Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation

Purpose: To compare the outcome of African American (AA) and Caucasian (C) breast cancer patients who had equivalent disease extent and were similarly treated. Patients and Methods: We compared prognostic characteristics, treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated with mastectomy between 1946 and 1987. The median follow-up duration was 15.6 years, Results: During the study period, there was a successive increase in the percent of patients who presented with early breast cancer, Between 1980 and 1987, 35.1% AA versus 47.6% C patients had less than or equal to 2-cm tumors and 50.0% AA versus 61.9% C patients were node-negative, while between 1946 and 1959, 27.7% AA and 31.3% C had less than or equal to 2-cm tumors and 41.5% AA versus 40.4% C patients were node-negative, The treatments were similar during the study period, The 20-year disease-free survival (DFS) rate of AA compared with C patients with node-negative less than or equal to 2-cm, 2.1- to 4-cm, and greater than 4-cm tumors and of patients with one to three and greater than or equal to four positive nodes was not significantly different, Equal-size tumors had similar proportion of positive axillary nodes in AA compared with C patients, The DFS for AA patients compared with C patients was similar in the periods 1946 to 1959, 1960 to 1969, and 1970 to 1979, but was lower between 1980 and 1987 (P = .02), In multivariable analysis, race was not a significant variable, Conclusion: In this large group of uniformly treated breast cancer patients, race was not an independent factor that influenced outcome, The racial differences seen between 1980 and 1987 are likely because of a larger percent of greater than 2-cm and node-positive tumors in AA patients, Education and access to early diagnosis should reduce or eliminate the racial differences seen. (C) 1997 by American Society of Clinical Oncology.