Without question, black women with breast cancer have a poorer survival rate than white women. However, given that breast cancers in black women more often present with poor prognostic features (e.g., larger tumor burden, estrogen receptor negative, etc.), it remains controversial whether race is an independent prognostic factor. Roach and colleagues in Cancer and Leukemia Group B (Cancer J Sci Am 1997;3:103-112) recently performed a multivariate analysis of protocol 8541 in which women with stage II breast cancer were given breast radiation followed by cyclophosphamide, doxorubicin, and fluorouracil (CAF) chemotherapy at low, standard, or high dose intensity. Twelve percent of the 1572 women on the study were black. Multivariate analysis identified several risk factors including dose intensity, number of positive nodes, estrogen receptor status, tumor size, and age. However, when the groups were balanced for these variables, race was not an independent prognostic factor. Several issues remain unexplained: why are black women more likely to be younger at presentation and to have more advanced disease at diagnosis? Is care-seeking behavior modifiable? If black women seek medical attention at an early age and stage of disease, will survival be comparable to that of white women?
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