During her monthly breast self-exam, Angie Vitale of Canton, Ohio, found a lump in her breast.

"I immediately thought it was cancer," she said. "But I was only 27. People don't get breast cancer at that age."

But this wasn't a typical case of breast cancer. It was an uncommon form that targets younger women, like Vitale, as well as black and Latino women.

After a mammogram and an ultrasound, Vitale's suspicions were confirmed. She had stage 2 breast cancer.

Soon after, she learned a new term — triple negative, the name of her type of cancer.

"I knew that I was negative for all these things, but I had no idea what any of that meant," said Vitale, a middle school special-education teacher.

Neither, it turned out, did any of the other 70 or so women she has met during the past three years who also have been treated for breast cancer. Vitale, who had a lumpectomy then chemotherapy and radiation treatments, was the only one she knew with a triple negative diagnosis.

There are several subtypes of breast cancer, which usually are diagnosed by the presence, or lack, of three receptors (substances found inside breast cells that give rise to cancer): estrogen, progesterone and HER2. None of the receptors is found in women with triple negative cancer. Because doctors target therapies specifically to those receptors, triple negative cancer is difficult to treat; the tumors are more aggressive and higher grade.

Only about 15 percent of breast cancers fall under the triple negative subtype. And triple negative tends to strike younger, pre-menopausal women and black and Latino women — those who normally have a lower risk of getting breast cancer.

It's all information that Vitale — who is white and who has no close relatives with breast cancer — learned after her March 2005 diagnosis.

Because the receptors normally present in breast cancer aren't there, drugs designed as targeted therapies don't work. Therefore, physicians can offer surgery, chemotherapy and radiation, but no other drug therapies.

Vitale said that wasn't exactly bad news. "I don't have to take any drugs because that's all hormone-related. That's actually a benefit to this crazy cancer."

Another unexpected benefit is that advances in chemotherapy over the years seem to have increased the success of treating triple negative breast cancer.

"They (the improvements) probably benefited the triple negative subtype as much, if not more, than everyone else," Dr. Lisa Carey, medical director of the University of North Carolina-Lineberger Breast Center, said during a recent teleconference about triple negative breast cancer.

That is key, because physicians rely on chemotherapy to prevent cancer relapse.

"What we do know is that improvements in chemotherapy have had an important impact on women with triple negative," said Dr. Eric Winer, director of the Breast Oncology Center at Dana-Farber Cancer Institute in Boston and chief scientific adviser for the national Susan G. Komen for the Cure organization.

"Before Herceptin (a drug first made available in 1998 to treat HER2), we treated everyone the same," he said. "Ten, 12 years ago we talked about breast cancer as stage 1, stage 2. We noted the extent of the disease, but not the personality."

With the advent of Herceptin came a medication that women with early-stage breast cancer could take. But that left out women with triple negative breast cancer, he said.

The latest cancer research studies try to identify the molecular profile of different types of cancer cells and to use that information to figure out new drugs that will fight those cells.

Trials are under way to explore targeted therapies for triple negative breast cancer.

"The most encouraging part of this is that we're actually doing something," Winer said. "There is basic research going on. We'll have newer and better drugs in five to 10 years."

At Cleveland's University Hospitals Case Medical Center, Dr. Joseph Baar, the director of breast cancer research and the Breast Cancer Survivor Program at the Ireland Cancer Center, has been studying a vaccine that targets proteins found in breast cancer, including in triple negative patients.

Baar won't know for a couple months if the National Cancer Institute will pay for the vaccine trial, which would enroll about 35 patients and last a couple of years. To his knowledge, no one else in the country is working on a similar vaccine.

At the American Society of Clinical Oncology's annual meeting earlier this month in Chicago, Baar and others heard updates about possible treatments, including a new drug that is being tested to work with chemotherapy.

"We're starting to realize that all triple negative breast cancers are not equal," he said. "(But) we still have a lot of homework to do."

Researchers also are studying African women with breast cancer to explore if there is a genetic link to African-American women who have triple negative cancer.

This summer, a group of girlfriends from New Jersey hope to surpass the $230,000 they raised last year at the inaugural "Peace, Love and a Cure" event. The women are friends of Nancy Block-Zenna, who was diagnosed in early 2005 with triple negative breast cancer.

Frustrated over not being able to find information about Block-Zenna's disease, the women started contacting some of the country's top oncologists, including Winer, for help.

Not long after, the Triple Negative Breast Cancer Foundation was born. The first "Peace, Love and a Cure" event received national attention with the involvement of hostess Malaak Compton-Rock, a friend of Block-Zenna and the wife of comedian Chris Rock.

Block-Zenna died in August, two months after the inaugural event.

"We hope we will be able to start funding research," said board executive director Allison Axenrod. "That was our main goal all along."

A woman's risk of getting cancer again within five years of her initial diagnosis (breast or another form) are higher with a triple negative cancer. But if she's cancer free for seven to 10 years, and beyond, her risk for recurrence is less than with other breast cancers.

Vitale, who sees her medical oncologist every four months and checks in with her surgeon and radiation oncologist once a year, recently got the results back from her annual mammogram.

"Everything is fine," said an upbeat Vitale. "I'm doing well."

CANCER FACTS

182,460 — Estimated new breast cancer cases in women, 2008.

40,480 — Estimated female deaths, 2008.

1,990 — Estimated new breast cancer cases in men, 2008.

450 — Estimated male deaths, 2008.

15 percent — Estimated cancer deaths in 2008 that are women with breast cancer.

1 in 8 — A woman's chance of developing breast cancer in her lifetime.

90 percent — Breast cancer survival rate for white women (based on five-year relative survival rates of cancer patients diagnosed from 1996-2003).

78 percent — Breast cancer survival rate for black women (Based on five-year relative survival rates of cancer patients diagnosed from 1996-2003).

BREAST CANCER WARNING SIGNS:

• Lump, hard knot or thickening in the breast.

• Swelling, redness or increased warmth in the breast.

• Change in the size or shape of the breast.

• Itchy, sore or scaling area on the nipple/areola.

• Nipple discharge (particularly if bloody) that starts suddenly.

• Inverted nipple or nipple direction change.

• Dimpling or puckering of the skin on the breast.

• Unusual pain in an area of the breast.

SCREENING GUIDELINES:

• Yearly mammograms recommended starting age 40.

•Clinical breast exam every three years for women starting at age 20. Every year for women 40 and older.

• Breast self-exam is an additional option for women starting in their 20s.

• Screening MRI recommended for women with a 20 percent to 25 percent or greater lifetime risk of breast cancer, including women with a strong family history of breast or ovarian cancer and women treated for Hodgkin's disease.

(Source: American Cancer Society)

MORE INFORMATION:

• African American Breast Cancer Alliance Inc., Box 8981, Minneapolis, MN 55408. www.aabcainc.org.

• Amigas Unidas, a program at MetroHealth Cancer Care Center that in late 2007 started training Latino women to become "Amigas," or breast health advocates. Email Gigi Caraballo at rcaraballo(at)metrohealth.org.

• Triple Negative Breast Cancer Foundation, www.tnbcfoundation.org.

• Young Survival Coalition, www.youngsurvival.org.

• "The Breast Cancer Journey Planner" ($29.95, Therapy in Seattle) by Carrie Sanders, a Washington state psychotherapist and cancer survivor, was published in April. The three-ring binder is a comprehensive organizer to help women deal with the challenges of breast cancer. For information, go to www.theidealcancerorganizer.com.