Health Awareness

Triple-negative breast cancer: risk factors, symptoms, and diagnosis

November 29, 2024

two women are talking and holding their hands.

Breast cancer is one of the most commonly diagnosed cancers in the world. There are many different types and subtypes of breast cancer that are defined by where in the breast they begin, how much they have grown or spread and how they behave. One of the more aggressive types is triple-negative breast cancer (TNBC).

What’s triple-negative breast cancer?

The tumours of patients with breast cancer may be tested for three receptors, or proteins, that make cancer grow. If the tumour tests negative for estrogen and progesterone receptors and does not over express HER2, then that patient is diagnosed with TNBC.

In New Zealand, around 3,500 people are diagnosed with breast cancer each year. About 10-20% of breast cancers are TNBC.

Risk factors for triple-negative breast cancer

Primary risk factors for TNBC include:

  • Sex: People assigned female at birth are at higher risk for TNBC compared to people assigned male at birth.
  • Age: TNBC is more common in women younger than other breast cancer types.
  • Genetic mutations: Mutations in genes such as BRCA1 and BRCA2 are strongly associated with TNBC.

What are the symptoms of breast cancer?

TNBC can have the same signs and symptoms as other common types of breast cancer. However,  signs and symptoms of breast cancer differ from person to person, and some will never show symptoms.

Here are some symptoms of breast cancer to watch out for:

  • Swelling of all or part of a breast
  • Skin dimpling
  • Breast or nipple pain
  • Nipple retraction
  • Nipple or breast skin that’s red, dry, flaking or thickened
  • Nipple discharge
  • Swollen lymph nodes, under the arm or near the collar bone

Many breast changes are not a sign of cancer, but it’s always important to have any changes checked by a doctor.

The Breast Cancer Foundation NZ recommends women start being breast aware from the age of 20.

This means understanding the usual look and feel of your breasts and checking for any changes.

How is triple-negative breast cancer diagnosed?

If you’re experiencing symptoms, speak with your doctor, especially if you have a higher risk of having TNBC. Some tests include:

  • A breast exam by a doctor: During a breast exam, your doctor will check your breasts for any possible signs of breast cancer or other breast problems.
  • Mammogram: An X-ray of the breast that allows doctors to look for changes in breast tissue. Mammograms can often find breast cancer early.
  • Magnetic resonance imaging (MRI): An MRI uses radio waves and strong magnets to make detailed pictures of the inside of the breast. Doctors use MRIs along with mammograms to screen people who are considered at high risk for breast cancer.
  • Ultrasound: An ultrasound uses sound waves and their echoes to make computer pictures of the inside of the breast. While not typically used as a routine screening test for breast cancer, an ultrasound can be useful for looking at some breast changes such as lumps – especially when they can be felt but not seen on a mammogram.
  • Biopsy: After a breast cancer diagnosis is made with a biopsy, a health care provider may determine whether a patient has TNBC with an assessment of cells from that biopsy, which are checked for estrogen, progesterone and HER2 receptors, to determine the cancer subtype.

What are the stages of triple-negative breast cancer?

Stage 0

Cancers diagnosed at stage 0 are confined to the milk ducts or lobules of the breast.


Stage 1

Cancers diagnosed at stage 1 are small, localised and have not spread beyond the lymph nodes closest to the breast.


Stage 2

Stage 2 TNBC may have spread regionally (beyond the initial site), but not beyond the lymph nodes in the underarm area.


Stage 3

Stage 3 TNBC has extended beyond the immediate region of the tumour and may have invaded nearby lymph nodes and muscles but has not spread to distant organs.


Stage 4

Stage 4 TNBC, also known as metastatic breast cancer, has spread distantly to other areas or organs of the body, such as the brain, bones, lung or liver.


For further information about breast cancer or if you notice any breast changes, please talk to your doctor.

If you require extra support if you’ve been diagnosed with breast cancer, it may be helpful to reach out to a patient organisation.

References:

Arnold M et al. Triple-Negative Breast Cancer: A Brief Review About Epidemiology, Risk Factors, Signaling Pathways, Treatment and Role of Artificial Intelligence. Breast. 2022:66:15-23.

Almansour NM. Triple-Negative Breast Cancer: A Brief Review About Epidemiology, Risk Factors, Signaling Pathways, Treatment and Role of Artificial Intelligence. Front Mol Biosci. 2022:9:836417.

American Cancer Society. 2021. Types of Breast Cancer. Available at: https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer.html Accessed: 08 April 2022.

Health New Zealand – Te Whatu Ora. 2024. Cancer data web tool. Available at: https://tewhatuora.shinyapps.io/cancer-web-tool/. Accessed 12 November 2024.

Breast Cancer Aotearoa Coalition. Triple negative breast cancer Available at: https://www.breastcancer.org.nz/triple-negative-BC Last Accessed: 21 October 2024.

Centers for Disease Control and Prevention. 2024. Symptoms of Breast Cancer. Available at: https://www.cdc.gov/breast-cancer/symptoms/index.html. Accessed: 12 November 2024

American Cancer Society. 2023. American Cancer society Society Recommendations for the Early Detection of Breast Cancer. Available at: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html Accessed 12 November 2024.

American Cancer Society. 2022. Breast cancer signs and symptoms. Available at: https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-cancer-signs-and-symptoms.html Accessed 12 September 2023.

American Cancer Society. 2022. Breast Cancer Risk Factors You Cannot Change. Available at: https://www.cancer.org/cancer/types/breast-cancer/risk-and-prevention/breast-cancer-risk-factors-you-cannot-change.html Accessed 14 September 2023.

American Cancer Society. 2022. Mammogram basics. Available at: https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/mammogram-basics.html 12 September 2023.

American Cancer Society. 2022. Breast MRI. Available at: https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-mri-scans.html Accessed 12 September 2023.

American Cancer Society. 2022. Breast ultrasound. Available at: https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/breast-ultrasound.html Accessed 12 September 2023.

American Cancer Society. 2023. Triple-Negative Breast Cancer. Available at: https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/triple-negative.html Accessed 9 March 2023.

Breast Cancer Foundation NZ. 2024. Taking care of your breasts in your twenties and thirties. Available at: https://www.breastcancerfoundation.org.nz/breast-awareness/taking-care-of-your-breasts/20-39 Accessed on 13 September 2024.

BreastNet NZ. Clinical breast examination. Available at: https://www.breastnet.nz/topic/clinical-breast-examination Accessed on 29 October 2024

National Breast Cancer Foundation. 2024. Stages 0 breast cancer overview. Available at: https://www.nationalbreastcancer.org/breast-cancer-stage-1/ Accessed 12 November 2024.

National Breast Cancer Foundation. 2024. Stages 1 breast cancer overview. Available at: https://www.nationalbreastcancer.org/breast-cancer-stage-1/ Accessed 12 November 2024.

Moffitt Cancer Center. 2023. Triple negative breast cancer stages. Available at: https://www.moffitt.org/cancers/triple-negative-breast-cancer/diagnosis/stages Accessed 13 September 2023.

National Breast Cancer Foundation. 2024. Stage 2 breast cancer overview. Available at: https://www.nationalbreastcancer.org/breast-cancer-stage-2/ Accessed 12 November 2024.

National Breast Cancer Foundation. 2024. Stage 3 breast cancer overview. Available at: https://www.nationalbreastcancer.org/breast-cancer-stage-3/ Accessed 12 November 2024.

National Breast Cancer Foundation. 2024. Stage 4 (IV) breast cancer. Available at: https://www.nationalbreastcancer.org/breast-cancer-stage-4/Accessed 12 November 2024.

American Cancer Society. 2024. Breast Cancer Stages. Available at: https://www.cancer.org/cancer/types/breast-cancer/understanding-a-breast-cancer-diagnosis/stages-of-breast-cancer.html 12 November 2024.

NZ-NON-00454 V1.0 Last Updated November 2024

Health Awareness

Helping protect health from birth to adulthood

April 1, 2024

a family siting on grass in a park

Vaccines are one of the greatest public health success stories in history

They help protect against more than 20 potentially life-threatening diseases.

We recognise and support the many global health stakeholders, including the World Health Organization, for their efforts in raising awareness about the importance of vaccination and helping prevent infectious diseases around the world.

“Immunization is a global health and development success story…helping people of all ages live longer, healthier lives…It’s also one of the best health investments money can buy. Vaccines are also critical to the prevention and control of infectious disease outbreaks [and] underpin global health security…”

  • World Health Organization, 2023

Broader vaccination coverage along with other public health measures have eradicated smallpox and significantly decreased the incidence of other vaccine-preventable diseases.

Vaccine equity is a global challenge

The COVID-19 pandemic triggered unprecedented disruptions to vaccination programs around the world, resulting in the largest sustained decline in childhood vaccination rates in approximately 30 years.  

The pandemic also revealed underlying health inequities and reminded us of the importance of preserving trust in and advancing equitable access to vaccines.

Crowded street downtown

Global vaccination coverage dropped 5% between 2019 and 2021.

a child has a first aid plater on the harm

Between 2019 and 2021, the number of completely unvaccinated children increased by 5 million worldwide.

Recovering vaccination rates together

Now, more than ever, we have an opportunity to reimagine the role we all can play.

At MSD, our vaccines help prevent diseases affecting individuals around the world and across all stages of life, from infancy through older adulthood.

But, we can’t be successful alone. That’s why we are working with a variety of stakeholders to help build trust in vaccination and enable equitable global access to vaccination services for everyone who can benefit from them.

Through our work in vaccines, we are committed to helping protect people today and for generations to come.

a girl with her mother consult with a doctor

Globally, MSD and our legacy companies have a 130+ year history of innovation and commitment to helping prevent disease by discovering, developing, supplying and delivering vaccines.

To keep pace with the ever-evolving disease landscape, we go where the need is to find new ways to address complex public health problems. We continue to invest in groundbreaking research and breakthrough technologies to help protect against potentially life-altering vaccine-preventable diseases.

References:

World Health Organization. Vaccines and Immunization. Available at: https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1 Accessed on: 28 March 2023

Greenwood, B. The contribution of vaccination to global health: past, present and future. Philos Trans R Soc Lond B Biol Sci. 2014;369(1645):20130433

World Health Organization. Smallpox. Available at: https://www.who.int/news-room/questions-and-answers/item/smallpox Accessed on: 26 March 2023

World Health Organization. Smallpox Eradication Programme – SEP(1966-1980). Available at: https://www.who.int/news-room/feature-stories/detail/the-smallpox-eradication-programme—sep-(1966-1980) Accessed on: 23 April 2023

World Health Organization. Call to action: Vaccine Equity. Available at: https://www.who.int/campaigns/vaccine-equity/vaccine-equity-declaration Accessed on: 28 March 2023

UNDP Global Dashboard for Vaccine Equity Available at: https://data.undp.org/vaccine-equity/ Accessed on: 28 March 2023

Abrams EM & Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med. 2020(8):659-661.

Paremoer L et al. Covid-19 pandemic and the social determinants of health. BMJ. 2021;28:372:n129.

World Health Organization. COVID-19 pandemic fuels largest continued backslide in vaccinations in three decades. Available at: https://www.who.int/news/item/15-07-2022-covid-19-pandemic-fuels-largest-continued-backslide-in-vaccinations-in-three-decades Accessed on: 22 September 2022

Perry BL, Aronson B & Pescosolido BA. Pandemic precarity: COVID-19 is exposing and exacerbating inequalities in the American heartland. Proc Natl Acad Sci USA. 2021;118(8):e2020685118.

World Health Organization. 2022. Immunization Coverage. Available at: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage Accessed on: 21 September 2022

Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Routine Vaccination Coverage – World wide, 2021. Available at: https://www.cdc.gov/mmwr/volumes/71/wr/mm7144a2.htm Accessed on: 20 March 2023

Centers for Disease Control and Prevention. Overview, History, and How the Safety Process Works. Available at: https://www.cdc.gov/vaccinesafety/ensuringsafety/history/index.html Accessed on: 13 April 2021

Centers for Disease Control and Prevention. Recommended Adult Immunization Schedule United States 2023. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html Accessed on: 27 February 2023

Centers for Disease Control and Prevention. Recommended Child and Adolescent Immunization United States Schedule 2023. Available at: https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html Accessed on: 15 February 2023

NZ-NON-00403 TAPS: NP20725 Last Updated on March 2024

Health Awareness

5 facts about lung cancer

What everyone needs to know about one of the most common types of cancer

November 3, 2023

article hero thumbnail

In 2020, it was estimated that more than 2 million people were diagnosed with lung cancer, changing their lives and setting them on a path that they likely didn’t anticipate and that no one wants to travel. MSD is fighting for these patients and their families by advancing research and fostering greater awareness and understanding of the disease.

Here are five facts about lung cancer that we think everyone needs to know.

01.

Every person with lung cancer deserves compassion and support.

People with lung cancer may face social stigma if they have smoked in the past. But, the truth is, there is no room for blame. Every person diagnosed with lung cancer experiences similar kinds of challenges as anyone who learns they have cancer. People with lung cancer are worthy of all the compassion and support their families, care teams and the wider cancer community can provide to help them stand against this disease.

Caregiver holding patient's hand

02.

It takes a village to navigate life with lung cancer.

When coping with a lung cancer diagnosis, it’s important to build a circle of support that includes the oncologist, health care teams, family and friends.

Connecting with others can provide a sense of support and comfort to help patients through everything that goes into managing this disease.

“Life for people with lung cancer seems like it’s completely broken and changed – days are full of doctor appointments and tests. Living with lung cancer seems to become the new normal.”

Dr. Cathy Pietanza, an oncologist and distinguished scientist at MSD Research Laboratories

03.

There’s no one type of person who develops lung cancer.

Lung cancer strikes both men and women. While it is mostly diagnosed in older people, younger people can develop the disease. In fact, in 2020, more than 285,000 cases of lung cancer were estimated to be diagnosed worldwide among people 54 years and younger.

Crowded street downtown

04.

There are multiple risk factors for lung cancer, including some outside our control.

Smoking is the greatest risk factor for developing lung cancer, but there are others as well, including having a family history of the disease and exposure to certain environmental substances.

Environmental risks include

  • Radon gas
  • Exposure to asbestos, second-hand smoke and other carcinogens in the air, such as arsenic, chromium and nickel

05.

Scientific advances are making an impact in lung cancer.

Over the past decade, scientific advances have helped lead to more survivors.

Researcher in lab coat

View infographic

References:

American Cancer Society. Adjusting to life with cancer. Available at: https://www.cancer.org/treatment/survivorship-during-and-after-treatment/coping/adjusting-to-life-with-cancer.html Accessed on: 13 November 2023

American Cancer Society. Lung cancer risk factors. Available at: https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection/risk-factors.html Accessed on: 1 October 2019

American Cancer Society. Survivorship: During and After Treatment. Available at: https://www.cancer.org/treatment/survivorship-during-and-after-treatment/ Accessed on: 7 January 2021

American Lung Association. Your lung cancer team. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/patients/lung-cancer-team/ Accessed on: 22 November 2022

Febbraro M, Gheware A, Kennedy T, Jain D, de Moraes FY, Juergens R. Barriers to access: global variability in implementing treatment advances in lung cancer. Am Soc Clin Oncol Educ Book. 2022;42:1-7. doi:10.1200/EDBK_351021

WHO Global Cancer Observatory Estimated age-standardized incidence rates (world) in 2020, world, females, all ages (excl. NMSC). Available at: https://gco.iarc.fr/today/online-analysis-multi-bars?v=2020&mode=cancer&mode_population=countries&population=900&populations=900&key=asr&sex=1&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=10&group_cancer=1&include_nmsc=0&include_nmsc_other=1&type_multiple=%257B%2522inc%2522%253Atrue%252C%2522mort%2522%253Afalse%252C%2522prev%2522%253Afalse%257D&orientation=horizontal&type_sort=0&type_nb_items=%257B%2522top%2522%253Atrue%252C%2522bottom%2522%253Afalse%257D Accessed on: 9 December 2022

WHO Global Cancer Observatory Estimated number of incident cases worldwide, both sexes, ages 0-54. Available at: https://gco.iarc.fr Accessed on: 18 November 2022

WHO Global Cancer Observatory Estimated number of new cases in 2020, world, both sexes, all ages. Global Cancer Observatory. Available at: https://gco.iarc.fr/today/online-analysis-table?v=2020&mode=cancer&mode_population=continents&population=900&populations=900&key=asr&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&group_cancer=1&include_nmsc=1&include_nmsc_other=1 Accessed on: 18 November 2022

WHO Global Cancer Observatory Lung cancer fact sheet. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/15-Lung-fact-sheet.pdf Accessed on: 18 December 2020

WHO Global Cancer Observatory World Cancer Fact Sheet. Available at: https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf Accessed on: 12 October 2022

GO2 For Lung Cancer. Available at: https://go2.org/lung-cancer-stigma/ Accessed on: 18 November 2022

TAPS Approval No: NP20080 NZ-NON-00404 Last Updated on October 2023

Health Awareness

Understanding melanoma: The signs, symptoms and risk factors

June 16, 2021

a senior couples are doing gardening.

What is melanoma?

Melanoma is the most serious form of skin cancer. Characterised by the uncontrolled growth of pigment-producing cells, melanoma accounts for approximately 2% of new cancer cases worldwide.

Melanomas can occur anywhere on the skin, including areas without sun exposure, but they are more likely to start in certain locations.

Illustration of common sites

The average age of diagnosis is 65, but melanoma is not uncommon among people younger than 30. In fact, it’s one of the most common cancers in young adults — especially young women.

Rates have been rising for 30 years

In 2020, it's estimated that there were more than
324,000

new melanoma cases worldwide

Signs and symptoms

A new spot on the skin or one that changes in size, shape or color, or one that looks different — is an important warning sign of melanoma and should be checked by a doctor. The ABCDE rule outlines the characteristics of moles that may be melanomas and is helpful guidance for monitoring skin changes:

A is for Asymmetry

One half of a mole or birthmark does not match the other.

B is for Border

The edges are irregular, ragged, notched or blurred.

C is for Color

The color is not the same all over and may include different shades of brown or black, or sometimes with patches of pink, red, white, or blue.

D is for Diameter

The spot is more than 6 millimeters across (about 1/4 inch – the size of a pencil eraser), although melanomas can sometimes be smaller than this.

E is for Evolving

The mole is changing in size, shape, or color.

Any of these warning signs should be discussed with a doctor, especially if you feel you are at risk for melanoma.

Risk factors

  • Ultraviolet (UV) light exposure
  • Moles
  • Fair skin, freckles and light hair
  • Family history
  • Personal history of having melanoma or other skin cancers
  • Having a weakened immune system
  • Being older
  • Being male
  • Xeroderma pigmentosum (a rare skin condition that affects the skin’s ability to repair DNA damage)

Ways to lower risk

Melanoma can’t be entirely prevented, but there are ways to lower risk. The number one way to lower risk is to protect against UV rays, which damage the DNA of skin cells and impact the genes that control skin cell growth. The top source of UV rays is the sun. That’s why it’s important to practice sun safety every time you go outside, even on cloudy days when UV rays can still shine through. Here are a few ways to protect yourself:

Seek shade

UV exposure is greatest between the hours of 10 a.m. and 4 p.m. If you need to be outside during these hours, seek shade – under a tree, an umbrella or an awning.

Wear a hat

Try to find a hat with a wide brim – at least 2 or 3 inches wide – to protect your face, top of the head, ears and neck.

Cover up

Choose clothing with a tight knit or weave, and avoid shirts that you can see through. Remember, if light is getting through, then UV rays are too.

Use sunscreen

Use a water-resistant, broad spectrum sunscreen that has an SPF of at least 30, and has the AS/NZ 2604 standard on the label.

Wear sunglasses

Protect your eyes and the sensitive skin around them. Pick a pair that will block as close to 100 percent of both UVA and UVB rays as possible.

References:
Summa Health: Skin Cancer 2020 Available at: https://www.summahealth.org/medicalservices/cancer/cancer-care/skin-cancer Accessed on 17/03/2021
American Cancer Society: What is melanoma skin cancer? Available at: https://www.cancer.org Accessed on 17/03/2021
International Agency for Research on Cancer: Melanoma of skin Fact Sheet. Global Cancer Observatory. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/16-Melanoma-of-skin-fact-sheet.pdf Accessed on 8/03/2021
American Cancer Society: Key statistics for melanoma skin cancer. Available at: https://www.cancer.org Accessed on 17/03/21
American Cancer Society: Risk factors for melanoma skin cancer. Available at: https://www.cancer.org Accessed on 17/03/21
American Cancer Society: Signs and symptoms of melanoma skin cancer. Available at: https://www.cancer.org Accessed on 17/03/21
American Cancer Society: Can melanoma skin cancer be prevented?. Available at: https://www.cancer.org Accessed on 17/03/21
American Cancer Society: How do I protect myself from ultraviolet (UV) rays? Available at: https://www.cancer.org Accessed on 17/03/21
Cancer Society New Zealand: SunSmart https://www.cancer.org.nz Accessed on 26/10/21

TAPS NA 13280 NZ-NON-00208 Last Updated October 2023