-negative breast cancers given the change in the definition of HER2 and hormone receptor positivity according to the ASCO/CAP guidelines.[66,67] Despite these definitional issues, the clinical interest in these tumors stems from the lack of tailored therapies for this group of breast cancer patients and the overlap with the profiles of basal-like cancers.

The main characteristics of triple-negative cancers that have emerged from the literature illustrate their similarities to basal-like cancers, including the fact that they more frequently affect younger patients (<50 years),[24,30,31,59,61,62] are more prevalent in African-American women,[62–64] often present as interval cancers, and are significantly more aggressive than tumors of other molecular subtypes.[24,28,59,61–63] This aggressiveness is best exemplified by the fact that the peak risk of recurrence is between the first and third years and the majority of deaths occur in the first 5 years following therapy.[59,61] Patients with triple-negative cancers,[59,63] similar to those with basal-like cancers,[42] have a significantly shorter survival following the first metastatic event when compared with those with non-basal-like/non-triple-negative controls.

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