TNBC BRCA Negative _ Doctors opinion required

I am on NACT ( AC/ T 130 mg ) 6 cycles before surgery. Finally 2 more remaining and im trying to keep myself fit by walking an hour everyday and doing some light yoga ..since i have a bard port fitted for chemo need to be careful :).I had dreaded chemotherapy but docs said it was mandatory as its a case of TNBC (ER 5%) LABC ( unfortunately misdiagnosed as a fibroidenoma 6 months ago considering my age 29 at that time).Thankfully there has been no side effect except after chemotherapy except for taste change first 4-5 days. But blood works show a slight decrease in HB level and platelets before 4th cycle.

Pet CT after 3 cycles showed significant improvement and residual mlidly metabolic tissue thickening was seen and no abnormalities. Docs have planned surgery after 6th cycle most likely BCS. Also got the genetic counselling after which i went for BRCA 1 & 2 tests which came out negative without mutation.

I need advice on the following :

1) Should i go for the hereditary cancer panel test at this point. I have no family history of breast cancer but of esophageal cancer from dads side.

2)Will BCS have any impact on my survival / relapse and overall prognosis. Or is mastectomy recommended. I am unsure of how much difference it will make as my oncologist said there will be no difference and suggested a BCS.

3)Any recent clinical trials for TNBC in India.

4)I am single and have not gone for fertility preservation as i did not have much time & resources available and starting treatment asap was a priority. No doctors could tell me with certainty on the effect on my reproductive system however they mentioned it will impact but to what extent even the gynaecologists could not say as they did not check my reserves before starting treatment. Can i get some light on the same too.



3 Replies

  • 1. You have already undergone the most important hereditary panel test BRCA 1 and 2.

    2. No difference in distant metastases whether BCS or MRM. Slighlty higher incidence of local relapse after BCS, but thats fine and acceptable.

    3. Don't know any recent trials in India. There will be many, I am not aware as trials are limited to Institutes and small doctors like me won't know much.

    4. No one can predict how chemo will affect ovaries; preferable to meet some infertility specialist and let your Oncologist personally discuss with the Infertility Specialist about the same. Infertility specialist, not for reason of infertility, but for their knowledge of ovum preservation.

  • Thanks Dr Sumeet for point wise clarification. For point 2 regarding distant metastases and local relapse does it always occur? If yes contributing factors need to be known.Can I have some link for studies on young TNBC cases for reference.

    Or should I not go very deep into statistics considering the population size of the studies.

  • Your Oncologist would be the right person to answer this. I would prefer you talk to him / her in detail.

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