The purpose of this study was to evaluate incidence, management, and survival of breast cancer in a primarily black population. Data were collected retrospectively for patients with breast cancer diagnosed, treated or followed during the period from 1964 to 1986 in Harlem Hospital Center in New York City. In this sample, 94% of the patients were black.

The authors describe the demographic and clinical characteristics of the population: 10% were less than 40 years, 23% had no children, and most had no family history of breast cancer. This was a primarily poor population: 46% had no insurance, 29% had Medicaid, 17% had Medicare, and 8% had other insurance. The most common prior illnesses were diabetes, hypertension, and ischemic heart disease. The most common presenting symptom was a breast mass (86%). Forty-four percent presented for treatment within 3 months of initial symptoms, 37% between 3 and 6 months, and 29% presented more than 6 months after symptoms. Infiltrating duct carcinoma was the most common histological type (89%). Among those tested, 50% of the women were ER positive.

With regard to treatment, 84% received surgical treatment (radical mastectomy in 51% and modified radial in 20%). Additionally, 24% were treated with radiotherapy postoperatively, 2% preoperatively, and 0.6% both pre and postoperatively. Only 9.5% had chemotherapy pre or post operatively. The 5-year survival rate for this group was 39%, and the 10-year survival was 27%.

Thirteen percent were treated primarily with radiotherapy without surgery; 4% were treated primarily with chemotherapy without surgery. The 5-year survival was 6% in this group, and the remaining patients died of the disease.

With regard to other outcomes, 15% of the patients had a second primary.

The authors point out that late diagnosis is the single most important cause of low survival in this population. They concluded that these findings support the previous suggestions that black and white differences in case survival are primarily related to SES disparities and suggested "the impact of multiple factors (e.g., culture, life style, degree of poverty) may intensify the effect of poverty in blacks in relation to cancer survival."

(While documenting the clinical characteristics of black breast cancer populations is valuable for future comparisons, the conclusions suggested by the authors are not supported by the present study which does not make direct comparisons with a non-black population and does not directly test the influence of SES on survival.)