The goal of this study was to evaluate the role of treatment in survival for black and white patients with advanced breast cancer. Data from the Piedmont Oncology Association clinical trials were used for this assessment. Five different treatment regimens were given to patients in this study. All black patients and an equal number of white patients in each protocol were selected for the analysis.

There were no racial differences with regard to demographic or pretreatment clinical characteristics. Whites were more likely to have bone metastases, and blacks were more likely to have skin recurrence. Of the evaluable black patients, 31% responded to treatment (18% with a complete response); of evaluable white patients, 25% responded (7% complete response). After adjusting for pretreatment clinical characteristics, there was no racial difference in response (p=0.47). Time to progression did not differ for blacks and white after controlling for pretreatment clinical variables. Toxicity was compared between racial groups. White experiences a greater degree of gastrointestinal toxicity and blacks had lower hemoglobin values. Blacks were much more likely to have missing data on toxicity variables though. Survival times differed: the median survival time for whites was 20.3 months, versus 14.3 months for blacks; race was significant after controlling for other covariates, including stage of illness.

The authors conclude that the major determinant for survival in the present studies was not treatment, but other factors related to natural progression of disease. It is important to note that this is a small clinical trial, and a range of potentially important variables was not tested (such as family support and SES).