HER-2 Negative Breast Cancer: Treatment Options and Prognosis

HER-2 Negative Breast Cancer: Treatment Options and Prognosis

HER2− breast cancer accounts for around 65-70% of all breast cancer cases. In this type of breast cancer, the cancer cells do not overexpress the HER-2 protein which helps in dividing and growing cancer cells rapidly. Knowing the HER-2 status helps determine the best treatment plan and predict prognosis. This article discusses the key aspects of HER2− breast cancer.

Types of Breast Cancer
Breast cancers are broadly classified into three main types based on the presence of receptors on the cancer cells - hormone receptor-positive, HER2-positive, and triple-negative. HER2− breast cancer can be either hormone receptor-positive or triple-negative.

Hormone receptor-positive HER2− breast cancer
Around 50-60% of breast cancers are hormone receptor-positive and do not overexpress the HER-2 protein. This means the cancer grows in response to the hormones estrogen and/or progesterone. Treatment involves medications that block the effects of hormones or lower their levels in the body. Common medication options include tamoxifen, aromatase inhibitors, luteinizing hormone-releasing hormone agonists, and ovarian ablation. Chemotherapy may also be recommended depending on the risk level.

Triple-negative HER-2 negative breast cancer
Around 10-20% of breast cancers are triple-negative meaning they lack estrogen receptors, progesterone receptors, and do not overexpress HER-2. These cancers tend to be more aggressive and have poorer prognosis than other types. The treatment approach relies on chemotherapy as these cancers do not respond to hormones or HER-2 targeted therapies. Newer immunotherapies are also being studied.

Prognosis
The prognosis or outlook of HER2− breast cancer depends on factors like tumor size, lymph node involvement, and tumor grade. In general, hormone receptor-positive cancers have a better prognosis than triple-negative cancers. Some key points about prognosis:

- Hormone receptor-positive cancers - Her-2 Negative Breast Cancer With proper treatment including hormonal therapy, the 5-year survival rate is over 80%.

- Triple-negative cancers - The 5-year survival rate is lower at around 75-80% if the cancer has not spread. It drops to below 30% if it has spread to other parts of the body.

- Lymph node involvement - At least 3 positive lymph nodes indicates a less favorable prognosis regardless of other factors.

- Tumor size - Larger tumor size of more than 2 cm is associated with worse prognosis.

- Histological grade - Higher grade tumors with abnormal cells tend to have poorer outcomes.

- Gene expression profiles - Recent tests examining multiple genes can better predict risk of recurrence and help guide treatment decisions.

Treatment and Management
The main treatment approaches for HER2− breast cancer depend on whether it is hormone receptor-positive or triple-negative.

For hormone receptor-positive cancers:
- Surgery to remove the tumor (lumpectomy or mastectomy)
- Radiation therapy after breast-conserving surgery
- Medications like tamoxifen or aromatase inhibitors as hormonal therapy for 5-10 years
- Chemotherapy may be recommended for higher-risk cases
- Regular follow-ups and testing to check for recurrence

For triple-negative cancers:
- Surgery to remove the tumor
- Chemotherapy both before and after surgery
- Radiation therapy after breast-conserving surgery
- Consider newer immunotherapy drugs if cancer has spread
- Close monitoring for recurrence due to aggressive nature
- Clinical trials exploring targeted therapies

The goal is complete removal of the cancer with proper adjuvant treatment to lower the risk of recurrence. Lifelong follow-ups involving regular exams and scans are necessary to diagnose any relapse at an early stage. Supportive therapies help manage side effects and improve quality of life. Ongoing research continues to enhance outcomes.

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