RACE AND CLINICAL OUTCOME IN BREAST-CANCER IN A SERIES WITH LONG-TERMFOLLOW-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 chara cteristics, treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated with mastectomy between 1946 and 1987. The median fo llow-up duration was 15.6 years, Results: During the study period, the re 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 ve rsus 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 t o 2-cm, 2.1- to 4-cm, and greater than 4-cm tumors and of patients wit h one to three and greater than or equal to four positive nodes was no t significantly different, Equal-size tumors had similar proportion of positive axillary nodes in AA compared with C patients, The DFS for A A 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 ou tcome, The racial differences seen between 1980 and 1987 are likely be cause of a larger percent of greater than 2-cm and node-positive tumor s in AA patients, Education and access to early diagnosis should reduc e or eliminate the racial differences seen. (C) 1997 by American Socie ty of Clinical Oncology.