Background: Women diagnosed with breast cancer under the age of 40 years (yrs) have a poorer prognosis as compared to older women. While black women overall have a slightly lower incidence of developing breast cancer than white women, black women are twice as likely to develop breast cancer under 40 yrs as compared to white women. There are a paucity of data and an urgent need to evaluate response to neoadjuvant chemotherapy (NACT) and determine long-term outcomes in young black women with breast cancer.. Methods: We analyzed data from 2,196 black and white patients (pts) with early-stage (stages 1-3) breast cancer treated at the University of Chicago over the last two decades. Pts were divided into four groups: white women <= 40 yrs (young white, n=235), black women <= 40 years (young black, n=151), White women >= 55 years (older white, n=982), and black women >= 55 years (older black, n=828). Overall survival (OS) and recurrence free survival (RFS) were determined using Cox proportional hazards models that controlled for stage, tumor grade, subtype, and Carlson comorbidity index. Risk of recurrence was examined using the method by Fine and Gray, accounting for competing risk from non-recurrence death. Pathologic complete response rate (pCR, ypT0/isN0) was determined with logistic regression controlling for subtype, stage, and tumor grade.. Results: The cohort members were followed for a median of 81 months. Of the four groups, young black pts had the highest risk of recurrence, which was 22% higher than young white pts (p=0.43) and 76% higher than older black pts (p=0.008). These age/racial differences in recurrence rates were not statistically significant after adjusting for subtype, stage, and grade. In terms of overall survival, older black patients had the worst outcome. After adjusting for stage, grade, subtype and comorbidities, increased mortality in older black vs older white pts persisted (adjusted hazard ratio: 1.55, 95% CI: 1.23-1.96, p<0.001). In the 397 pts receiving NACT, 37.3% of young white pts achieved a pCR, compared to 11.9% of young black pts. In older white and black pts, 24.6% and 26.2% achieved a pCR, respectively. After adjusting for subtype, grade, and stage, young black pts were still less likely to achieve a pCR as compared to young white pts (adjusted odds ratio: 0.41, 95% CI: 0.19-0.88, p=0.022).. Conclusions: Black pts with early-stage breast cancer had poorer outcomes compared to white pts. In general, older pts had poorer OS compared with younger pts, with older black pts having the poorest OS. Young white pts had the highest pCR rates, while young black pts had the lowest. Future studies will work to elucidate the underlying reasons driving these disparities in clinical outcomes, which disproportionately affect black women.

Citation Format: Elizabeth Terman, Jori Sheade, Fangyuan Zhao, Frederick M. Howard, Nora Jaskowiak, Jennifer Tseng, Olwen Hahn, Gini Fleming, Olufunmilayo I. Olopade, Dezheng Huo, Rita Nanda. The impact of race and age on response to neoadjuvant therapy and long-term outcomes in black and white women with early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-14-15.