Her2 Negative Breast Cancer

Overview

HER2-negative breast cancer is a type of breast cancer where the cancer cells do not have large amounts of a protein called HER2 on their surface, and they do not have extra copies of the HER2 gene. HER2 stands for human epidermal growth factor receptor 2 — a protein that normally helps cells grow and repair. When a breast cancer is 'HER2-negative', it means medicines that specifically target HER2 will not help. Doctors then look at other features of the cancer, such as whether it responds to the hormone oestrogen, to choose the treatment that is most likely to work.

Yes. HER2-negative breast cancer is the most common type of breast cancer. Around 7 to 8 out of every 10 breast cancers are HER2-negative.

It can affect anyone with breast tissue, though it is far more common in women. Risk rises with age, and most cases are diagnosed in people over 50. It can also affect younger women, men, and people with a family history of breast or ovarian cancer.

Symptoms

Common symptoms

• A lump or thickening in the breast or under the arm that feels different from the rest of the breast tissue
• A change in the size or shape of one breast
• Skin changes on the breast, such as dimpling (like orange peel), puckering, redness or a rash
• The nipple turning inwards (inverted) or changing shape
• Fluid leaking from the nipple, especially if it is bloody or only from one side
• A patch of skin on the breast that feels scaly, itchy or looks like eczema
• Swelling, warmth or a heavy, aching feeling in one breast
• A lump or swelling in the armpit or above the collarbone

Symptoms in children

• Breast cancer is extremely rare in children and teenagers — most breast lumps in young people are harmless, such as benign growths or infections.
• Even so, any new breast lump, swelling, pain or nipple change in a child should be checked by a doctor, because it is always better to be sure.

Symptoms in older adults

• Breast lumps may be painless and easier to miss, so regular checking and screening invitations matter.
• Symptoms such as tiredness, weight loss or general unwellness can sometimes be the first clue, so it is worth mentioning any change to your doctor.
• Other health conditions may affect which tests and treatments are suitable, so care is usually tailored to the individual person.

Causes

Main causes

• Breast cancer happens when cells in the breast develop changes (mutations) in their DNA that make them grow and divide out of control.
• There is no single cause, and in most cases no clear reason can be found.
• HER2-negative simply describes the make-up of the cancer cells — it does not mean anything you did or did not do caused it.

Risk factors

• Being female and getting older (most cases occur after age 50)
• A strong family history of breast, ovarian or prostate cancer, or an inherited gene change such as BRCA1 or BRCA2
• Previous breast cancer or certain non-cancerous breast changes
• Starting periods early, reaching menopause late, or never having a pregnancy — these affect lifetime exposure to oestrogen
• Taking hormone replacement therapy or, in some cases, long-term use of combined hormonal contraception
• Drinking alcohol regularly, smoking, being overweight after menopause, and not being physically active
• Past radiation treatment to the chest, especially at a young age
• Dense breast tissue, which can also make mammograms harder to read

When to see a doctor

See a doctor urgently if:

• You find a new lump or thickening in your breast or armpit
• You notice bloody nipple discharge, or discharge from one nipple only
• The skin on your breast looks dimpled, red, puckered or feels different
• Your nipple turns inwards or changes shape
• You have breast pain that stays in one place and does not go away

Book a routine appointment if:

• You are invited for breast screening — go for it, even if you feel well
• You have a family history of breast or ovarian cancer and want to talk about your risk
• You notice a change that has been there for a few weeks and is not settling
• You are due a follow-up after breast cancer treatment

Diagnosis

Doctors usually follow a three-step approach called 'triple assessment': a physical examination of the breast and armpit, imaging scans, and a small tissue sample (biopsy). The biopsy sample is tested in a laboratory to confirm whether it is cancer and to find out the HER2 status and hormone-receptor status. These results tell the care team which treatments are likely to work best.

Tests that may be done

• Clinical breast examination — your doctor feels the breasts, armpits and collarbone areas
• Mammogram — an X-ray of the breast
• Breast ultrasound — a painless scan using sound waves, often used for younger people or dense breasts
• Core needle biopsy — a small sample of breast tissue taken with a fine needle, using local anaesthetic, to look at under a microscope
• Laboratory tests on the biopsy sample to measure HER2 protein and gene levels and hormone receptors (oestrogen and progesterone receptors)
• Blood tests to check your general health
• Scans such as CT, MRI, ultrasound or a bone scan if doctors need to check whether the cancer has spread (called staging)
• Genetic testing in some cases, if there is a strong family history or the cancer has particular features

What to expect at your appointment

Waiting for results is often the hardest part. You may have several appointments in a short space of time, and results usually take one to two weeks. It can help to bring someone with you, write down your questions, and ask your care team to explain anything that is unclear. You are entitled to ask what each result means for your treatment options.

Treatment

Treatment is planned around you — the size and type of the cancer, whether it has spread, your hormone-receptor status, your age and general health, and what matters to you. HER2-negative breast cancer cannot be treated with HER2-targeted medicines, but there are many other effective treatments. Most people have a combination, such as surgery plus radiotherapy, or chemotherapy before or after surgery, and hormone therapy if the cancer is hormone-receptor positive.

Self-care at home

• Keep a simple diary of appointments, side effects and questions so you feel more in control
• Ask your care team before starting any new supplement, herbal remedy or over-the-counter medicine, as some can interfere with treatment
• Rest when your body asks for it, and pace yourself — fatigue during treatment is very common and usually improves
• Keep gently active, for example short daily walks, unless your team advises otherwise
• Look after your skin during radiotherapy as your team advises — use only products they recommend
• Tell your team early about side effects such as sickness, mouth sores, pain or low mood, because there is usually something that can help

Medical treatments

Treatment may include surgery to remove the cancer, radiotherapy to the area of the breast or chest wall, chemotherapy given into a vein or as tablets, hormone therapy for cancers that are hormone-receptor positive, and other targeted treatments or immunotherapy for certain types. Some treatments are given before surgery to shrink the cancer, and some after surgery to lower the chance of it coming back. Which combination is right for you depends on your test results and preferences. Your specialist team will explain the aim of each treatment and its likely benefits and side effects.

When is surgery considered?

Surgery is usually part of treatment and is often the first step, unless the team decides to shrink the cancer with treatment first. The two main operations are breast-conserving surgery (removing the lump with a margin of normal tissue, sometimes called a lumpectomy or wide local excision) and mastectomy (removing the whole breast). Nearby lymph nodes may be checked or removed at the same time. Breast reconstruction can often be done at the same time as mastectomy, or later. Your surgeon will talk through the options with you.

Living with this condition

Life during and after treatment often settles into a new rhythm. Many people find it helpful to plan around treatment days, accept offers of practical help, and keep some gentle routine. Follow-up appointments are usually more frequent at first and then spaced out. Over time, most people return to work, hobbies and family life, sometimes with changes to how they pace themselves.

Lifestyle tips

• Stay as physically active as feels comfortable — walking, swimming, cycling or gentle strength work all count
• Eat a balanced diet with plenty of vegetables, fruit, whole grains and protein; there is no single 'anti-cancer' food, so be wary of strict diets
• Limit alcohol and avoid smoking; ask for support if you want help to stop
• Aim for a healthy weight, gently, without crash dieting
• Protect your skin from the sun, especially on areas treated with radiotherapy
• Look after your arm on the side of surgery or radiotherapy — keep the skin healthy and tell your team about any swelling
• Get enough sleep and rest, and build in time for things you enjoy

Diet and exercise

There is no special diet that treats HER2-negative breast cancer, but a balanced, varied diet helps you keep your strength and recover from treatment. Gentle, regular movement helps with tiredness, mood, bone strength and weight. Your care team can refer you to a physiotherapist or dietitian if you need extra support, and many areas offer specialised exercise programmes for people who have had cancer.

Mental health and emotional wellbeing

Feeling shocked, frightened, angry or low is very common after a breast cancer diagnosis, and it can come in waves even after treatment ends. Anxiety about follow-up scans and fear of the cancer returning are also normal. These feelings usually become easier to manage with time and support. If low mood, worry or sleep problems are affecting your daily life, please tell your care team — talking therapies and other support are available. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line straight away.

Prevention

HER2-negative breast cancer cannot be completely prevented, and no one is to blame for getting it. But some steps can lower your overall risk: staying physically active, keeping to a healthy weight, limiting alcohol, not smoking, and attending breast screening when invited. If you have a strong family history, your GP can discuss referral to a specialist clinic for assessment and risk-reducing options.

Vaccines

There is currently no vaccine that prevents breast cancer.

Screening programmes

Breast screening (mammography) can find breast cancers early, often before they can be felt. In the UK, the NHS invites women aged 50 to 70 for screening every three years, and the age range is being extended. Screening is not perfect — it can miss some cancers and can find changes that would never have caused harm — so see your doctor if you notice a change at any age, even if your last mammogram was normal.

Complications

If left untreated

• The cancer can grow and spread into nearby tissue and lymph nodes
• It can spread (metastasise) to other parts of the body such as the bones, lungs, liver or brain
• Spread to distant organs can cause pain, breathlessness, tiredness and other symptoms, and is much harder to treat
• Early treatment greatly reduces the chance of the cancer coming back

Long-term outlook

The outlook for HER2-negative breast cancer has improved steadily over recent decades, and many people are treated successfully and live long, full lives. The chance of recovery depends on the size and grade of the cancer, whether it has spread, the hormone-receptor status, and how well the cancer responds to treatment. Your care team can talk honestly with you about your own situation. Whatever your diagnosis, there is support to help you live as well as possible.

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