It's hard to put into words the fear and shock you feel when you find out you have breast cancer. You have so many questions in your mind. It's normal to have questions like, "Why did this happen to me?", "What do I do now?", "Can this be cured?". In this journey, I'm trying to explain things simply and in a language you can understand. Knowing exactly what type of cancer you have is like understanding the enemy before starting a battle. That's the first and most important step in choosing the treatment that's right for you.
Hormone Receptor-Positive Breast Cancer
This is the most common type of breast cancer. Roughly speaking, about 80 out of every 100 breast cancers fall into this category.
So what does this "hormone-dependent" mean?
Simply think about it. Our bodies, especially women's bodies, have two naturally occurring hormones called estrogen and progesterone . These are essential for normal processes in our bodies. However, some cancer cells are very "addicted" to these hormones. That is, on the surface of these cancer cells, there are little "receptors" or doors that these hormones can come and stick to. When the estrogen hormone comes and knocks on that door, the cancer cell receives nourishment from it and begins to grow and divide. Just like when you water a plant, it grows bigger.
If your medical report says `ER-positive` (Estrogen Receptor-Positive), it means that your cancer cells are sensitive to the hormone estrogen. If it says `PR-positive` (Progesterone Receptor-Positive), it means that it is sensitive to the hormone progesterone. If it is sensitive to either of these, the cancer is called a hormone receptor-positive cancer.
This is actually good news in a way. Because if we know what cancer uses to grow, we can block that pathway and control the cancer. That's what "hormone therapy" is used for.
Hormone therapy is usually given after surgery, chemotherapy, or radiation to prevent the cancer from coming back. These medications work by closing the "doors" on cancer cells, or by stopping the body from making estrogen.
| Treatment category | Simple explanation and examples |
|---|---|
| SERMs (Selective ER Modulators) | These block the hormone receptor on the cancer cell, preventing the hormone from entering. Examples: Tamoxifen, Toremifene . |
| SERDs (Selective Estrogen Receptor Degraders) | These not only block the receptor, but also destroy it. Examples: Fulvestrant (Faslodex), Elacestrant (Orserdu) . |
| Aromatase Inhibitors | These stop the body from producing the hormone estrogen (often given to postmenopausal women). Examples: Anastrozole (Arimidex), Letrozole (Femara) . |
| LHRH Agonists | These temporarily stop the ovaries from producing estrogen. Examples: Goserelin (Zoladex), Leuprolide (Lupron) . |
| Other Targeted Therapies | Other drugs that increase the success of hormone therapy. Examples: Palbociclib (Ibrance), Ribociclib (Kisqali), Alpelisib (Piqray) . |
HER2-Positive Breast Cancer
Now let's talk about another type. Some breast cancer cells (about 20% of all cancers) produce too much of a special protein on their surface called HER2 (Human Epidermal growth factor Receptor 2) .
Think of HER2 as a little antenna that tells the cancer cell to "grow faster, divide faster." A normal cell has only a few of these antennas. But a HER2-positive cancer cell has many of these antennas. That's why these types of cancers can be more aggressive .
But there's good news here too. With advances in science, there are now "targeted therapies " that target and destroy these very HER2 antennae. Because these find and attack only the cells that have too much HER2, there is less damage to normal cells.
The main and most effective drug given for this is Trastuzumab (Herceptin) . This helps greatly in preventing the cancer from coming back. However, there is a small risk of some effects on the heart or lungs when taking this treatment. Don't worry about that , your doctor will always check for it.
| Other targeted therapies used for HER2-positive cancers | |
|---|---|
| Pertuzumab (Perjeta) | Ado-trastuzumab emtansine (Kadcyla) |
| Lapatinib (Tykerb) | Neratinib (Nerlynx) |
| Tucatinib (Tukysa) | Enhertu (Fam-trastuzumab deruxtecan-nxki) |
"Triple-Negative" Breast Cancer
This is the third main type. About 10%-20% of breast cancers fall into this type. Do you know why it's called "triple-negative" or "triple negative"?
Because in these cancer cells ,
1. No estrogen receptor (ETU) .
2. No progesterone receptor (PR).
3. There is not much HER2 protein.
Because these cancer cells lack the three main targets we discussed earlier, neither hormone therapy nor HER2-targeted therapies like Herceptin work on them. So treating them can be a bit challenging.
This type of cancer is often linked to a mutation in a gene called BRCA1 , so if you have triple-negative cancer, your doctor may also suggest genetic testing.
This type is mainly treated with surgery, chemotherapy, and radiation . However, there are now new treatments that are specific to this type.
- PARP Inhibitors: Drugs like Olaparib (Lynparza) and Talazoparib (Talzenna) are used for people with BRCA gene mutations. These block the ability of cancer cells to repair themselves.
- Immunotherapy: Drugs like Atezolizumab (Tecentriq) help fight cancer cells by using our own immune cells.
This may all seem a little complicated. That's normal. The important thing is to remember that no matter what type of cancer you have, there are treatments available today that are suitable for it. Your doctor and medical team will work with you to create the best treatment plan for you.
Take-Home Message
- Breast cancer is divided into 3 main types: Hormone Receptor-Positive, HER2-Positive, and Triple-Negative .
- Knowing what type of cancer you have is essential for planning treatment.
- Hormone-positive cancers respond well to hormone therapy.
- Although HER2-positive cancers grow rapidly, there are highly effective targeted therapies developed specifically for them.
- Although treating triple-negative cancers is challenging, they can be fought with chemotherapy and new targeted therapies.
- If you have any questions about anything in your medical record, don't be afraid to ask . Ask your doctor for a clear explanation. You are not alone, and there are many people who can help you.
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