Differences in disease presentation, management techniques, treatment outcome, and toxicities in African-American women with early stage breast cancer treated with breast-conserving therapy

Background: Data on patients who received breast-conserving therapy (BCT) for early stage breast cancer were examined to detect differences in disease presentation, management techniques, long-term treatment outcomes, and toxicities based on race.

Methods: Six hundred ninety-nine women with breast cancer (39 African-American [AA] women and 660 Caucasian [C] women) who received BCT were analyzed on race, clinical and pathologic characteristics at presentation, management techniques, treatment-related toxicities, recurrence, and survival. The median follow-up was 12.2 years.

Results: At diagnosis, AA women were younger (aged<50 years, 49% vs 29%; P=.002), had larger tumors (mean, 17.0 mm vs 13.9 mm; P=.032), had more estrogen receptor-negative tumors (56% vs 18%; P<.001), and higher nuclear grade tumors (grade 3, 52% vs 29%; P=.006). Compared with C women, AA women more frequently received adjuvant chemotherapy (59% vs 19%; P<.001) and lymph node irradiation (26% vs 13%; P=.033). No other significant treatment differences were observed. After treatment, AA women experienced more breast pain (P=.001), more arm edema (P=.046), and less excellent cosmetic results (P=.008), but there were no statistically significant differences in local recurrence (P=.232), distant metastasis (P=.263), overall survival (P=.131), or cause-specific survival (P=.092) based on race.

Conclusions: The current results suggested that AA women present with larger and more aggressive breast tumors and, as a result, more frequently received adjuvant chemotherapy and lymph node irradiation. Small differences in treatment-related toxicities and cosmesis were observed, but no differences in efficacy were identified.