The relations between race, type of initial treatment, and survival with breast cancer were investigated using 36,905 cases reported to nine registries in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute in the years 1978-82. The patients were followed for survival through 1984.

“Using the crude treatment categories of surgical/nonsurgical/untreated, Blacks were found to have received less aggressive therapy. They were more likely than Whites to be treated nonsurgically (OR=1.4, 95% CI= 1.2-1.7) or to have no cancer-directed therapy (OR=1.7, 95% CI= 1.3-2.3), even after adjusting by logistic regression for differences in age, stage, and histology. These treatment variables strongly affected five-year survival, after adjusting for age, stage, race, and histology.”

“Decreased survival of Black patients with breast cancer relative to White patients has been reported in a number of recent publications. Several factors have been implicated as contributing to this racial survival difference. Black patients have consistently been diagnosed at a more advanced clinical stage than Whites. Socioeconomic factors have been reported as mediating some of the racial differences. Tumor differentiation and hormone receptor status have been noted to differ in the two racial groups. However, treatment differences have received little attention.”

“We have noted racial differences in the type of breast cancer treatment reported by registries in the SEER program; the potentially curative modality of surgery was reported less frequently for Black patients, and both non-surgical treatment and no treatment were reported more frequently in Black patients.”

“A number of possible factors could account for the racial differences in treatment….There may be racial differences in patient acceptance of recommended treatment, because of attitudes, economics, or other factors. Finally, there may actually be differences in the types of treatment available to Blacks compared to Whites, independent of the factors listed above.”