title: Differences in disease presentation, management techniques, treatment outcome, and toxicities in African-American women with early stage breast cancer treated with breast-conserving therapy.
abstract: 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.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. fvicini@beaumont.edu
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
authors.forename: Pamela
authors.initials: P
authors.lastname: Jones
authors.forename: Aeisha
authors.initials: A
authors.lastname: Rivers
authors.forename: Michelle
authors.initials: M
authors.lastname: Wallace
authors.forename: Chris
authors.initials: C
authors.lastname: Mitchell
authors.forename: Larry
authors.initials: L
authors.lastname: Kestin
authors.forename: Ishmael
authors.initials: I
authors.lastname: Jaiyesimi
authors.forename: Nayana
authors.initials: N
authors.lastname: Dekhne
authors.forename: Alvaro
authors.initials: A
authors.lastname: Martinez
mesh_terms: D001741:Black or African American; D001943:Breast Neoplasms / Q000175:diagnosis / Q000208:ethnology* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D044465:White People