HIV and Triple-Negative Breast Cancer (TNBC) are two of the most deadly diseases that can afflict women. According to the Centers for Disease Control and Prevention (CDC), HIV affects nearly 1.2 million people in the United States. Black Americans are most affected by the virus, accounting for 42-percent of all new diagnoses — the most of any group.
Despite these figures, there is very little awareness about how these diseases intersect and the increased risk of death associated with treatment outcomes when they do.
What Is Triple-Negative Breast Cancer?
Triple-negative breast cancer is a form of invasive breast cancer that accounts for about 15-percent of all breast cancers in the United States.
This type of cancer lacks the three proteins normally found on breast cancer cells -- estrogen receptors, progesterone receptors, and human epidermal growth factor receptor 2 (HER2). As a result, these tumors are not as readily responsive to hormonal therapy or HER2-targeted drugs that are used to treat other forms of breast cancer.
Triple-negative breast cancer forms when some cells within the breast tissue become cancerous.
The cancer cells can continue to grow and spread if left untreated. In more advanced cases, the cancer can penetrate the breast wall or spread to the lymph nodes in the armpits or neck.
It can also spread to other parts of the body such as the bones and lungs.
The most common symptom of triple-negative breast cancer is a lump or thickening of the breast skin. However, many women with this type of cancer do not experience any symptoms in the early stages of the disease.
How are HIV and TNBC Related?
Black women in America are disproportionately affected by both HIV and TNBC. In fact, Black women are approximately three times more likely to be diagnosed with HIV than non-Hispanic white women. TNBC is twice as likely to occur among Black women than white women.
Women who have both HIV and TNBC are at an increased risk of death than other women with either condition alone. Specifically, Black women who are HIV positive who are diagnosed with TNBC have higher mortality rates that HIV-negative women. One study showed an 82-percent decrease in survival for women with HIV who had TNBC compared to women who were only diagnosed with breast cancer. In over 90-percent of instances of death among women treated, 90-percent were caused by the cancer.
These statistics show an urgent need for greater awareness of the connection between HIV and TNBC among Black women. Studies have shown that early intervention and treatment can help improve outcomes for both conditions. Early detection is critical, especially for patients at high risk for developing these conditions.
Challenges In Treating TNBC
Triple-negative breast cancer can be more difficult to treat than other types of breast cancer because it is generally more aggressive and spreads (metastasized) faster. Additionally, it isn't responsive to hormonal therapies used to treat other forms of breast cancer.
Those challenges are compounded for HIV-positive women. “Chemotherapy is almost always called for,” says DR. Bonnie Sun, a Breast Cancer Surgeon at Johns Hopkins, noting that chemo treatment for TNBC can be especially intense.
Chemotherapy, however, can have increased adverse affects on women living with HIV. One study found that HIV-positive patients undergoing chemotherapy or radiotherapy can experience a loss in CD4 cell counts (a type of white blood cell that fights infection), thereby increasing risk of death.
Cancer treatments that affect the immune system, such as radiation and chemotherapy, can affect women living with HIV differently than HIV-negative patients. Thus, the complexities of treating TNBC as an aggressive form of cancer are compounded with specific treatment considerations for HIV-positive women.
Awareness Can Save Lives
Triple-negative breast cancer presents unique challenges for Black women, especially considering the significant healthcare disparities in the U.S. Black women are more likely to have an advanced stage of disease at the time of diagnosis.
TNBC is more likely to occur among Black and Latinx women who are under the age of 50. This represents a major differentiator from other forms of breast cancer which tend to affect women over the age of 60. Given the increased incidence of TNBC in younger Black women, awareness and access to healthcare knowledge is critical to ensuring better outcomes for women diagnosed with the disease.
With access to earlier screening and effective treatment options, we may be able to better address the high mortality rate of TNBC among women with HIV.
Educating and Empowering With the NANA Project
The New Alliance for Novel Approaches (NANA) Project is a collaborative initiative to empower and educate Black women to take control of their health when it comes to TNBC and HIV. We aim to provide women with access to knowledge on how to use self-check techniques to be able to detect TNBC earlier.
The NANA Project is a collaborative partnership with SisterLove, Dr. BK Edmond and The B.Edmond Project, Women With a Vision, and Dr. Mausiki Scales of Common Ground Sound to implement a unique, cultural, and practical community education project.
The goal of the project is to increase awareness of the higher occurrences of TNBC in Black communities and its intersection with HIV. NANA aims to empower women with prevention techniques and methods of early detection.