There is substantial disagreement in the medical literature on the outcome of black breast cancer patients as compared to their white counterparts. This issue is complex, and there are a variety of ways to approach the question. The first approach is to view the issue on the broader population level. There is general agreement that black patients have inferior outcomes at a population level. The Surveillance, Epidemiology, and End Results (SEER) data indicate that black patients with breast carcinoma have a poorer prognosis than white women. Sepa­rate analysis performed on the SEER database for women younger than age 35 showed that African-American women have inferior survival.

The other approach would be to review information on individual patients and their prognostic factors. It is also known that black women have a number of well-established poor prognostic factors when compared to their white counterparts. Black patients present at a younger age and with higher stage disease. canadian discount drugs

Significant differences have also been noted in tumor size, lymph node status, presence of necrosis, vascular/lymphatic invasion, perineural invasion, and estrogen receptor (ER) and progesterone receptor (PR) status, with black patients having statistically higher risk of the poor prognostic factors. Differences have also been noted in tumor grade with black patients more likely to have higher-grade tumors.

Black patients have also been found to have poorer socioeconomic status. Two studies exploring the role of access to care had conflicting results. One study that reviewed patients over age 65 and eligible for medicare showed no difference in survival based on race. However, a study that reviewed the Department of Defense database, in which all of the patients have equal access to uniform healthcare, revealed that the African-American patients had inferior survival. Cultural differences may explain some of the differences in survival between black and white women. Another group reviewed psy­chosocial factors and found that African-American and white patients had similar levels of support and outcomes. Some authors have attempted to adjust for the negative prognostic factors and in those studies, the differences are reduced or become insignificant. Two meta analyses have shown that

African-American patients with breast carcinoma have increased mortality in comparison to their white counterparts.
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Single institutions have analyzed their data in patients treated with breast conservation and shown a poorer outcome for black patients. Other institutions have shown control rates in black patients comparable to historic controls. There is also conflicting data with retrospective review of patients enrolled on randomized trials. A review performed on the NSABP B-06 patients showed race to be an independent prognostic factor. However, a study that pooled the patients from NSABP B-13 and B-14 did not show any difference. Also, CALGB 8541 showed no difference in survival between the races in multivariate analysis. At Emory, we have reviewed the experience at an inner-city hospital at which the patients are primarily black and medically indigent. In this analysis of 72 high-risk patients, it was found that the black patients did as well as published controls in a series of primarily white patients. A portion of the patients from that analysis are also included in this study. The conflicting results of the data in the published literature were generally based on small numbers of patients. The purpose of this study was to review the outcome of a relatively large number of black patients in comparison to their white counterparts when diagnosed with early-stage disease treated with breast conserving therapy followed by radiotherapy.