In this webinar, Dr. Onyinye D. Balogun and Dr. Lisa Newman of Weill Cornell Medicine-New York Presbyterian Hospital Network discuss all aspects of triple negative breast cancer and its impact on women of color in recognition of Black History Month

1. Cancer Prevention, Diagnosis & Treatment
Onyinye Balogun, MD
Assistant Professor of Clinical Radiation Oncology
2.7.19
onb9003@med.cornell.edu
TRIPLE NEGATIVE
BREAST CANCER

2. Cancer Prevention, Diagnosis & Treatment
What is cancer?
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Normal cells
Reproduce when and where it's needed
Self destruct when they become damaged or too old
Cancer cells
Reproduce continually
Ignore signals to self destruct
Image from www.cancerresearchuk.org

3. Cancer Prevention, Diagnosis & Treatment
BACKGROUND
• Most common cancer among women in the United States
• Estimated ~270,000 new cases in 2018
• Risk factors for breast cancer
• Age
• Personal history of breast cancer or noncancerous breast
disease
• Family history of breast cancer (≤50 years old, male breast
cancer)
• Personal history of radiation therapy to the breast or chest
• Obesity
• Alcohol

4. Cancer Prevention, Diagnosis & Treatment
PREVENTION / EARLY DETECTION
• Self-exam
• Mammograms
• Mastectomy if BRCA+
• SERMs/Aromatase inhibitors
• Exercise
• Limit alcohol consumption
Images from http://livsfighten.blogg.se

5. Cancer Prevention, Diagnosis & Treatment
SYMPTOMS & DIAGNOSIS
• COMMON SYMPTOMS
• Breast or armpit lump
• Indentation or puckering of the breast
• Nipple discharge
• Redness/swelling of the breast
• DIAGNOSTIC TESTS
• Mammogram
• ± MRI of the breasts
• Biopsy
Ultrasound-guided breast biopsy
Mammogram-guided breast biopsy

6. Cancer Prevention, Diagnosis & Treatment
TREATMENT
• Surgery
• Lumpectomy
• Mastectomy
• Reconstruction
• Radiation therapy
• Hormonal therapy
• Chemotherapy
• Recommended for most TNBC
patients
• Targeted therapy
• Commonly used for HER2+
breast cancer

7. Cancer Prevention, Diagnosis & Treatment
RADIATION THERAPY DELIVERED BY LINEAR ACCELERATOR

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Transitioning from 2-D to 3-D Conformal Radiation Therapy for Breast Cancer
Doses for Breast Cancer
• Early breast cancer
– 40 Gy in 15 fractions
– RTOG 1005 – 50Gy in 25 fractions vs. 40 Gy in 15
fractions
– Whelan T et al, 42.56 Gy in 16 fractions vs. 50 Gy in 25
fractions
• No difference in local control or OS after >10 years of
follow-up
• Locally Advanced breast cancer
– 50 Gy in 25 fractions

9. Cancer Prevention, Diagnosis & Treatment
Supine position Prone position

10. Cancer Prevention, Diagnosis & Treatment

11. Cancer Prevention, Diagnosis & Treatment
TREATMENT
• 36 patients with Stage I-II triple-negative breast cancer
• Weekly carboplatin x 6 weeks
• Radiotherapy to the breast for 3 weeks (40.5 Gy to the entire breast)
• 2 years later, 94% (34 out of 36) alive and disease free
• Compares favorably with 30% recurrence rate seen at 1-4 years in other
studies
• 64% received additional chemotherapy after carboplatin

12. Cancer Prevention, Diagnosis & Treatment
Drug Developments for TNBC
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• Androgen receptor
• PARP inhibitors

13. Cancer Prevention, Diagnosis & Treatment

14. Cancer Prevention, Diagnosis & Treatment
THANK YOU!
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